Citation Nr: 21023731 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 14-24 509 DATE: April 21, 2021 ORDER Service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), bipolar disorder, anxiety disorder, and depressive disorder, is denied. FINDING OF FACT The weight of the evidence is against a finding that the Veteran’s current bipolar disorder had its onset during military service or is otherwise related to such service. CONCLUSION OF LAW The criteria for service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), bipolar disorder, anxiety disorder, and depressive disorder, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from November 1968 to September 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which confirmed and continued the previous denial of service connection for PTSD. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in June 2015. A copy of the transcript has been reviewed and associated with the claims file. This matter was before the Board in January 2018, at which time it was reopened and remanded for additional evidentiary development. The Board also expanded the scope of the claim to include any mental health disability that may reasonably be encompassed by the Veteran’s description of the claim, reported symptoms, and other information of record, to include PTSD, bipolar disorder, anxiety disorder, and depressive disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 4-6 (2009). This matter was again before the Board in June 2020, at which time it was remanded for an additional medical opinion. In the June 2020 decision, it was noted that the Veteran was awarded a Purple Heart Medal. After a review of the subsequent evidentiary development, the Board finds that the Veteran was not awarded the Purple Heart Medal and this was awarded to a veteran with the same first name, middle initial, and last name but a different number identifier and service date. See 09/03/1970, Certificate of Release or Discharge from Active Duty; 12/21/2018, Military Personnel Record, p. 10; 09/23/2020, VA Memo. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), bipolar disorder, anxiety disorder, and depressive disorder Service connection will be granted for a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection for PTSD generally requires: (1) medical evidence diagnosing the condition in accordance with applicable criteria; (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f); Anglin v. West, 11 Vet. App. 361, 367 (1998). During the claim period, a new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was released and represents the most up-to-date clinical diagnostic guidelines. This revised version of the DSM applies to all claims pending at the RO on or after August 4, 2014, as was the case here. See 38 C.F.R. § 4.125(a). In adjudicating these claims, the Board must assess the competence and credibility of the Veteran. Washington v. Nicholson, 19 Vet. App. 362 (2005). Lay testimony is competent to establish the presence of observable symptomatology and “may provide sufficient support for a claim of service connection.” Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (lay person competent to testify to pain and visible flatness of his feet). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. In the present case, the Veteran has been diagnosed with bipolar I disorder. See e.g., 02/10/2014, C&P Exam. Thus, a present disability has been established by the evidence. The Veteran submitted a statement in May 2013 and indicated that he was ambushed by mortar and artillery small arms fire in service. This is confirmed by his receipt of the Army Commendation Medal for his service in connection with military operations against an armed hostile force in the Republic of Vietnam. See 12/21/2018, p. 8. Thus, an in-service incurrence has been shown by the evidence. The remaining question is whether the Veteran’s current bipolar disorder is related to the in-service event. The Veteran’s July 1968 entrance and September 1970 separation examinations revealed normal psychiatric evaluations. He did not report any mental health symptoms during his active duty service. The Veteran testified at the June 2015 hearing and indicated that he always felt a sense of danger in Vietnam and did not return as the same person. He received treatment for bipolar disorder in the mid-1980s and has had continuous treatment for his bipolar disorder for the past ten years at the VA. The Veteran’s VA treatment records reveal that he commenced treatment for mental health issues in September 2001. At that time, he reported a long history of depression and manic episodes for approximately forty years. He reported flashbacks for about a year following his service in Vietnam. He was to be evaluated to rule out bipolar affective disorder, depression recurrent, and possible PTSD. He was ultimately diagnosed with bipolar disorder, in major depression, in February 2002. In June 2004 he was diagnosed with bipolar disorder manifested by depressed mood, insomnia, and irritable mood. In January 2009, the Veteran reported that his first clear memory of depression was during his senior year in high school when he was seventeen. He indicated that his episodes of depression are now the same for him. The treating provider noted that his psychiatric symptoms were complex and that the Veteran labeled them as anxiety, panic, mania, depression, and obsessive-compulsive disorder. However, the treating provider concluded that his psychiatric symptoms were best explained by bipolar I disorder, rapid cycling type, and he did not warrant an additional psychiatric diagnosis, including obsessive compulsive personality disorder. A December 2011 VA treatment record revealed a diagnosis of obsessive-compulsive disorder and bipolar I disorder, with the most recent episode of anxiety disorder and unspecified depression. His VA treatment records from October 2012 to September 2020 note diagnoses of bipolar I disorder, bipolar affective disorder, type II, obsessive-compulsive disorder, panic disorder, anxiety disorder, and depression. His treatment records in January and July 2014 indicate that he did not have a diagnosis of PTSD or any additional psychiatric disability other than bipolar II disorder with the latest episode of depression. The Veteran underwent a VA examination in February 2014, at which time he was diagnosed with bipolar I disorder with the most recent episode of depression. The examiner noted that the Veteran first sought mental health treatment in 1984, at which time he was placed on lithium. He did not seek additional mental health treatment until 2001 at the VA and he was currently being treated for bipolar disorder. His symptoms included mania and depression. The examiner concluded that there was no evidence that his bipolar disorder was related to service. The February 2014 examiner further concluded that he did not meet the diagnostic criteria for PTSD under DSM-5. Although he experienced small arms fire and mortar attacks in service that met criterion A for PTSD, he did not meet the additional criteria for a diagnosis of PTSD given that he did not have a history of reexperiencing the symptoms, avoidance, or arousal symptoms. The Veteran submitted a subsequent statement in September 2014 and indicated that he had a period of flashbacks in the late 1970s and has persistently thought to himself that he wished that he had died since Vietnam. The Veteran’s VA treatment records dated in January 2019 and September 2020 note a diagnosis of PTSD. His treatment records in April and July 2020 list a primary diagnosis of depression, but he was ultimately assessed with bipolar I disorder, by history. Pursuant to the Board’s remand instructions, a medical opinion was obtained in September 2020. The examiner conducted a full review of the record and concluded that the Veteran met the DSM-5 criteria for bipolar I disorder. The examiner also indicated that there was no evidence to suggest that he has ever carried an additional accurate mental health diagnosis and that his records indicate that he has been treated for symptoms of bipolar disorder for many years. Moreover, there was no supporting evidence that the Veteran had a diagnosis of PTSD. In this regard, there was no mention of a PTSD diagnosis until January 2019 with no documentation of the PTSD criteria experienced by the Veteran to support such a diagnosis. Later this diagnosis was changed to bipolar disorder and then subsequently changed back to PTSD with no supporting evidence for the diagnosis. Lastly, the September 2020 examiner concluded that it was less likely than not that the Veteran’s symptoms of bipolar I disorder are related to active service, including his military related trauma. Although there was no question that he experienced military related trauma and flashbacks for a short period of time based on his statements of record, hearing testimony, and VA treatment records, there was no evidence that his bipolar disorder was incurred in service, including due to the in-service traumatic events. The examiner reasoned that bipolar disorders are primarily biologically related disorders and the evidence of record reveals that his symptoms of bipolar disorder did not have their onset until over a decade following his release from active duty. After a review of the evidence, the Board finds that service connection for an acquired psychiatric disability is not warranted. In this regard, the competent and probative medical evidence finds that there is not a relationship between the Veteran’s current psychiatric disorder and service. Although the Veteran reported that his depressive symptoms commenced when he was seventeen, his entrance examination revealed a normal psychiatric evaluation. Accordingly, the Board finds that there is not clear and convincing evidence that his current bipolar disorder existed prior to service. Thus, the presumption of soundness applies. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Moreover, there is no evidence of any reported mental health symptoms in service and his separation examination in September 1970 revealed a normal psychiatric evaluation. The Veteran’s hearing testimony and treatment records reveal that he was initially evaluated for a mental health disorder in the mid-1980s. He commenced treatment at the VA in September 2001 and was ultimately diagnosed with bipolar disorder. The Veteran was afforded a VA examination in February 2014 and a medical opinion was issued in September 2020. Both the February 2014 and September 2020 examiners reviewed the record in its entirety and concluded that the Veteran’s bipolar disorder was not incurred in service, including due to his conceded in-service small arms fire and mortar attacks. The September 2020 examiner reasoned that his bipolar symptoms did not have their onset until over a decade following his release from active service. The Board acknowledges the various mental health diagnoses listed in his VA treatment records, including PTSD, depression, anxiety, and obsessive-compulsive disorder. However, the Board finds that throughout the rating period on appeal, the Veteran’s correct diagnosis is bipolar I disorder. In this regard, both the February 2014 and September 2020 examiners concluded that the Veteran only met the DSM-5 criteria for bipolar I disorder. The February 2014 examiner noted that his most recent episode of his bipolar disorder included depression. In addition, his January and July 2014 VA treatment records reveal that his mental healthcare provider indicated that he only had one mental health disability, which was bipolar disorder. Lastly, the February 2014 and September 2020 VA examiners concluded that he did not meet the criteria under DSM-5 for PTSD. Accordingly, the Board finds that to the extent the additional symptoms of depression, anxiety, and obsessive-compulsive disorder are noted throughout his treatment records, they are symptoms of his bipolar disorder as confirmed by the September 2020 examiner. Moreover, the Veteran has not met the DSM-5 criteria for a diagnosis of PTSD throughout the rating period on appeal. Lastly, the Board acknowledges the Veteran’s statements indicating that he suffered from depression prior to and after service, had flashbacks after service, and has persistently wished he had died since Vietnam. However, there is no medical evidence indicating this his current bipolar disorder is related to service. Although in some cases a lay person is competent to offer an opinion addressing the etiology of a disorder, the Board finds that, in this case, the determination that his bipolar disorder was incurred in service is a medical question and not subject to lay expertise. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). As such, the Board places no weight on the Veteran’s statements to this effect. In light of the foregoing, the Board finds that service connection is not warranted for the Veteran’s bipolar disorder or any additional psychiatric disorder, to include anxiety, depression, PTSD, and obsessive-compulsive disorder. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim of service connection for an acquired psychiatric disorder must be denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53. K. OSBORNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. (Hurley) Merrick 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.