Citation Nr: 21007694 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-40 908 DATE: February 10, 2021 ORDER Entitlement to an increased initial rating of 100 percent for unspecified bipolar and related psychiatric disorders, currently rated as 50 percent disabling from August 27, 2015, 70 percent disabling from February 8, 2019, and 50 percent disabling from August 23, 2019 is granted. FINDING OF FACT The Veteran’s unspecified bipolar disorder is characterized by depression, anxiety, suicidal ideation and history of prior attempts, heightened irritability, social isolation, and impaired impulse control, resulting in total occupational and social impairment. CONCLUSION OF LAW The criteria for entitlement to an increased initial rating of 100 percent for unspecified bipolar disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code 9432. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 2012 to August 2015. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2019, the Veteran testified before the undersigned Veterans Law Judge. A transcript of this hearing has been added to the claims file. This issue was remanded by the Board in July 2019 for additional development. It has now been returned to the Board. Entitlement to an increased initial rating for unspecified bipolar and related disorder, currently rated as 50 percent disabling from August 27, 2015, 70 percent disabling from February 8, 2019, and 50 percent disabling from August 23, 2019 The Veteran seeks an initial disability rating for his service-connected bipolar disorder. He asserts this disability results in a greater degree of impairment, and a higher evaluation is therefore warranted. Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Bipolar disorder is rated under Diagnostic Code (DC) 9432, which is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. The General Rating Formula for Mental Disorders provides that a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent disability rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgement, thinking, or mood, due to symptoms such as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); or inability to establish and maintain effective relationships. A 100 percent disability rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9432. In evaluating psychiatric disorders, the Board is mindful that the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that VA “intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms.” The Federal Circuit stated that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Under the General Formula for Mental Disorders (General Formula), the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). As part of his claim, the Veteran has been afforded multiple VA psychiatric examinations and outpatient treatment. He has also submitted private medical records and lay statements from friends and family in support of his claim. This evidence will be addressed below. As noted above, the Veteran was recently awarded staged ratings for his bipolar disorder, consisting of a 50 percent rating from August 27, 2015, 70 percent from February 8, 2019, and 50 percent from August 23, 2019. After considering the totality of the record and affording the Veteran the full benefit of the doubt, the Board finds a 100 percent rating is warranted for the entirety of the appeals period. According to the evidence, the Veteran’s symptoms of his bipolar disorder are characterized by such symptoms as suicidal ideation, social isolation, inability to adapt to stressful situations, and memory loss, resulting in near total impairment. Additionally, on his most recent examination, in November 2019, the Veteran was diagnosed by the VA examiner with bipolar disorder and generalized anxiety disorder with panic disorder. A history of multiple suicide attempts was noted, along with ongoing suicidal ideation. Since service, the Veteran had completed approximately three semesters of college, and held four different jobs. During manic episodes, the Veteran’s bipolar disorder resulted in such symptoms as inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, and heightened distractibility. During depressive episodes, his symptoms included a depressed mood, isolation, weight fluctuations, and extended periods of sleep. His generalized anxiety disorder was also noted to result in anxiety, fatigue, poor concentration and focus, panic attacks, frequent nausea and vomiting, and irritability. Other symptoms included memory loss, difficulty handling stress, obsessive rituals, impaired impulse control, memory loss, and neglect of personal hygiene. This is consistent with the Veteran’s July 2019 hearing wherein he vomited during the pre-hearing conference and displayed difficulty controlling his emotions. Although the examiner characterized the Veteran’s impairment as resulting in occupational and social impairment with deficiencies in most areas, after affording the Veteran the benefit of the doubt, the Board finds that a 100 percent rating is granted for his bipolar disorder with generalized anxiety disorder for the entirety of the appeal period. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Thomas D. Jones, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.