ANXIETY DISORDER

Summary

The Veteran, an Air Force Veteran who served from September 2005 to January 2014, appeals the denial of service connection for an acquired psychiatric disorder and erectile dysfunction (ED). The Veteran initially claimed anxiety and panic disorder due to in-service racial harassment. While the VA Regional Office (RO) noted favorable findings of a current anxiety disorder diagnosis from 2017 and 2019, and suspected anxiety in service separation records, it did not obtain a VA examination to establish a nexus. The Veteran submitted a private psychological opinion from Dr. T.F. that positively linked his symptoms to service, citing in-service chest pains and suspected anxiety, and finding the condition likely began during service. The Board found the evidence approximately evenly balanced, applying the benefit of the doubt to grant service connection for an acquired psychiatric disorder. For ED, claimed as secondary to the psychiatric disorder, the Board noted the lack of a VA opinion but relied on Dr. T.F.'s private opinion, which found ED at least as likely as not related to the psychiatric disorder. The Board granted service connection for ED as secondary to the psychiatric disorder, overturning the RO's denial which was based on the primary psychiatric condition not being service-connected at that time. Service connection for the acquired psychiatric disorder and ED were both granted.

Rationale

Evidence of current anxiety disorder diagnosis and treatment; Suspected anxiety in service separation records; Private psychologist provided positive etiological opinion; Evidence approximately evenly balanced, doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26000599
Decision Date: 01/05/26	Archive Date: 01/05/26

DOCKET NO. 250911-585416
DATE: January 5, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder and panic disorder, is granted.

Entitlement to service connection for erectile dysfunction (ED) as secondary to an acquired psychiatric disorder is granted. 

FINDINGS OF FACT

1. Resolving reasonable doubt in his favor, the Veteran has an acquired psychiatric disorder that is at least as likely as not related to his military service.

2. The Veteran's ED is due to his acquired psychiatric disorder.

CONCLUSIONS OF LAW

1. The criteria for establishing service connection for an acquired psychiatric disorder have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f).

2. The criteria for establishing service connection for ED, on a secondary basis, have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from September 2005 to January 2014.

This matter is on appeal to the Board of Veterans' Appeals (Board) from a December 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).  The December 2024 rating decision was a Higher-Level Review decision that considered the evidence of record at the time of a previous decision by the RO in June 2024.  38 C.F.R. §§ 3.2500(a), 3.2601.  

In the September 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 June 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 that decision, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.301, 20.801. 

The Board also notes that, prior to the issuance of the June 2024 rating decision that was followed by his request for Higher-Level review, the Veteran filed a VA Form 20-0995, Decision Review Request: Supplemental Claim in January 2024 following an initial denial in September 2023.  In the decision on appeal, the AOJ found that no change in the prior decisions to deny the appellant's claim was warranted.  Although the AOJ did not explicitly determine in December 2024 that the Veteran had submitted new and relevant evidence, because the AOJ reconsidered its prior decisions and discussed the additional evidence submitted since the initial decision in September 2023, the Board concludes that the AOJ implicitly determined that new and relevant evidence had been received to warrant re-adjudicating the previously denied claim.  The Board will therefore not disturb this favorable finding and proceed to the merits of the claim on appeal.

Service Connection

Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. § § 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link ("nexus") between the current disability and the disease or injury incurred or aggravated in service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may also be established on a secondary basis when there is evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected
) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link ("nexus") between the current disability and the disease or injury incurred or aggravated in service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may also be established on a secondary basis when there is evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  See 38 C.F.R. § 3.310; but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding all that is needed is a "but for" causation or aggravation to show entitlement to secondary service connection).  

There is no "temporal" requirement to receive an award of secondary service-connection and, therefore, a claimant is not precluded from service-connection under 3.310 merely because the primary service-connected disability was diagnosed after the disability claimed as secondary. "the primary disability need not be service-connected or even diagnosed at the time the secondary condition is incurred."  Frost v. Shulkin, 29 Vet. App. 131, 134.

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  If the positive and negative evidence is in approximate balance-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt.  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

1. An acquired psychiatric disorder.

The Veteran, in his initial claim, sought service connection for anxiety and a panic disorder due to in-service stressors that included experiencing racism at the hands of superiors.  See June 2023 Form 21-526EZ; January 2024 Form 21-4138.   

The provisions of 38 C.F.R. § 4.125(a) require that a diagnosis of a mental disorder conform to the American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5).  

At the outset, and as to a current disability for service connection purposes, the AOJ noted as a favorable finding that the Veteran's VA treatment records note 2017 and 2019 diagnoses of, and treatment for, an anxiety disorder and panic disorder, respectively.  Given the nature of the claim and the various diagnoses reflected in the record, the Board has broadened and recharacterized the claim as one for any acquired psychiatric disorder.  See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

While the record does not reflect that any attempt was made to verify the Veteran's reports of in-service harassment, including obtaining information on the investigations that he asserts were conducted in supporting statements, his service treatment records do note him seeking treatment for chest pain.  Diagnostic testing, however, did not show any cardiac conditions.  A June 2013 STR, just prior to separation, notes that while the Veteran did not report any stress, the clinician indicated that anxiety was suspected.

The Board also notes that, while the Veteran did not assert any psychiatric complaints at the time of his service separation, he did report to his VA medical center in 2015 for continued chest pains.  He would eventually be diagnosed with anxiety in April 2016.  In October 2017, he reported to VA clinicians that he had been dealing with anxiety for "about 3-4 years."

As to nexus, the AOJ provided the Veteran with no VA examination to determine the nature and etiology of his anxiety and panic, despite evidence of a current disability and timeline of suspected anxiety since as early as his military service.  The Board notes, however, that the Veteran did submit his own opinion from a private psychologist, Dr. T.F., who provided a positive etiological opinion as to his symptoms.  While the AOJ denied the claim based on the fact that Dr. T.F.'s conclusions are based only on the Veteran's self-reports, the Board notes that the private clinician stated the opposite.  Dr. T.F
 to VA clinicians that he had been dealing with anxiety for "about 3-4 years."

As to nexus, the AOJ provided the Veteran with no VA examination to determine the nature and etiology of his anxiety and panic, despite evidence of a current disability and timeline of suspected anxiety since as early as his military service.  The Board notes, however, that the Veteran did submit his own opinion from a private psychologist, Dr. T.F., who provided a positive etiological opinion as to his symptoms.  While the AOJ denied the claim based on the fact that Dr. T.F.'s conclusions are based only on the Veteran's self-reports, the Board notes that the private clinician stated the opposite.  Dr. T.F specifically noted that they reviewed the claims file, even referencing certain records that only someone in possession of the claims file could note.  

The Veteran reported to Dr. T.F. that his mental health problem manifested while in service, but that he did not seek help from VA providers until around 2015 or 2016, which the Board has confirmed above.  He explained to the examiner that he did not seek mental health treatment sooner due to military culture and his background, finally realizing that something was "wrong" with him.  He related his symptoms, including his in-service chest pains and palpitations to race-related incidents with superior officers.  Dr. T.F. stated that there are "multiple markers in the record consistent with a likely onset of anxiety during his military service which has continued since that time, including his in-service reports of chest pain and suspected anxiety at that time.

Based on the above, given the opinion provided by Dr. T.F., the incomplete determinations by the AOJ, and the Veteran's competent lay statements that his anxiety began in service and persisted until his eventual diagnosis only roughly three years after, the Board finds the evidence of record is approximately evenly balanced as to whether the Veteran has an acquired psychiatric disability that is etiologically related to his active duty service.  As such, after resolving all doubt in the Veteran's favor, service connection is warranted, and the claim is granted.  

2. Erectile dysfunction.

The Veteran also seeks service connection for ED as secondary to an acquired psychiatric disorder.  See 38 C.F.R. § 3.310.  While no VA examiner's opinion is of record as to this point, a VA examination was nevertheless provided which contains the Veteran's reports that his ED and arousal issues which began as early as 2016.  In December 2019, the Veteran reported sporadic sexual side effects when discussing his psychiatric medication, which were not discounted by the clinician at the time.  Further, Dr. T.F. did opine that the Veteran's ED was at least as likely as not related to his acquired psychiatric disorder, citing the Veteran's medical history and treatise evidence.  The Board finds no reason to limit the probative weight of this opinion.   

The RO denied the claim in the decision on appeal in part because the primary disability was not service connected at that time.  However, as the Veteran's acquired psychiatric disorder claim has now been granted above, the claim for ED on a secondary basis is also granted.  

The Board thanks the Veteran for his service.

 

 

P.M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scarduzio, Robert

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.