Citation Nr: 18154130
Decision Date: 11/29/18	Archive Date: 11/29/18

DOCKET NO. 16-52 002
DATE:	November 29, 2018
Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and bipolar disorder, is remanded.  
Service connection for substance abuse disorder is remanded.  
The Veteran served on active duty from September 2006 to August 2010.  
This case comes to the Board from a January 2014 rating decision.  
The Board notes that although the Veteran’s July 2014 notice of disagreement (NOD) reflects disagreement with an April 2014 rating decision, the rating decisions addressing the claims on appeal are dated in January 2014 and June 2014.  As the RO construed the NOD as disagreement with both the January 2014 and June 2014 rating decisions, the Board finds that the earlier January 2014 rating decision is properly on appeal.  
Further, the NOD limits the issues on appeal to service connection for PTSD, bipolar disorder, and substance use disorder.  The Board notes that the record indicates psychiatric symptoms/disorders including not only PTSD and bipolar disorder but also depression and anxiety disorder.  The most appropriate diagnosis of the Veteran’s psychiatric condition is unclear.  Nonetheless, for purposes of adjudicating the service connection claims before the Board, the Board has recharacterized the claims of service connection for PTSD and bipolar disorder to one for service connection for a psychiatric disorder.  Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).  Due to its nature, the substance abuse disorder claim is listed separately.
1. Service connection for a psychiatric disorder.  
2. Service connection for substance use disorder.  
The Veteran asserts he has a psychiatric disorder related to service, to include traumatic events during service in Iraq.  In addition, he maintains that his substance use disorder is secondary to his psychiatric disorder.  
The Veteran has a complex history of substance abuse intertwined with the treatment of psychiatric disorders.  The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that compensation cannot be awarded pursuant to 38 U.S.C. §§ 1110, 1131 and 38 C.F.R. § 105(a) either for a primary substance abuse disability incurred during service or for any secondary disability that resulted from primary substance abuse during service.  Allen v. Principi, 237 F.3d 1368, 1376 (Fed. Cir. 2001).  However, service connection may be granted for an alcohol or drug abuse disability acquired secondary to, or as a symptom of, a service-connected disability.  Thus, as the issue with respect to service connection for a psychiatric disorder is being remanded, so, too, is the issue of service connection for substance use disorder.  
In addition, and although VA treatment records in November 2013 indicate that the Veteran did not meet Criterion A for a diagnosis of PTSD, the RO’s December 2013 VA examination request notes that the stressor for PTSD had been conceded based on the Veteran’s award of an Iraq Campaign Medal.  The Board will not disturb this favorable finding, especially in view of his service records, as well as the May 2014 VA examiner’s determination that the Veteran’s stressor meets Criterion A for a diagnosis of PTSD.  
Further, the VA treatment records note that although the Veteran reported several arousal symptoms, a PTSD diagnosis did not account for these symptoms, as the Veteran’s level of caffeine consumption (3 to 4 energy drinks per day) prohibited a diagnosis of any anxiety-related disorder due to symptom overlap between caffeine intoxication and an anxiety disorder.  The Veteran’s report of heavy alcohol use and emotional numbness after his return from service in Iraq was noted.  
Additionally, the May 2014 examiner stated that neither the Veteran’s reported symptoms nor testing supported a diagnosis of PTSD, noting an absence of avoidance symptoms.  Although the examiner determined the Veteran only met the criteria for substance use disorders, to include substance/medication-induced bipolar and related disorders, none of which were noted to be related to service, the opinion does not sufficiently address the Veteran’s relevant history.  More specifically, the November 2013 VA treatment records note that the Veteran initially sought mental health treatment after service in October 2010, at which time he was diagnosed bipolar disorder, mixed episode, as well as a mood disorder, not otherwise specified (NOS) and anxiety disorder, NOS.  As such, the examination report is not completely adequate for a determination.  
Further, VA inpatient records in June 2014 reflect an admission due to increasing mood symptoms and anxiety in the setting of a Wellbutrin misuse and a drug and alcohol binge.  Primary diagnoses listed at hospital discharge were unspecified bipolar disorder; unspecified anxiety disorder rule out PTSD; alcohol use disorder; cocaine use disorder; benzodiazepine use disorder; anabolic steroid use; narcissistic and antisocial personality traits; and history of intermittent explosive disorder.  
In view of the evidence and the Veteran’s assertions, a new VA examination is warranted.  
Prior to the examination, any outstanding records of pertinent medical treatment must be obtained and added to the record.  
The matters are REMANDED for the following action:
1. Obtain complete VA treatment records since June 2014.  
2. After completion of the above, schedule the Veteran for an appropriate VA examination.  The record should be reviewed by the examiner, including the Veteran’s service treatment records, post-service medical records, and statements.  
Identify all of the Veteran’s psychiatric disorders present since separation.  Diagnoses of PTSD and bipolar disorder, as well as substance abuse disorder, must be ruled in or excluded.  If PTSD is not diagnosed, it should be explained why this is so.  If a substance abuse disorder is diagnosed, it should be explained why it is a primary or why it is a secondary disorder.
For any currently diagnosed PTSD or bipolar disorder, or other psychiatric disorder other than a substance use disorder, the examiner should offer an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any such disorder had its onset during, or is otherwise related to, the Veteran’s military service, to include traumatic events and stressors during service in Iraq.  
If the examiner finds that the Veteran has a psychiatric disorder due to his military service, he or she should state whether it is as at least as likely as not (a 50 percent or greater probability) that the Veteran has a substance use disorder caused by the psychiatric disorder(s) related to his service.  
If a VA examination is unable to be conducted, the examiner should still address the questions above based on a review of the Veteran’s records, history, and lay statements.  
(Continued on the next page)
A detailed rationale for all opinions expressed should be provided.
Veterans Law Judge
Board of Veterans’ Appeals

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