RAM to ISM to Revit - Operation Terminated Prematurely

When updating Revit from ISM repository, I am getting an "Operation Terminated Prematurely" error. Below is what the ismrevitlink.log file shows. Any advice on how to troubleshoot this one?

*** Start of Exception *********************************
System.Exception: CommitChangeSet has fatally terminated before commiting all instances because of the following exception: Was not able to create the relatioship. The reason maybe that it already exists(Bentley.ECSystem.Operations.BatchExecutionTerminatedException: CommitChangeSet has fatally terminated before commiting all instances because of the following exception: Was not able to create the relatioship. The reason maybe that it already exists ---> Bentley.DgnPlatformNET.DgnPlatformNETException: Was not able to create the relatioship. The reason maybe that it already exists
at Bentley.DgnPlatformNET.DgnEC.DgnECRelationshipEnabler.CreateRelationshipOnElement(IECRelationshipInstance relationshipInstance, IDgnECInstance instanceA, IDgnECInstance instanceB)
at Bentley.DgnPlatformNET.DgnEC.DgnECRelationshipEnabler.CreateRelationshipOnElement(IECRelationshipInstance relationshipInstance, DgnModel dgnModel, Boolean useQualifiedPep)
at Bentley.DgnECPlugin.DgnECPersistenceProvider.CommitChangeSet(RepositoryConnection connection, ChangeSet changeSet, String comments, WriteModifiers writeModifiers, IList`1 preCommitSequence, IList`1 postCommitSequence, BatchExecutionController`1 batchExecutionController, IExtendedParameters extendedParameters)
at Bentley.EC.Persistence.PersistenceServiceInProcess.CommitChangeSet(RepositoryConnection connection, ChangeSet changeSet, String comments, WriteModifiers writeModifiers, IList`1 preCommitSequence, IList`1 postCommitSequence, BatchExecutionController`1 batchExecutionController, IExtendedParameters extendedParameters)
--- End of inner exception stack trace ---
at Bentley.EC.Persistence.PersistenceServiceInProcess.CommitChangeSet(RepositoryConnection connection, ChangeSet changeSet, String comments, WriteModifiers writeModifiers, IList`1 preCommitSequence, IList`1 postCommitSequence, BatchExecutionController`1 batchExecutionController, IExtendedParameters extendedParameters)
at Bentley.DesignSync.DesignSyncConnection.CommitChangeSet(ChangeSet changeSet, String commitMessage, WriteModifiers writeModifiers, IList`1 preCommitSequence, IList`1 postCommitSequence, BatchExecutionController`1 batchExecutionController, IExtendedParameters extendedParameters)
at Bentley.DesignSync.DGNDesignSyncConnection.UpdateRepository(ChangeSet changeSet, String commitMessage, WriteModifiers writeModifiers, IList`1 preCommitSequence, IList`1 postCommitSequence, BatchExecutionController`1 batchExecutionController, IExtendedParameters extendedParameters, ITransformHandler transformHandler, Boolean isMajorRevision)
at Bentley.Structural.Ism.DgnRepository.IsmDgnRepository.InternalCommitChangeSet(ChangeSet changeSet, Boolean skipPostCommitModelUpdate, String commitMessage, Boolean isMajorRevision)
at Bentley.Structural.Ism.EngineImp.Utilities.ExchangeUtilities.GetInstancesFromChangeSet(IsmDgnRepository workingRepository, ChangeSet changeSet, List`1& newInstances, List`1& modifiedInstances, List`1& deletedInstances)
at Bentley.Structural.Ism.EngineImp.Utilities.ExchangeUtilities.UpdateApplicationParseChangeSet(IsmDgnRepository workingRepository, ChangeSet acceptedChangeSet, Dictionary`2 targetInstanceSyncIdToIsmId, String& updatedAppTxrPath, String& addedObjectsTxrPath, String& deletedObjectsTxrPath, String& modifiedObjectsTxrPath)
at Bentley.Structural.Ism.EngineImp.RepositoryOperations.UpdateApplication.TxrFileECInstances.UpdateApplication(IsmDgnRepository workingRepository, ChangeSet acceptedChangeSet, Dictionary`2 targetInstanceSyncIdToIsmId)
at Bentley.Structural.Ism.EngineImp.RepositoryOperations.UpdateApplicationWithUi.ExecuteInternal()
at Bentley.Structural.Ism.EngineImp.IsmEngineTask.SafeExecute())
at Bentley.Structural.Ism.ApiImp.IsmExceptionHelper.Throw(Exception exception)
at Bentley.Structural.Ism.ApiImp.IsmApi.InternalUpdateApplication(String repositoryPath, IsmModel appModel, String filterDllPath, String filterClassName, String filterInitializer, Boolean useUi)
at Bentley.Structural.Ism.ApiImp.IsmApi.Bentley.Structural.Ism.Api_7_0.IIsmApi.UpdateApplicationWithUi(String repositoryPath, IIsmModel appModel, String filterDllPath, String filterClassName, String filterInitializer, String applicationModelId)
at Bentley.IsmRevitLink.WorkflowContext.UpdateApplicationImpl(String repositoryPath, IIsmModel appModel, Boolean showUI, String selectionFilePath, String substructureId)
at Bentley.IsmRevitLink.WorkflowContext.UpdateFromRepository()
at Bentley.IsmRevitLink.WorkflowContext.ExecuteWithUI()
*** End of Exception *********************************