POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, a Veteran who served from August 2002 to April 2004, appeals the denial of an increased rating for PTSD above 70% and the denial of service connection for diabetes mellitus (DM) and obstructive sleep apnea (OSA). The Board denied the increased PTSD rating, finding the Veteran's symptoms did not meet the criteria for total occupational and social impairment. Evidence showed the Veteran managed rental properties, engaged in politics, and performed household chores, contradicting claims of total impairment. The Board noted that while the Veteran's PTSD, low back disability, and asthma impacted his mobility and lifestyle, leading to morbid obesity, this obesity was the primary trigger for his DM and OSA. Despite other potential risk factors like genetics, the Board found the obesity, stemming from service-connected conditions, was the most likely cause. Therefore, service connection for DM and OSA was granted, as they were found to be proximately due to or the result of service-connected conditions, with obesity acting as an intermediary link. The appeal for an increased PTSD rating above 70% was denied.

Rationale

Veteran's activities (managing properties, politics, chores) inconsistent with total occupational/social impairment.; PTSD symptoms did not meet criteria for total impairment under 38 C.F.R. § 4.130.; TDIU rating was granted based on PTSD, but this does not equate to total schedular impairment.

Full Decision Text

Citation Nr: 25011266
Decision Date: 09/02/25	Archive Date: 09/02/25

DOCKET NO. 18-10 174
DATE: September 2, 2025

ORDER

A rating in excess of 70 percent for post-traumatic stress disorder (PTSD) for the period from April 8, 2014, to January 9, 2023, is denied. 

Service connection for diabetes mellitus (DM) is granted.

Service connection for obstructive sleep apnea (OSA) is granted.

FINDINGS OF FACT

1. The evidence of record fails to show that the severity levels of the Veteran's PTSD during the rating period on appeal most closely approximated total social and total occupational impairment. 

2. The evidence of record persuasively favors the finding that the Veteran's DM and OSA were proximately caused by his morbid obesity due to functional impact of his service-connected PTSD, low back disability, and asthma.

CONCLUSIONS OF LAW

1. The criteria for rating PTSD in excess of 70 percent for the period from April 8, 2014, to January 9, 2023, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411.

2. The criteria for service connection for DM have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

3. The criteria for service connection for OSA have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 2002 to April 2004. In an April 2015 rating decision, the Regional Office (RO) denied a rating for his PTSD in excess of 70 percent, along with denying service connection for DM and OSA. The Veteran appealed. In March 2022, he testified before the Board.  The transcript is of record.  Following the most recent November 2023 remand for further development which has been completed, the appeal returned to the Board. 

Increased Rating

At the outset, the Board's notes that by the same April 2015 rating action denying a rating for PTSD in excess of 70 percent, the RO awarded a total disability due to individual unemployability (TDIU) rating effectuated from June 2008. This award was predicated on a March 2015 VA mental health evaluation reflecting a medical opinion that the Veteran's PTSD alone renders him unable to secure and follow a substantially gainful employment, that is, apart from his other service-connected disabilities ratable at 30 percent. This essentially means that the Veteran's PTSD has been rated as totally disabling for the entire rating period on appeal, namely, from April 8, 2014, the receipt date of increased rating claim, to January 9, 2023, the day prior to the effective date of the total schedular rating for PTSD. As of January 10, 2023, his TDIU rating had been effectively subsumed and replaced by the schedular total rating for PTSD. 

The principal guide to evaluating disabilities for VA compensation purposes is the VA Schedule for Rating Disabilities. 38 C.F.R. 4.1. All mental disorders, however diagnosed, are evaluated under the General Rating Formula for Mental Disorders (Formula). 38 C.F.R. § 4.130. A total (100 percent) disability, which the only rating available in excess of 70 percent the Veteran is seeking in this appeal, is assigned only when a psychiatric disability is shown to cause both total occupational and total social impairment. Id.

"Total" means "whole, not divided; full; complete," and "utter, absolute." Black's Law Dictionary, 1498 (7th ed. 1999). Although for VA compensation purposes, the regulations clearly do not require the absolute degree of impairment in its literal sense and do allow approximations, the clinically significant psychiatric symptoms and resulting severity levels of functional impairment in occupational and social spheres still must be shown to most closely approximate a near-complete inability to function independently on account of persistently and predominantly impulsive behaviors with gross cognitive and/or gross emotional dysregulation. See 38 C.F.R. §§ 4.7, 4.130. This is not the case before the Board. 

The Veteran's VA treatment records and examination reports reflect that he has been residing with his "cultural" wife and her two minor children, while he also does have a few friends. This alone precludes the Board from finding total social impairment. Further, for example, a
 absolute degree of impairment in its literal sense and do allow approximations, the clinically significant psychiatric symptoms and resulting severity levels of functional impairment in occupational and social spheres still must be shown to most closely approximate a near-complete inability to function independently on account of persistently and predominantly impulsive behaviors with gross cognitive and/or gross emotional dysregulation. See 38 C.F.R. §§ 4.7, 4.130. This is not the case before the Board. 

The Veteran's VA treatment records and examination reports reflect that he has been residing with his "cultural" wife and her two minor children, while he also does have a few friends. This alone precludes the Board from finding total social impairment. Further, for example, a November 2021 functional assessment report reflects that the Veteran helps with dishes and other chores, as well as waking up the kids, taking them to and picking them up from school. Otherwise, he spends the majority of his day on the computer, which implies that he also is fully capable of using computer hardware and software for the majority of the day every day. 

In May 2015, the Veteran further indicated that he had 8 rental properties and was keeping busy with managing them. Along the same lines, for example, the January 2019 progress notes reflect that he currently owns 4 commercial and 3 residential buildings that he rents out. In January 2019, he further reported that he wants to be in politics and is running a political campaign. In December 2019, it was again noted that the Veteran is involved in politics and is running for office. This picture is incongruent with total occupational and social impairment, as contemplated by the Formula for a total schedular rating for PTSD which thus is not warranted. 

In accordance with the law, absent evidence of record supporting the legal basis for a schedular total rating, a rating in excess of 70 percent for PTSD is denied.  

Service Connection

In seeking service connection for DM and OSA, the Veteran's chief contention is that these disabilities resulted from or were proximately caused by his service-connected PTSD, low back disability, and asthma, to include on account of his obesity as an intermediary causal link.

Secondary service connection generally is granted, so long as the evidence of record establishes that obesity is an intermediate link in the causal chain leading from the service-connected disabilities to the claimed secondary disability. See 38 C.F.R. § 3.310(a); Walsh v. Wilkie, 32 Vet. App. 300, 306 (2020). To this end, the evidence of record must show that it is at least as likely as not that the Veteran's service-connected PTSD, low back disability, and asthma caused his obesity; his obesity was a substantial causal factor in developing his DM and OSA; and these disabilities would not have occurred but for his obesity. VAOPGCPREC 1-2017 at 9-10. This is likely the case before the Board.

The record is replete with the medical evidence of substantially limited mobility due to the Veteran's low back disability, which is not ameliorated by his asthma attacks for which he was seen multiple times at the ER, as detailed in his VA treatment records. These limitations are further exacerbated by his cognitive and emotional dysregulation on account of his PTSD prompting his irrational behavior, to include his poor diet and other lifestyle habits he is too "paranoid" to alter, along with his severe anxiety and depression noted to result in "lack of motivation to improve his health." Given the impact of these mental and physical limitations, the Board finds that it is at least as likely as not the Veteran's service-connected disabilities caused his obesity.

The evidence of record further reflects multiple medical opinions largely agreeing that the Veteran's morbid obesity is the most obvious and most likely contributing causal factor among the other well-known risk factors for developing both DM and OSA. To this end, for example, at least one report of examination in October 2018 reflects an unequivocal medical opinion that the Veteran's obesity is the culprit.

Although this report further reflects a medical opinion that the Veteran's obesity was caused neither by his low back disability nor his asthma, this report is silent about any impact of the Veteran's PTSD and further is devoid of any apparent consideration given to the collective, synergistic impact of all service-connected disabilities. By implication, akin to any other medical opinion formed on the basis of incomplete information, the probative value of this opinion at best is minimal.

The Board further acknowledges that several examiners did identify other risk factors, to include the Veteran's family history of diabetes and his Asian heritage, which made him more prone to DM and OSA. Yet such genetic predisposition clearly is immutable and has not changed from the time he entered and separated from service in sound health to the time of the clinical diagnoses of DM and OSA. As
 neither by his low back disability nor his asthma, this report is silent about any impact of the Veteran's PTSD and further is devoid of any apparent consideration given to the collective, synergistic impact of all service-connected disabilities. By implication, akin to any other medical opinion formed on the basis of incomplete information, the probative value of this opinion at best is minimal.

The Board further acknowledges that several examiners did identify other risk factors, to include the Veteran's family history of diabetes and his Asian heritage, which made him more prone to DM and OSA. Yet such genetic predisposition clearly is immutable and has not changed from the time he entered and separated from service in sound health to the time of the clinical diagnoses of DM and OSA. As such, even if he were genetically predisposed, his DM and OSA likely would not have occurred but for obesity which is the only apparent trigger in his case. 

The Veteran's weight of 164 pounds with a body mass index (BMI) well under 20 percent shortly prior to his separation from service in April 2004 has increased by more than 65 pounds resulting in his BMI ranging from 37 to 39 and preceding by at least several years the clinical diagnoses of his DM in January 2010 and OSA in January 2012. Absent any apparent intercurrent causes that may be suggested by the evidence of record and further absent any other substantial lifestyle risk factors that have been identified by any examiners between the time of discharge and the time of diagnoses, the Board ultimately agrees with the medical opinion that the Veteran's morbid obesity is the most obvious and most likely culprit in his case. 

(Continued on next page) 

In sum, absent any persuasive evidence of record that affirmatively may place into doubt the Board's finding that the Veteran's service-connected low back disability, asthma, and PTSD resulted in morbid obesity that was a substantial causal factor in developing his DM and OSA, neither of which had been triggered by any known risk factors other than his obesity, the legal criteria for secondary service for DM and OSA are met. To this extent, the appeal is granted. 

 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Alex Bardin, Counsel

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.