Citation Nr: 21010848 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 17-28 963 DATE: February 25, 2021 REMANDED Entitlement to service connection for residuals of a concussive injury characterized as loss of balance is remanded. Entitlement to service connection for an acquired psychiatric disorder to include bipolar disorder is remanded. REASONS FOR REMAND The Veteran had active service from July 1969 to March 1970. 1. Service connection for residuals of a concussive injury is remanded. The Veteran contends that his concussive injury manifested by loss of balance is due to an explosion injury during basic training. Alternatively, he asserted that his loss of balance is secondary to his service-connected bilateral hearing loss. During his September 2020 Board hearing, the Veteran stated that he was subjected to an explosion during training. He was dazed and was pulled away by an instructor. Later that day, he had a loud live fire exercise that caused hearing problems. The Veteran reportedly has had balance issues since these events. He noted that his episodes have worsened, but he did not seek treatment. VA treatment records, as well as an October 2016 VA examination, have noted that the Veteran has not had a traumatic brain injury. The Board cannot make a fully-informed decision on the issue of a concussive injury, which the Veteran claims is manifested by balance issues which began on active duty because no VA examiner has opined both whether it is related to his active service, or is secondary to his service-connected bilateral hearing loss. 2. Service connection for an acquired psychiatric disorder to include bipolar disorder is remanded. The Veteran contends that his current psychiatric disorder to include bipolar disorder, and which clearly and unmistakably preexisted the Veteran’s service, was aggravated by his active service. In October 2016, a VA examiner diagnosed the Veteran with persistent depressive disorder (dysthymia) and intermittent explosive disorder. The examiner concluded that the Veteran’s claimed condition was less likely than not incurred in or caused in-service injury, event, or illness as the Veteran had a clear history of significant preexisting behavioral health problems including marked impulse control difficulties and interpersonal difficulties. He saw a psychiatrist throughout high school per his own report. The Veteran had significant behavioral problems during basic training. He was treated by a military psychologist that obtained his civilian mental health records, which clearly indicated the Veteran’s history of behavioral and psychiatric problems existed prior to active service. Subsequently, he was discharged due to his behavioral health issues as he was deemed unsuitable for the military. The examiner indicated that the Veteran has exhibited a long-term pattern of significant adjustment issues in terms of both psychosocial and occupational functioning. These issues had been present since his adolescence, prior to military service. Based on the above, the examiner opined that in no way was the Veteran’s chronic psychiatric problem caused by military service. Also, the examiner stated that there is no evidence that his psychiatric problems were in anyway aggravated by military service. Lastly, the examiner opined that whether the Veteran joined the military or not, it is at least as likely as not that he would have had his long-term mental health problems, which he had had during high school and throughout his adult life. During his September 2020 Board hearing, the Veteran stated that his VA treating physicians believed his psychiatric disabilities were aggravated by his military service. Therefore, the Veteran’s treatment records should be obtained, as the last treatment records in the file are dated in November 2017. Also, in addition to the various acquired psychiatric diagnoses of record such as bipolar disorder and persistent depressive disorder (dysthymia), the Veteran has also been diagnosed as having a personality disorder. See October 2016 VA examination; January 2017 VA behavioral health note. Although the October 2016 VA examiner did indicate, in pertinent part, that the Veteran had preexisting psychiatric disorders that were not aggravated in service, for personality disorders the central question is whether a diagnosed personality disorder was subject to any superimposed acquired psychiatric disorder in service, resulting in additional current disability. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from November 2017 to the present from the VA Medical Center in Rome, New York. 2. Obtain a VA opinion to ascertain the nature and etiology of the Veteran’s balance issues claimed as due to concussive injury or as secondary to service-connected disability. If a clinical evaluation is deemed necessary to answer the questions presented, schedule a VA examination. However, if an in-person examination is not feasible, provide the Veteran an opportunity to describe the symptoms of his balance issues to a VA examiner through other means. Based on a review of the record and any examination findings, the examiner should provide an opinion as to whether: (a.) it is at least as likely as not (50 percent or greater likelihood) that balance issues had their onset in service, or that they are otherwise causally or etiologically related to a period of active duty service to include an explosion during training. (b.) It is at least as likely as not (50 percent probability or greater) that any current balance issue is proximately due to, or the result of, the Veteran’s service-connected bilateral hearing loss. (c.) It is at least as likely as not (50 percent probability or greater) that any current balance issue is aggravated beyond the natural progress of the disease by the Veteran’s service-connected bilateral hearing loss. In rendering the opinions, the examiner should consider the statements of the Veteran regarding the symptoms of his balance issues to be competent. The examiner should provide a complete rationale for all opinions expressed and conclusions reached. 3. Obtain a VA psychiatric opinion to determine the nature and etiology of the claimed psychiatric disorder to include bipolar disorder. If a clinical evaluation is deemed necessary to answer the questions presented, schedule a VA examination. However, if an in-person examination is not feasible, provide the Veteran an opportunity to describe the symptoms of his psychiatric disorder to a VA examiner through other means. Based on a review of the record and any examination findings and as to each diagnosed psychiatric disorder to include bipolar disorder, persistent depressive disorder (dysthymia), and personality disorders including personality disorder NOS and intermittent explosive disorder, the examiner should respond to the following: (a.) For each psychiatric disorder (other than any diagnosed personality disorder) and to include bipolar disorder and persistent depressive disorder (dysthymia), is there clear and unmistakable evidence that such condition existed prior to the Veteran's service? If so, is there clear and unmistakable evidence that it was not aggravated during the Veteran's service? (b.)For each diagnosed personality disorder, is it at least as likely as not that any of the psychiatric disorders diagnosed above were superimposed on the underlying personality disorder as a result of service? The examiner should provide a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide an opinion regarding symptoms without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Costello, 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.