Citation Nr: 22070240 Decision Date: 12/19/22 Archive Date: 12/19/22 DOCKET NO. 18-02 198 DATE: December 19, 2022 ORDER Service connection for bipolar disorder secondary to service-connected posttraumatic stress disorder (PTSD) with major depressive disorder is granted. FINDING OF FACT Bipolar disorder is aggravated by the Veteran's service-connected PTSD with major depressive disorder. CONCLUSION OF LAW The criteria for entitlement to service connection for bipolar disorder secondary to service-connected PTSD with major depressive disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1985 to April 1987. Her claim comes before the Board of Veterans' Appeals (Board) on appeal of a November 2013 Department of Veterans Affairs (VA) rating decision. The Board remanded this claim to the Agency of Original Jurisdiction (AOJ) in May 2019 and July 2022. Initially, the Board characterized the claim as entitlement to service connection for a psychiatric disability claimed as major depression and bipolar disorder. In a November 2020 Decision Review Officer decision, however, the AOJ granted the Veteran service connection for major depressive disorder as part of her service-connected PTSD. That condition is thus no longer before the Board for appellate review. Entitlement to service connection for bipolar disorder secondary to service-connected PTSD with major depressive disorder The Veteran seeks service connection for bipolar disorder on either a direct basis, as related to a documented in-service rape, or secondary basis, as related to her service-connected PTSD with major depressive disorder. The evidence supports this claim. Service connection may be granted for a disability or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To prevail in a claim for service connection on a direct basis, there must be competent evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be granted on a secondary basis for disability that is proximately due to or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013). To prevail in a claim for service connection on a secondary basis, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition asserted to be proximately due to of aggravated by the service-connected disability or disabilities. Buckley v. West, 12 Vet. App. 76, 84 (1998); Wallin v. West, 11 Vet. App. 509, 512 (1998); Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(b). Here, treatment records dated since 2012, reports of VA examinations conducted since September 2013, and VA opinions submitted since November 2013 establish that the Veteran currently has bipolar disorder. The question is whether this disorder is related to service or her service-connected PTSD with major depressive disorder. Service treatment records document an in-service rape, but there is no evidence specifically relating the bipolar disorder to that event or otherwise to the Veteran's service. However, the AOJ service connected the Veteran for a psychiatric disability characterized to include PTSD and major depressive disorder based on this event, and there are reports of VA examinations conducted in September 2013 and November 2022, which indicate that symptoms of the Veteran's bipolar disorder cannot be differentiated from symptoms of the service-connected psychiatric disability. The rating currently assigned that disability contemplates all psychiatric symptoms. Even assuming otherwise, in October 2022, a VA examiner specifically found that, although the Veteran's bipolar disorder is not due to or caused by her service-connected psychiatric disability, it is aggravated by such disability. Citing to medical literature that links worsening bipolar symptoms to PTSD, the examiner explained that the aggravation occurs because the PTSD causes sleep disruption, which places the Veteran at high risk for manic episodes. This evidence is sufficient to establish the Veteran's entitlement to service connection for bipolar disorder secondary to and as part of her service-connected PTSD and major depressive disorder. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. N. 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.