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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys it's Leah B from Prestige Veteran Medical Consulting. I'm a U. S. Army veteran, physician assistant, and former compensation and pension examiner. So welcome back to our channel where we like to discuss all things VA disability related and we discuss VA disability benefits in plain terms for those who have served.
Leah Bucholz:And again I'm your host Leah B and we're going to dive into an important mental health topic and that is bipolar disorder and VA disability compensation. So whether you've been diagnosed with bipolar disorder during or after your service or you're just trying to understand if VA is going to recognize it, this episode is probably for you. So what are we going to cover today? We're going to cover what bipolar disorder is, how it may be connected to your time and service, how VA rates mental health conditions, common mistakes that I see when I'm reviewing files, and how veterans support their cases. So what is bipolar disorder?
Leah Bucholz:So let's start with a clear definition of what bipolar disorder is. Bipolar disorder is a serious mental health condition marked by extreme mood swings from depression or depressive lows to manic or hypomanic highs. So there are different types. There's bipolar one that includes full manic episodes or bipolar two which involves hypomania and depression. Cyclothymic disorder is a milder but longer lasting fluctuations between the two.
Leah Bucholz:Symptoms can include things like mania or high energy, racing thoughts, risky behavior, little need for sleep, depression with fatigue, hopelessness, loss of interest, suicidal thoughts, irritability, impulsivity, difficulty with relationships or employment. These symptoms can be debilitating and often get misdiagnosed as depression, anxiety, or PTSD, especially in veterans. So let's talk about direct service connection for bipolar disorder. So this means that your bipolar disorder started during active duty or symptoms clearly began while you uniform, right? So examples of direct service connection can be something like you had a documented mental health episode during service, maybe you were hospitalized or treated for depression or anxiety, but the diagnosis was incomplete.
Leah Bucholz:Maybe you were actually diagnosed with bipolar disorder on active duty. You were discharged early for something like a personality disorder but years later a civilian psychiatrist diagnosed you with bipolar disorder. It could be that that was an early manifestation and maybe was not diagnosed properly. You experienced a major life stressor in service like combat or an assault or a trauma that triggered your first manic or depressive episode. Even if your official diagnosis came after discharge, symptoms and records from your time in service and in the uniform can support a direct claim especially if a medical expert can connect the dots.
Leah Bucholz:So let's talk about secondary service connection. We often talk about secondary service connection where one disability that you're already service connected for causes or worsens your bipolar disorder. So bipolar disorder can also be secondarily service connected, meaning it was again caused or made worse by another condition that you're already rated for. So some common secondary connections include PTSD or depression. Maybe you were misdiagnosed or there's overlapping symptoms and they may evolve into bipolar diagnosis later.
Leah Bucholz:Traumatic brain injury, there's medical evidence linking mood disorders to head injuries. Chronic pain, veterans dealing with long term pain may develop mood instability and bipolar like symptoms over time. So a real world example is that you may be service connected for PTSD. Over time your psychiatrist updates your diagnosis to bipolar disorder explaining that the initial symptoms were actually part of a larger mood disorder that began during service. That can form the basis of a secondary service connection.
Leah Bucholz:That doesn't necessarily mean you're going to get rated separately because VA likes to rate things if the symptoms overlap. There's something called pyramiding where if you've got symptoms related to PTSD, depression, bipolar disorder, and they're all sort of overlapping symptoms, it's probably going to be combined with that rating. But you definitely want to reach out to an accredited representative like a VSO or a claims agent or an attorney and they can kind of advise you on your case. So let's talk about some medical literature. I always like to throw some medical literature out there for you guys to look at.
Leah Bucholz:So there's strong medical support for veterans with bipolar disorder. Studies definitely show that veterans with TBI or PTSD are at significantly higher risk for developing bipolar spectrum disorders. Bipolar disorder is often misdiagnosed in veterans due to overlapping symptoms as we mentioned especially when manic episodes are mild. The VA recognizes bipolar disorder as a rateable condition and does not require combat exposure for you to qualify. If you're denied because VA says that it's not related to service, you can always get a second opinion.
Leah Bucholz:You can ask your doctor to write a medical opinion that may help you overturn that denial. So how does VA rate bipolar disorder? So VA rates all mental health conditions using the same general scale under 38 CFR 4.13. So you may see ratings of like zero percent if the symptoms are present but don't affect work or relationships. Ten to thirty percent may be mild to moderate symptoms, some occasional work or social impairment.
Leah Bucholz:Fifty percent reduced reliability and productivity issues with mood, memory and judgment. So at seventy percent, major difficulty in relationships and work, frequent panic or depression, and one hundred percent total occupational and social impairment, inability to work isolation, etc. So you don't have to be hospitalized or in full mania to qualify for a high rating. It's all about your symptoms and how they impact your daily functioning. So again this is just the current ratings as of today.
Leah Bucholz:The mental health ratings may be subject to change and I think there's some changes coming down the pipeline in late twenty twenty five, early twenty twenty six. So always recheck on those things. So what can you expect at a C and P exam? So if you file a claim, you're going to get scheduled for a C and P exam most likely with a VA mental health provider or a contracted mental health provider. They're going to ask you about things like mood swings, energy levels, behavior during episodes.
Leah Bucholz:They're going talk to you about your work history, legal issues, hospitalizations, how often symptoms interfere with relationships, sleep or self care. It's important to be honest and don't downplay your symptoms even if you're having a good day. You want to describe your worst episodes too and that's what helps determine your true levels. So how can you support your case? So before we wrap up there's a few things that I want to go over that can help you support your case for bipolar disorder.
Leah Bucholz:So having a diagnosis from a psychiatrist or a psychologist, whether that's from the VA or a private doctor, looking through your service records for signs of mood issues or disciplinary problems. You can ask your doctor for a nexus letter if they're willing to provide you one explaining the link to service. You can document your impact at work, relationships and daily life by journaling. If you're already related for another mental health condition you can think about if it was misdiagnosed or a progression of that. And you can be rated for only one mental health condition most of the time.
Leah Bucholz:But the VA will assign the diagnosis with the highest rating potential if it's related to your service. So bipolar disorder is a serious condition like we mentioned earlier and if it's manageable you can live a normal healthy and happy life and it can be recognized by the VA for disability purposes. So if your symptoms started in service were triggered by trauma or misdiagnosed as something else, you have the right to file a claim and to receive disability benefits. If the VA denied you before that doesn't mean that it's over. You can get help from a VSO.
Leah Bucholz:You can consider a psychological evaluation and don't be afraid to appeal with the help of those accredited representatives. So as always thank you for watching and tuning in and please like and subscribe. Please let us know if you have any experience with these. I always love to hear about y'all stories especially ones with good outcomes and I hope this helps some of you guys out there and thanks for watching.