Citation Nr: 21012917 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-26 100 DATE: March 5, 2021 ORDER Service connection for bipolar disorder is granted. FINDING OF FACT The evidence is at the very least in equipoise as to whether the Veteran’s bipolar disorder had its onset during active military service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for bipolar disorder are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1963 to January 1966. In October 2018, he testified before the undersigned at a videoconference hearing. A transcript of the hearing is associated with the claims file. In an August 2020 decision, the Board granted entitlement to service connection for posttraumatic stress disorder (PTSD), due to military sexual trauma (MST), and remanded the instant claim. The Veteran asserts that his current bipolar disorder developed due to MST sustained in service. See July 2015 VA Form 9. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. To establish service connection for a disability, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). It is not in dispute that the Veteran has a diagnosis of bipolar disorder. See January 2021 VA examination report. The Board has also previously found his assertions of MST in service to be credible. Accordingly, the first two elements of service connection are met, and the question is whether there is a nexus, or link, between the Veteran’s current disability and service. As an initial matter, the Board notes that the Veteran reported a history of bipolar symptoms prior to service to the January 2021 examiner. The Board points out, however, that a veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). The term “noted,” in 38 U.S.C. § 1111, refers to “[o]nly such conditions as are recorded in examination reports.” 38 C.F.R. § 3.304(b). A “[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such condition.” 38 C.F.R. § 3.304(b)(1); see also Crowe v. Brown, 7 Vet. App. 238, 245 (1994). Here, the Veteran’s February 1963 service entrance examination is of record, and shows that the Veteran was noted as having a normal psychiatric clinical evaluation. He did not report any psychiatric symptoms on his corresponding report of medical history. Although the Veteran is certainly competent to report a history of psychiatric problems prior to service, a veteran’s report of history, even when related by a medical professional, without an independent basis in the record, is insufficient to rebut the presumption of soundness. Miller v. West, 11 Vet. App. 345 (1998). Therefore, given the normal entrance examination, the Board finds that the evidence is not clear and unmistakable that any psychiatric disability, including bipolar disorder, pre-existed service and was not aggravated in service and the Veteran is presumed sound at service entrance. 38 U.S.C. § 1111. Thus, the question for the Board becomes one of direct service connection. The only nexus opinion evidence of record as noted is the January 2021 opinion. In supplying a negative nexus opinion, the January 2021 examiner concluded that even though the Veteran has a diagnosis of bipolar disorder, it is less likely as not related to service because the Veteran “reported having some bipolar like symptoms before going into service,” and that “his bipolar symptoms were not made worse, or exacerbated by, his time in service.” The examiner did not explain why, in his view, the Veteran’s bipolar symptoms were not exacerbated in service. To the extent that the examiner appears to assess the Veteran’s claim for service connection under the theory of aggravation, as noted above, in this case the Veteran is presumed sound upon entry. Therefore, the January 2021 opinion afforded less probative weight in the resolution of the claim. See Reonal v. Brown, 5 Vet. App. 460, 461 (1993). The Board has examined the remaining evidence on file. Treatment records show that the Veteran received treatment for panic attacks and anxiety dating from at least 1980. A letter from Dr. T.J. in October 1987 indicates that he was treating the Veteran for symptoms of depression. A December 1988 psychological evaluation shows that the Veteran reported a long history of bipolar disorder. He told the provider at that time that his manic episodes first occurred in the late 1960s. A February 2002 VA medical record shows a diagnosis of bipolar disorder. A June 2002 VA treatment note appears to be the first time that the Veteran revealed to a treatment provider that he had experienced MST. In December 2009, the Veteran told a VA mental health provider that he saw Dr. T.J., a private psychiatrist, in the 1970s due to anxiety attacks that started at that time and worsened, and that Dr. T.J. diagnosed the Veteran with bipolar disorder. Dr. C.G., a VA clinical psychologist, submitted a letter in May 2018 wherein she indicated that the Veteran participated in VA treatment for his bipolar I disorder and subthreshold PTSD. She noted that when the Veteran experienced an episode with his bipolar disorder, his PTSD symptoms were exacerbated. In light of the foregoing and after resolving all doubt in the Veteran’s favor, the Board concludes that service connection is warranted for bipolar disorder. The Veteran has credibly reported that he experienced his first manic bipolar episode in the late 1960s, and treatment records show that he has received consistent treatment for anxiety, depression, and bipolar disorder since at least the 1980s, likely earlier, based on the Veteran’s statements. The Veteran is also competent to report observable symptomatology and the onset of his symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994). In this regard, the Veteran’s statements regarding his bipolar disorder symptoms are competent evidence which the Board finds to be credible, as his testimonies and assertions have remained consistent with regard to the onset and continuation of his symptomology since service. The Board also finds it notable that the Veteran did not start receiving psychiatric treatment until after service, and that he specifically told a provider in 1988 that he experienced his first manic bipolar episode in the late 1960s. Also notable is that no medical provider has ever offered any other explanation for or etiology of the Veteran’s bipolar disorder; indeed, his psychiatric symptoms have only ever been discussed in the context of their relation to active service. The evidence, in the Board’s view, is at least evenly balanced as to whether the Veteran’s bipolar disorder is related to service. As reasonable doubt must be resolved in favor of the Veteran, entitlement to service connection for bipolar disorder is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Polly Johnson, 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.