BIPOLAR DISORDER (MANIC-DEPRESSIVE PSYCHOSIS)

CHRISTOPHER SEPPANEN · 2026 · Case ID: A26029923

DENIED

Summary

The Veteran, who served from August 2017 to August 2023, appeals the denial of an initial rating in excess of 30 percent for bipolar I disorder and an initial rating in excess of 20 percent for lumbosacral strain. The Board reviewed the evidence of record as it existed at the time of the prior May 2024 decision, as the Veteran's appeal was filed in December 2024 via a Higher-Level Review request. For the bipolar I disorder claim, the Board considered the General Formula for Mental Disorders and the Veteran's reported symptoms, including anxiety, suspiciousness, and chronic sleep impairment. The VA examiner noted intact memory, insight, and judgment, adequate grooming, and normal speech and thought processes, with the Veteran actively seeking employment. The Board found the Veteran's symptoms most closely approximated a 30 percent rating, citing the ameliorative effects of medication and the Veteran's functional status, and thus denied the higher rating. For the lumbosacral strain claim, rated under Diagnostic Code 5237, the Board reviewed the General Rating Formula for Diseases and Injuries of the Spine. The Veteran reported pain and flare-ups with increased pain and limited forward flexion. The Board acknowledged the lay reports and functional loss due to pain but found the evidence weighed against a rating higher than 20 percent, as the limitations did not meet the criteria for higher ratings or ankylosis. The Board also considered and rejected the applicability of the Intervertebral Disc Syndrome (IVDS) formula and found no objective neurological abnormalities. Ultimately, the Board denied both claims for ratings in excess of those already assigned.

Rationale

Symptoms approximated 30% rating criteria; Ameliorative effects of medication considered; Intact memory, insight, judgment, grooming, speech, thought processes at exam

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251201-611391

Full Decision Text

Citation Nr: A26029923
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 251201-611391
DATE: April 2, 2026

ORDER

Entitlement to an initial rating in excess of 30 percent for bipolar I disorder is denied.

Entitlement to an initial rating in excess of 20 percent for lumbosacral strain is denied.

FINDINGS OF FACT

1. Bipolar I disorder is manifested by anxiety and chronic sleep impairment resulting in occupational and social impairment with reduced reliability and productivity.

2. The Veteran's lumbosacral strain is manifested by pain with forward flexion limited to 60 degrees at worst.

CONCLUSIONS OF LAW

1. The criteria for an initial rating in excess of 30 percent for bipolar I disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9432.

2. The criteria for an initial rating in excess of 20 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 2017 to August 2023.

In December 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a May 2024 decision. In March 2025, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior May 2024 decision. Therefore, the Board may only consider the evidence of record at the time of the May 2024 decision.

In the December 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the May 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to an initial rating in excess of 30 percent for bipolar I disorder

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher.

The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 50 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 30 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 30 percent rating.

A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either
seki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 50 percent or higher.

A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

The Veteran received a VA examination in January 2024. He reported that he was married, currently unemployed but driving for Uber and looking for work, and that he had not had any hallucinations for six to seven months after starting medication for his bipolar disorder. The examiner indicated that the Veteran was experiencing anxiety, suspiciousness and chronic sleep impairment. Upon examination the Veteran was adequate dressed and groomed, fully alert and oriented, exhibited good eye contact and good recall of remote and recent events. His speech and thought processes were normal. There was no evidence of delusions or paranoia and no perceptual disturbance. Insight and judgment were good. He denied any suicidal or homicidal ideation.

The Board finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 30 percent rating. The Veteran experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, but was generally functioning satisfactorily, with routine behavior, self-care, and normal conversation. At his January 2024 examination the Veteran exhibited intact memory, insight, and judgment; adequate grooming; full orientation; and normal speech and thought processes. He reported being married and actively looking for employment.

In reaching this conclusion, the Board notes that the evidence shows that the Veteran takes medication to treat his psychiatric symptoms. The Board further notes that the plain language of the criteria for a 10 percent rating under the General Rating Formula for Mental Disorders specifically contemplates the effects of medication. Consequently, the holding in Ingram v. Collins, 23 Vet. App. 1798 (2025), which extended the Court's holding in Jones v. Shinseki, 26 Vet. App. 56 (2012), does not apply, and the Board's evaluation of the Veteran's bipolar I disorder may include the ameliorative effects of medication. See McCarroll v. McDonald, 28 Vet.
for employment.

In this regard, the Board also notes that the Veteran was seen in the emergency department in July 2023 with complaints of having difficulty sleeping and experiencing audible hallucinations. However, this is prior to the Veteran's bipolar I disorder being service connected. The evidence of record shows that his condition improved after beginning medication and at his January 2024 VA examination he reported that he had not experienced hallucinations for the past six to seven months since beginning his medication.

In short, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 50 percent rating. The criteria for a 50 percent or higher rating are not met and the appeal must be denied. The evidence persuasively weighs against the claim. The benefit of the doubt doctrine is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to an initial rating in excess of 20 percent for lumbosacral strain

The Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless,
keletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

The Veteran received a VA examination for his thoracolumbar spine in February 2024. He reported experiencing pain that had worsened over time. He also reported flare-ups that occurred two to three times per month, last two to three weeks and cause severe pain. Upon examination he exhibited forward flexion to 70 degrees. The examiner estimated that during flare-ups the Veteran's forward flexion is further limited to 60 degrees.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for lumbosacral strain. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain during flare-ups. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he experiences increased pain during flare-ups would not result in limitation of motion more nearly approximating forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.

Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran does not have IVDS, and the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

Regarding neurological impairment, the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with the spine disability.

Caselaw requires the Board to take due consideration that the beneficial effects of medication are discounted unless such effects are otherwise contemplated in a particular diagnostic code. See Ingram v. Collins, 23 Vet. App. 1798 (2025). In this case, the VA examiner, in rendering ROM findings, noted and considered the Veteran's lay statements describing functional limitations when his pain and functional impairment is at its worst (e.g., during flare ups, on repetitive motion, due to lack of endurance, lack of coordination, etc.). The examination report as a whole does not indicate whether the Veteran was on any pain medications at the time of the examination, but in any case, it is clear the examiner already provided an opinion estimating ROM findings discounting any potential ameliorating effects of medication. As such, the Board finds the report and the remainder of the evidentiary record adequate to base a decision, resolving all reasonable doubt in the Veteran's favor.

Based on the foregoing, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for lumbosacral strain. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107

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