ANXIETY DISORDER

Summary

The Veteran, who served in the Air Force from April 1986 to January 1990 with additional National Guard service, appeals the denial of service connection for a psychiatric disorder, including PTSD and anxiety, and for headaches as secondary to a psychiatric disorder. The Board found that the Veteran had a current disability, as he reported anxiety and had a history of anxiety and depression, and was treated by an online doctor. However, the Board found the evidence did not corroborate the claimed in-service stressor related to an Italian jet crash at Ramstein Air Force Base in Germany. The Veteran's testimony about the event was inconsistent with his private physician's report, and the private physician's opinion lacked a detailed rationale and DSM-5 compliance. The Board also noted the absence of VA medical records or opinions supporting the psychiatric claim at the time of the initial rating decision. For the secondary claim of headaches, the Board found a current disability based on the Veteran's reports, but since the primary psychiatric disorder was denied service connection, the secondary claim could not be granted. Service connection for both the psychiatric disorder and the secondary headaches was denied.

Rationale

Lack of corroboration for claimed in-service stressor.; Insufficient medical evidence linking current psychiatric disorder to service.; Private physician's opinion lacked detailed rationale and DSM-5 compliance.

Full Decision Text

Citation Nr: A26016570
Decision Date: 02/24/26	Archive Date: 02/24/26

DOCKET NO. 210119-135347
DATE: February 24, 2026

ORDER

1. Entitlement to service connection for a psychiatric disorder, to include post-traumatic stress disorder (PTSD) and anxiety, is denied.

2. Entitlement to service connection for headaches, as secondary to a psychiatric disorder, is denied.

FINDINGS OF FACT

1. The credible evidence of record does not corroborate a claimed in-service stressor related to a diagnosis of PTSD, and the evidence persuasively weighs against a finding that a psychiatric disorder was incurred during active duty service or is otherwise related to service.

2. The Veteran's headaches disability was not incurred during active duty service, is not otherwise related to service or shown to be caused by or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a psychiatric disorder, to include PTSD and anxiety have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38C.F.R. §§ 3.102, 3.303, 3.304, 4.125, 4.130.

2. The criteria for entitlement to service connection for headaches, to include as secondary to service-connected disability or disabilities, have not been met. 38 U.S.C. §§ 1101, 1110,1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1986 to January 1990, with additional National Guard service.

These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2020 rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO), which in pertinent part, denied the claims for service connection for anxiety and headaches as secondary to anxiety. In denying the service-connection claims, the AOJ found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of the decision. As the AOJ has already determined that new and relevant evidence has been submitted as to the claims, the Board need not address new and relevant evidence herein.

In January 2021, the Veteran timely appealed the claims to the Board by submitting a completed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD) and requesting a hearing with a Veterans Law Judge.

In September 2024, the Veteran testified before a Veterans Law Judge (VLJ) at a virtual Board hearing.

In an Appeals Modernization Act (AMA) appeal with a Board hearing, the Board considers the evidence of record at the time of the December 2020 rating decision and any evidence submitted by the Veteran and/or his representative at the hearing up to 90 days following the hearing, which would have been December 4, 2024. 38 C.F.R. § 20.302(a).

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision here. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

A claim for service connection for a mental disability may encompass claims for any psychiatric disability that may reasonably be encompassed by several factors, including the claimant's description of the claim, the symptoms the claimant describes and the information the claimant submits or that the Secretary of VA obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Accordingly, the Board has taken an expansive view of the Veteran's claim for service connection pursuant to Clemons and re-characterized it as shown on the cover page of this decision.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R
 that may reasonably be encompassed by several factors, including the claimant's description of the claim, the symptoms the claimant describes and the information the claimant submits or that the Secretary of VA obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Accordingly, the Board has taken an expansive view of the Veteran's claim for service connection pursuant to Clemons and re-characterized it as shown on the cover page of this decision.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. 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).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether the persuasive weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

1. Service connection for a psychiatric disorder.

The Veteran seeks service connection for a psychiatric disorder that he asserts was incurred in or otherwise related to service. The Veteran asserted that he was at an airshow in Germany at Ramstein Air Force Base and while watching, Italian jets ended up crashing into each other and landing on the crowd on a hill that he had just left. See September 2024 Board hearing transcript.

Service connection for post-traumatic stress disorder (PTSD) specifically requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. §§ 3.304(f), 4.125(a).

The diagnosis of PTSD must comply with the criteria set forth in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 5th edition, of the American Psychiatric Association (DSM-5). See 38 C.F.R. §§ 4.125(a), 4.130.

In 2010, amendments were made to 38 C.F.R. § 3.304 to liberalize, in some cases, the evidentiary standard for establishing the required in-service stressor. The amendment took into consideration the current scientific research studies relating PTSD to exposure to hostile military and terrorist actions. The amendment acknowledged the inherently stressful nature of the places, types, and circumstances of service in which fear of hostile military or terrorist activities is ongoing. However, in this case, the Veteran does not contend that he was in fear of hostile military or terrorist activities when the alleged "Italian jet crash" occurred.

The Board has carefully reviewed the evidence of record and finds that the persuasive weight of the evidence is against the claim for service connection for a psychiatric disorder, which is explained below.

The Veteran testified during the September 2024 Board hearing that he had anxiety, which he claimed was related to the alleged Italian jet crash in Germany. He indicated that he was not obtaining treatment for anxiety at the time of the hearing but was treated for anxiety with Valium and was "we[a]ned off." The Veteran reported that he would still get anxious sometimes and would just have to calm himself down and when he had bad dreams, it would be about being on a plane and crashing, not necessarily the event [of the airshow]. The Veteran also testified that he seen an online doctor for anxiety, again reiterating that he was put on medication for a while and was "we[a]ned" off it.

VA medical records reflect negative PTSD and depression screens in January 2019. The Veteran had denied issues, such as emotional issues (sadness, emptiness, depression), personal or family concerns, substance abuse concerns, and/or spiritual/religious concerns. The review of systems for psychiatric was negative for flashbacks to war, depression, hallucinations, and confusion. A review of systems in a December 2020 VA medical record was negative following a 10-point review of systems except for the Veteran's complaint of and recent diagnosis of obstructive
of the airshow]. The Veteran also testified that he seen an online doctor for anxiety, again reiterating that he was put on medication for a while and was "we[a]ned" off it.

VA medical records reflect negative PTSD and depression screens in January 2019. The Veteran had denied issues, such as emotional issues (sadness, emptiness, depression), personal or family concerns, substance abuse concerns, and/or spiritual/religious concerns. The review of systems for psychiatric was negative for flashbacks to war, depression, hallucinations, and confusion. A review of systems in a December 2020 VA medical record was negative following a 10-point review of systems except for the Veteran's complaint of and recent diagnosis of obstructive sleep apnea. However, the Veteran's past medical history included anxiety and depression.

The November 2020 and September 2024 opinion letters from Dr. Carroll allude to diagnoses of PTSD and anxiety, however, it is not specified if such diagnoses are based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Nonetheless, as the Veteran has reported treatment for anxiety by an online doctor during the September 2024 Board hearing and a past medical history included anxiety and depression, affording the Veteran the benefit of the doubt, the Board finds that the first element of a service connection claim, a current disability, is met.

As to PTSD, the Board finds that credible supporting evidence that the claimed in-service stressor occurred, has not been shown by the persuasive weight of the evidence. See 38 C.F.R. § 3.304(f).

The Board finds that the diagnoses of PTSD and anxiety provided above were based upon the Veteran's self-report of stressors and symptoms. During the September 2024 Board hearing, the Veteran reported that at the time, the alleged Italian jet crash incident did not bother him; however, it was later in life when he started flying for work that he started to have bad dreams about crashing. He stated that he did not really know if it had something to do with it or not, as he was not a doctor. He indicated that he did not have bad dreams about the event, but his dreams were more about being on a plane and crashing. He was not traveling anymore, and it seemed the problem started when he started traveling for work. 

The Veteran's Certificate of Release or Discharge From Active Duty (DD Form 214) indicates that he served just over one year and 11 months of foreign service. However, the Veteran did not provide any specific details of when the airshow was nor any other credible supporting evidence.

Specifically, in the November 2020 opinion letter, Dr. Carroll indicated that the Veteran had been evaluated in his office for multiple years secondary to diffuse polyarticular arthralias. He stated that the Veteran suffered from decreased concentration and attention span secondary to PTSD for accidents he witnessed that happened during his time in the Air Force. However, Dr. Carroll did not detail any of the particular accidents or reference the Italian jet crash. Dr. Carroll also indicated that the Veteran stated it had affected his ability to concentrate as well as his attention span and had caused reactive insomnia regarding recurrent headaches and depressive type symptoms.

In a September 2024 statement, Dr. Carroll documented that he was a practicing family physician and had the pleasure of taking care of the Veteran for 30 years and had seen the Veteran on that day. He noted that the Veteran had marked anxiety with post-traumatic stress syndrome, which had caused severe tension headaches. He wrote this occurred secondary during his service time of witnessing Italian jets crashing at the air show he attended at Ramstein Air Base in Germany, which occurred on the hill that he had just left. Dr. Carroll added that the Veteran stated that he frequently thought about this and it caused him to have anxiety, headaches, and insomnia, as well as post-traumatic stress syndrome. 

The September 2024 statement from Dr. Carroll was less than a week after the September 2024 Board hearing, and the Veteran had provided the same details to Dr. Carroll about the Italian jet crash regarding him having just left the hill where the planes allegedly crashed. However, the Dr. Carroll noted that the Veteran stated he frequently thought about it, which is inconsistent with what the Veteran reported during the Board hearing. He stated that he did not have bad dreams of the event, but his dreams were more about being on a plane and crashing and not necessarily about the event.

It does not appear that Dr. Carroll had treated the Veteran for his psychiatric symptoms. In November 2020, Dr. Carroll indicated that he treated the Veteran for multiple years secondary to diffuse polyarticular arthralias. In September 2024, Dr. Carroll indicated that he was a family physician and did not indicate in either written opinion that the Veteran's reported psychiatric symptoms were evaluated under the DSM-5. Dr.
. However, the Dr. Carroll noted that the Veteran stated he frequently thought about it, which is inconsistent with what the Veteran reported during the Board hearing. He stated that he did not have bad dreams of the event, but his dreams were more about being on a plane and crashing and not necessarily about the event.

It does not appear that Dr. Carroll had treated the Veteran for his psychiatric symptoms. In November 2020, Dr. Carroll indicated that he treated the Veteran for multiple years secondary to diffuse polyarticular arthralias. In September 2024, Dr. Carroll indicated that he was a family physician and did not indicate in either written opinion that the Veteran's reported psychiatric symptoms were evaluated under the DSM-5. Dr. Carroll did not provide a rationale for his claimed statements but rather documented only what the Veteran reported to him. During the September 2024 Board hearing, the Veteran reported only treatment by an online doctor, who treated him with Valium and "we[a]ned" him off it. Notably, the Veteran testified that he really did not know whether his psychiatric symptoms had something to do with his claimed witnessing of the Italian jet crash, as he was not a doctor. Thus, at the time, a medical professional, including Dr. Carroll, had not told the Veteran his claimed psychiatric symptoms were related to the alleged Italian jet crash.

Therefore, a diagnosis of PTSD was provided first in November 2020, by Dr. Carroll, based on the Veteran's reported stressor of "accidents" he reported to have witnessed in service. However, Dr. Carroll did not detail any of the particular accidents or reference the Italian jet crash. As mentioned above, in the November 2020 statement, Dr. Carroll indicated that he was treating the Veteran for multiple years secondary to diffuse polyarticular arthralias, not for psychiatric symptoms. In both the November 2020 and September 2024 statements, Dr. Carroll provided a cursory diagnosis of PTSD and anxiety based on the Veteran's own report. Dr. Carroll did not indicate the diagnoses were based upon the DSM-5 or provide explanation for the diagnoses. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020), aff'd sub nom. Martinez-Bodon v. McDonough, 28 F.4th 1241, 1247 (holding that a diagnosis under DSM-5 is required for compensation for psychiatric disorders). A medical opinion without rationale is not probative. Miller v. West, 11 Vet. App. 345 (1998). Therefore, this opinion is not probative and does not support Veteran's claim.

Without corroboration of a PTSD stressor or a VA psychiatrist or psychologist confirming that the claimed stressor is related to the Veteran's fear of hostile military or terrorist activity and is adequate to support a diagnosis of posttraumatic stress disorder and that the Veteran's symptoms are related to the claimed stressor, the facts do not meet the requirements for service connection for PTSD.

Moreover, the Veteran has not provided probative and competent evidence establishing a nexus between the current psychiatric disorder, other than PTSD, and service. Lay evidence may be competent to establish etiology or nexus. However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to." Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). A diagnosis of a psychiatric disorder requires specialized training for determinations as to diagnosis and causation, and is, therefore, not susceptible to lay opinions on etiology. Therefore, the Board finds that the lay assertions proffered by the Veteran lack probative value. 

Prior to the December 2020 rating decision, the Veteran was not afforded a VA medical examination or medical opinion in connection with the claim for service connection for a psychiatric disorder. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Veteran had first testified to the alleged Italian jet crash and online treatment for his psychiatric disorder during the September 2024 Board hearing. Thus, at the time of the December 2020 rating decision, there was no competent evidence of a current psychiatric disorder, as there were no private treatment records or VA medical records showing a psychiatric disorder or persistent or recurrent symptoms of a psychiatric disorder. Dr.
 claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Veteran had first testified to the alleged Italian jet crash and online treatment for his psychiatric disorder during the September 2024 Board hearing. Thus, at the time of the December 2020 rating decision, there was no competent evidence of a current psychiatric disorder, as there were no private treatment records or VA medical records showing a psychiatric disorder or persistent or recurrent symptoms of a psychiatric disorder. Dr. Carroll's November 2020 statement lacked rationale and was not probative. At least one of the criteria is not met, and, as such, an examination and/or medical opinion was not required, and there was no pre-decisional duty to assist error in not providing an examination and medical opinion. 

Further, the claimed stressor had not been corroborated by credible supporting evidence as Veteran did not provide any details of an Italian jet crash at the time of the December 2020 rating decision. The Board finds that VA does not have a duty to attempt to verify the claimed stressor and there was no pre-decisional duty to assist error in not attempting to verify the stressor. During the September 2024 Board hearing, the Veteran's representative requested remand for further development if the claim was not granted, but to this extent, as explained above, there is no further development required and remand is not warranted.

The Board finds no other competent and credible evidence in support of a nexus between the Veteran's psychiatric disorder and his military service, to include his reported stressor, and in the absence of a nexus, service connection for a psychiatric disorder cannot be established. The benefit of the doubt doctrine is therefore not for application, and the claim is denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102.

2. Entitlement to service connection for headaches as secondary to a psychiatric disorder.

The Veteran seeks service connection for headaches as secondary to a psychiatric disorder.

The Veteran nor his representative has contended or offered evidence to support that the Veteran's headaches had their onset during service or that they are directly related to service but rather contended that the disability is secondary to the claimed psychiatric disorder. The direct theory of entitlement it also not raised by the record. The Board will limit its analysis to the secondary theory advanced by the Veteran. Robinson v. Peake, 21 Vet. App. 545, 552-56.

The Board will first address whether there is a current disability. During the September 2024 Board hearing, the Veteran confirmed with his representative that he did not have headaches prior to service, but claimed they started once he started to have anxiety and had headaches that corresponded with the time he filed his service-connection claim. The Veteran testified that he had headaches about two months prior to the Board hearing and could not remember the one before that but previously had them regularly, which he described occurred a couple times a week. The Veteran indicated that he had previously seen an online doctor for his headaches and anxiety. A January 2019 VA record reflects a review of systems of the head that was negative for severe headache, head injury, stroke and seizure.

In the November 2020 letter, Dr. Carroll indicated that the Veteran stated that he had also suffered with decreased concentration and attention span secondary to post traumatic stress disorder for accidents he witnessed that happened during his time in the Air Force. Dr. Carroll wrote that the Veteran reported that witnessing these accidents had affected his ability to concentrate, as well as his attention span, and had caused reactive insomnia regarding recurrent headaches and depressive type symptoms. In the September 2024 statement, Dr. Carroll wrote that the Veteran had marked anxiety with post-traumatic stress syndrome, which had caused severe tension headaches. Affording the Veteran the benefit of the doubt, the Board finds that the first element of a service-connection claim, a current disability, is met.

Service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310(a). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App.
 Carroll wrote that the Veteran had marked anxiety with post-traumatic stress syndrome, which had caused severe tension headaches. Affording the Veteran the benefit of the doubt, the Board finds that the first element of a service-connection claim, a current disability, is met.

Service connection may be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310(a). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or aggravated by, a service-connected disease or injury.

The Veteran was not afforded a VA medical opinion in connection with the claim for service connection for headaches. The criteria for a VA examination were laid out above. McLendon, 20 Vet. App. 79. The Veteran has not credibly established evidence of an in-service event or that disability may be related to service and the Veteran is not in receipt of service-connection for a psychiatric disorder. Thus, at least one of the criteria is not met, and, as such, a medical opinion is not required. During the September 2024 Board hearing, the Veteran's representative requested remand for further development if the claim was not granted, but to this extent, no further development required and remand is not warranted.

The Veteran asserts that headaches are secondary to his acquired psychiatric disorder. However, the Veteran is not in receipt of service-connection for the psychiatric disorder, which is denied above herein. Therefore, the claimed headaches disability cannot be granted on a secondary basis as the psychiatric disorder is not a service-connected disability. Thus, the claim for entitlement to service connection for headaches is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th 776.

 

 

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Cheng, 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.