IRRITABLE COLON SYNDROME (SPASTIC COLITIS MUCOUS COLITIS)

J.P. NORMAN · 2026 · Case ID: A26017941

MIXED

Summary

The veteran served from May 2000 to October 2000, January 2003 to August 2003, and June 2004 to July 2005, with service in the Southwest Asia theater of operations. The veteran appealed the denial of service connection for obstructive sleep apnea (OSA), traumatic brain injury (TBI), gastroesophageal reflux disease (GERD), and chronic fatigue syndrome (CFS), as well as an increased rating for PTSD. The veteran also appealed the denial of service connection for constipation. The Board granted service connection for constipation, finding it to be a medically unexplained chronic multi-symptom illness (MUCMI) warranting presumptive service connection based on Southwest Asia service. For OSA, TBI, GERD, and CFS, the Board denied service connection, finding that the evidence persuasively weighed against a service connection, either due to lack of nexus to service, clear etiology, or absence of a current diagnosis. The Board denied an increased rating for PTSD, finding the veteran's symptoms most closely aligned with a 50% rating, not the 70% sought, based on a VA examination. Appeals for asthma and attention deficit disorder were withdrawn and dismissed. The Board noted that a secondary claim for OSA due to obesity, which was raised late in the process, was not reasonably raised by the record and therefore could not be adjudicated in this appeal.

Rationale

Constipation is a MUCMI; Presumptive service connection due to Southwest Asia service; VA examiner found condition to be MUCMI with partially explained etiology

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201202-125744

Full Decision Text

Citation Nr: A26017941
Decision Date: 02/27/26 Archive Date: 02/27/26

DOCKET NO. 201202-125744
DATE: February 27, 2026

ORDER

Entitlement to service connection for constipation is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

Entitlement to service connection for traumatic brain injury (TBI) is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

Entitlement to service connection for chronic fatigue syndrome (CFS) is denied.

Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied.

Entitlement to service connection for asthma has been withdrawn. The appeal is dismissed.

Entitlement to service connection for attention deficit disorder has been withdrawn. The appeal is dismissed.

FINDINGS OF FACT

1. The Veteran has qualifying service in Southwest Asia.

2. The Veteran's constipation is a chronic multi symptom disease of unknown etiology.

3. The evidence of record persuasively weighs against finding that OSA began during active service, or is otherwise related to an in-service injury or disease.

4. The Veteran's OSA is a disease with a clear and specific etiology.

5. The evidence of record persuasively weighs against finding that the Veteran has had a TBI at any time during or approximate to the pendency of the claim.

6. The evidence of record persuasively weighs against finding that GERD began during active service, or is otherwise related to an in-service injury or disease.

7. The evidence of record persuasively weighs against finding that the Veteran has had CFS at any time during or approximate to the pendency of the claim.

8. The Veteran's PTSD does not cause social and occupational impairment with deficiencies in most areas or total occupational and social impairment.

9. On July 26, 2024, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant's representative that a withdrawal of the appeals for asthma and attention deficit disorder is requested.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for constipation are met. 38 U.S.C. §§ 1110, 1112, 1113, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317.

2. The criteria for service connection for OSA are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a TBI are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for GERD are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for CFS are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for a disability rating in excess of 50 percent for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

7. The criteria for withdrawal/dismissal of the appeals for asthma and attention deficit disorder by the appellant (or his or her authorized representative) are met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from May 2000 to October 2000, from January 2003 to August 2003, and from June 2004 to July 2005.

In the December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On July 26, 2024, the Veteran withdrew the hearing request.

The Veteran had active service from May 2000 to October 2000, from January 2003 to August 2003, and from June 2004 to July 2005.

In the December 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On July 26, 2024, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the October 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

If the Veteran would like VA to consider any evidence that was submitted 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted on a direct basis for a disability resulting from personal injury suffered or disease contracted, or for aggravation of a preexisting injury suffered or disease contracted, in the line of duty in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

To establish service connection the following elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical "nexus" requirement). Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).

Service connection may also be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability that manifested either during active service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2026. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i).

The term MUCMI refers to a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Examples of MUCMIs include chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal disabilities). 38 C.F.R. § 3.317(a)(2)(i)(B).

On August 10, 2022, the PACT Act was enacted and, pertinent to this case, amended the law such that it expanded the definition of Persian Gulf veteran to include veterans who served in Afghanistan, Israel, Egypt, Turkey, Syria and Jordan, along with those who served in the Southwest Asia theater of operations. 38 U.S.C. § 1117.

The PACT Act also eliminated the manifestation period and the degree to which a qualifying chronic disability must manifest to be presumed as due to service in the Persian Gulf. See 38 U.S.C. § 1117. Thus, undiagnosed illness and MUCMIs may now manifest at any time and to any degree (including noncompensable). Therefore, there is no longer a requirement for a chronic disability to manifest to a degree of 10 percent or more prior to an end date (currently December 31, 2026), as stated in the regulation.
Syria and Jordan, along with those who served in the Southwest Asia theater of operations. 38 U.S.C. § 1117.

1. Entitlement to service connection for constipation is granted.

The Veteran asserts entitlement to service connection for constipation. The Board finds that as the Veteran has qualifying service in the Southwest Asia theater of operations and the Veteran's constipation has been found to be a diagnosable but medically unexplained chronic multi-symptom illness with a partially explained etiology, service connection is warranted on a presumptive basis.

The AOJ has made a favorable finding that the Veteran has qualifying service in the Southwest Asia theater of operations, and that element is conceded here.

The Veteran attended a September 2020 VA examination to evaluate service connection for constipation. At that examination the examiner opined that the Veteran's constipation was a diagnosable but medically unexplained chronic multi-symptom illness with a partially explained etiology. The examiner is deemed to be competent and credible to offer such a diagnostic evaluation, and the opinion is assigned high probative value. No other medical opinion in the evidence of record asserts that the Veteran's constipation symptoms are attributable to an intervening etiology. The evidence of record therefore weighs in favor of a finding that the Veteran's constipation is a MUCMI and entitled to presumptive service connection.

As such, the claim for service connection for constipation is GRANTED.

2. Entitlement to service connection for OSA is denied.

The Veteran asserts entitlement to service connection for OSA. The Board finds that as the Veteran's OSA did not have its onset during service, or is otherwise related to an in-service incurrence, service connection is not warranted for the condition. Furthermore, as the Veteran's OSA is found to be a disease with a clear and specific etiology and diagnosis, service connection is not warranted on a presumptive basis either.

As to the first element of direct service connection, the AOJ has made a favorable finding that the Veteran has a current diagnosis of OSA, and that element is conceded here.

As to the second element of an in-service incurrence, the Veteran asserts on his claim form that his OSA had its onset during service.

There still must be found a nexus, or link between the in-service incurrence and the current disability. There is one medical opinion in the evidence of record which addresses a nexus between the Veteran's current disability and an in-service onset.

The Veteran attended a VA examination in September 2020. The examiner concluded that it was less likely than not that the Veteran's OSA had its onset during service. The rationale offered to support this conclusion was that the Veteran's OSA was diagnosed significantly after the service period. The Veteran was also positive for multiple intervening risk factors for the development of OSA at that time. The examiner is deemed to be competent and credible to offer such an opinion, and it is assigned high probative value.

There are no other medical opinions in the evidence of record which endorse a nexus. As such, the evidence of record persuasively weighs against a finding that there is a nexus between the asserted onset of OSA during service and the Veteran's current diagnosis. Without a finding of a nexus a claim for direct service connection cannot be supported.

The Veteran was also evaluated as to whether his OSA may be presumptively be service connected due to Southwest Asia service.

The Veteran attended a September 2020 VA examination to evaluate whether his OSA was either an undiagnosed illness or a MUCMI such that service connection was warranted on a presumptive basis. The examiner opined rather that the Veteran's OSA was disease with a with a clear and specific etiology and diagnosis. The examiner is deemed to be competent and credible to offer such an opinion, and it is assigned high probative value. No other medical opinions in the evidence of record assert that the Veteran's OSA is of a nature that it would qualify as either an undiagnosed illness or a MUCMI.

The evidence of record therefore persuasively weighs against a finding that the Veteran's OSA is an
Veteran attended a September 2020 VA examination to evaluate whether his OSA was either an undiagnosed illness or a MUCMI such that service connection was warranted on a presumptive basis. The examiner opined rather that the Veteran's OSA was disease with a with a clear and specific etiology and diagnosis. The examiner is deemed to be competent and credible to offer such an opinion, and it is assigned high probative value. No other medical opinions in the evidence of record assert that the Veteran's OSA is of a nature that it would qualify as either an undiagnosed illness or a MUCMI.

The evidence of record therefore persuasively weighs against a finding that the Veteran's OSA is an undiagnosed illness or a MUCMI, and therefore service connection is not warranted on a presumptive basis.

The Veteran's representative asserts in a brief submitted after the withdrawal of the hearing that the Veteran's OSA is caused by an intermediary diagnosis of obesity which is in turn caused by the Veteran's service-connected conditions.

VA must "consider all lay and medical evidence of record in order to adjudicate entitlement to benefits for the claimed condition as well as entitlement to any additional benefits for complications of the claimed condition." 38 C.F.R. § 3.155(d)(2). The ordinary meaning of "complications" in § 3.155(d)(2) connotes a causal or aggravative relationship between the primary disease or condition and the resulting disease or condition, including as due to treatment for the underlying disease or condition, which is the same relationship that exists between primary and secondarily service-connected disabilities. Bailey v. Wilkie, 33 Vet. App. 188, 200 (2021) (holding, in part, that the duty to maximize benefits includes the duty to consider secondary service connection reasonably raised in the context of an increased rating claim). Because of this meaning, the regulation imposes a duty on VA to consider secondary-service-connection claims that are reasonably raised by the record with a claim for the initial rating for a primary disability, to include as involving complications of the primary disability or as logically related to the primary disability. See Wilson v. McDonough, 35 Vet. App. 103, 107 (2022) citing Bailey, 33 Vet. App. at 201.

Determining "whether a theory is reasonably raised generally depends on the evidence that is in the record before the agency." Robinson v. Peake, 21 Vet. App. 545, 552-53 (2008), aff'd sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). The Board's duty to address a reasonably raised theory of service connection arises when the evidence triggers VA's duty to provide a medical opinion. Healey v. McDonough, 33 Vet. App. 312, 319 (2021).

Here, the Board finds that secondary service connection for OSA as due to an intermediate diagnosis of obesity due to service-connected conditions is not reasonably raised by the record. While the Veteran does have multiple service-connected conditions that may affect his ability to exercise or otherwise maintain a healthy weight, the Veteran did not assert this theory of entitlement at any time before the rating decision on appeal. The Veteran attended a VA examination to assess service connection for the condition and did not raise the theory of entitlement at the examination. In this case the condition is not automatically implicated for secondary service condition simply because the Veteran has a diagnosis of obesity.

The first contention of the conditions being related was raised in the brief offered by the Veteran's representative during the evidentiary window following withdrawal of the hearing. As this assertion was not part of the record before the rating decision on appeal, it was not a pre-decisional duty to assist error to not evaluate the condition during the VA examinations.

The Board advises the Veteran that he is always free to file a supplemental claim asserting the theory of entitlement. The Board may not, however, adjudicate such a claim in the first instance in this determination, as it was not reasonably raised by the current record.

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for OSA is warranted. Rather, the evidence persuasively weighs against entitlement to service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. 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). The appeal is hereby DENIED.

3.
in this determination, as it was not reasonably raised by the current record.

3. Entitlement to service connection for TBI is denied.

The Veteran asserts service connection for a TBI. The Board finds that as the evidence of record persuasively weighs against a finding that the Veteran has a current diagnosis of a TBI, service connection is not warranted.

The first element of service connection requires a finding of a current disability.

The Veteran attended a September 2020 VA examination to assess service connection for a TBI. The examiner opined that the Veteran did not have a current diagnosis of a TBI. The examiner found that the Veteran did not have any symptoms attributable to residuals of a TBI. The Veteran was found to be within normal limits for all neuropsychological examinations. The Veteran's VA treatment records show that the Veteran was previously evaluated as having a diagnosis of a mild TBI based on reported symptoms from the Veteran. These records were reviewed by the examiner. As noted by the examiner, the Veteran's TBI evaluation failed to show objective evidence of TBI after a comprehensive evaluation including an MRI. This led the examiner to conclude that the diagnosis contained within the treatment records did not show chronic issues with residuals of a TBI. The examiner is found to be competent and credible to offer such a diagnosis, and it is assigned high probative value.

As noted above, the other evidence of record concerning a current diagnosis of a TBI is contained within the Veteran's VA treatment records. The highly probative opinion of the examiner did not find that these records established a current diagnosis, and the reasoning is found to be persuasive. The most recent treatment record concerning the TBI diagnosis from September 2020 notes that further evaluation and treatment for the TBI is not indicated. The symptoms of residuals are more likely indicated to be the result of other comorbidities rather than the remote TBI reported. The highly probative VA examination accounted for the medical records indicated and was persuasive in its rationale that continuing symptoms are not present. Similarly, the treatment records themselves indicate that continuing symptoms are not attributable to a TBI. Therefore, the diagnosis contained in the VA treatment records is found to be of low probative value as it relates to the presence of a current disability.

In weighing the evidence of record concerning a current diagnosis of a TBI, the highly probative VA examination did not endorse a current diagnosis. The VA treatment records previously contained an earlier in time diagnosis but were found to be of low probative value concerning the presence of a current diagnosis. The evidence of record therefore persuasively weighs against a finding that the Veteran has a current diagnosis of a TBI. Without a finding of a current diagnosis, a claim for service connection cannot be supported.

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service for a TBI is warranted. Rather, the evidence persuasively weighs against entitlement to service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. 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). The appeal is hereby DENIED.

4. Entitlement to service connection for GERD is denied.

The Veteran asserts entitlement to service connection for GERD. The Board finds that as the Veteran's OSA did not have its onset during service, or is otherwise related to an in-service incurrence, service connection is not warranted for the condition.

As to the first element of direct service connection, the AOJ has made a favorable finding that the Veteran has a current diagnosis of GERD, and that element is conceded here.

As to the second element of an in-service incurrence, the Veteran asserts on his claim form that his OSA had its onset during service.

There still must be found a nexus, or link between the in-service incurrence and the current disability. There is one medical opinion in the evidence of record
denied.

As to the first element of direct service connection, the AOJ has made a favorable finding that the Veteran has a current diagnosis of GERD, and that element is conceded here.

As to the second element of an in-service incurrence, the Veteran asserts on his claim form that his OSA had its onset during service.

The Veteran attended a VA examination in September 2020. The examiner concluded that it was less likely than not that the Veteran's GERD had its onset during service. The rationale offered to support this conclusion was that the service treatment records did not show any diagnosis, treatment, or complaints of GERD. The Veteran also reported at his separation physical that he did not have any gastrointestinal conditions. The examiner is deemed to be competent and credible to offer such an opinion, and it is assigned high probative value.

There are no other medical opinions in the evidence of record which endorse a nexus. As such, the evidence of record persuasively weighs against a finding that there is a nexus between the asserted onset of GERD during service and the Veteran's current diagnosis. Without a finding of a nexus a claim for direct service connection cannot be supported.

The Veteran was also evaluated as to whether his GERD may be presumptively be service connected due to Southwest Asia service. However, GERD is not a MUCMI for purposes of this presumption, as it is a structural gastrointestinal disorder rather than a functional gastrointestinal disorder. 38 C.F.R. § 3.317 (a)(2)(i)(B)(3); Atencio v. O'Rourke, 30 Vet. App. 74, 80-82 (2018).

In a brief submitted after the hearing withdrawal the Veteran's representative asserts that the Veteran's GERD is secondary to the Veteran's service-connected PTSD.

Here, the Board finds that secondary service connection for GERD as due to PTSD is not reasonably raised by the record. The Veteran attended a VA examination to assess service connection for the condition and did not raise the theory of entitlement at the examination. As GERD is a gastrointestinal disorder and PTSD a mental disorder, there is not an immediate and logical link between the conditions such that secondary service connection would be obviously indicated.

The first contention of the conditions being related was raised in the brief offered by the Veteran's representative during the evidentiary window following withdrawal of the hearing. As this assertion was not part of the record before
Healey v. McDonough, 33 Vet. App. 312, 319 (2021).

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for GERD is warranted. Rather, the evidence persuasively weighs against entitlement to service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. 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). The appeal is hereby DENIED.

5. Entitlement to service connection for CFS is denied.

The Veteran asserts service connection for CFS. The Board finds that as the evidence of record persuasively weighs against a finding that the Veteran has a current diagnosis of CFS, service connection is not warranted.

The first element of service connection requires a finding of a current disability.

The Veteran attended a September 2020 VA examination to assess service connection for CFS. The examiner opined that the Veteran did not have a current diagnosis of a CFS. The examiner found that the Veteran did not have any symptoms attributable to CFS and had normal physical findings other than those other conditions evaluated. The examiner is found to be competent and credible to offer such a diagnosis, and it is assigned high probative value.

No other medical opinions provide a diagnosis of CFS or present an analysis of attributable symptoms that indicate an undiagnosed illness or MUCMI.

In weighing the evidence of record concerning a current diagnosis of CFS, the highly probative VA examination did not endorse a current diagnosis. Without a finding of a current diagnosis, a claim for service connection cannot be supported.

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service for CFS is warranted. Rather, the evidence persuasively weighs against entitlement to service connection. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. 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). The appeal is hereby DENIED.

6. Entitlement to a rating in excess of 50 percent for PTSD is denied.

The Veteran asserts entitlement to a rating in excess of 50 percent for PTSD. The Board finds that as the Veteran's PTSD did not cause social and occupational impairment with deficiencies in most areas or total occupational and social impairment, a higher rating is not warranted.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more nearly approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38
; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Diagnostic Code 9411 for PTSD is rated under the General Rating Formula for Mental Disorders, which states in pertinent part:

A 30 percent rating is assigned when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of ability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name.

The is one examination during the rating period on appeal which addresses the level of disability experienced by the Veteran.

The Veteran attended a July 2020 VA examination. The examiner endorsed that the Veteran experienced the symptoms of depressed mood, anxiety, suspiciousness, weekly or less often panic attacks, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances including work or work like setting. This led the examiner to conclude that the overall level of social and occupational impairment caused by the Veteran's symptoms was that of occupational and social impairment with reduced reliability and productivity. While it is ultimately the duty of the Board as fact finder to determine the level of disability caused by the Veteran's condition, the examiner's opinion is nevertheless found to be highly probative of the issue. The examiner is found to be competent and credible to report the symptoms experienced by the Veteran and the examination is assigned high probative value.

The Veteran's representative advances the argument that a note from the Veteran's treatment records indicates that the Veteran's mental health provider indicated that the Veteran exhibited suicidal tendencies. This is based on a boilerplate comment that suicide risk should be regularly reevaluated. The actual content of the treatment note does not endorse any suicidal ideation or past suicide attempts. The Veteran was regularly reported to have no suicide risk at future evaluations. Therefore, this note is not found to be probative of indicating suicidal ideation for rating purposes.

In weighing the highly probative evidence of record concerning the mental health symptoms experienced by the Veteran, the symptoms of depressed mood, anxiety, suspiciousness, weekly or less often panic attacks, chronic sleep impairment, and mild memory loss are indicative of a 30 percent rating. The symptoms of disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships are indicative of a 50 percent rating. The symptom of difficulty in adapting to stressful circumstances including work or work like setting. The majority
not endorse any suicidal ideation or past suicide attempts. The Veteran was regularly reported to have no suicide risk at future evaluations. Therefore, this note is not found to be probative of indicating suicidal ideation for rating purposes.

In weighing the highly probative evidence of record concerning the mental health symptoms experienced by the Veteran, the symptoms of depressed mood, anxiety, suspiciousness, weekly or less often panic attacks, chronic sleep impairment, and mild memory loss are indicative of a 30 percent rating. The symptoms of disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships are indicative of a 50 percent rating. The symptom of difficulty in adapting to stressful circumstances including work or work like setting. The majority of symptoms indicate that the Veteran experiences symptoms exemplary of either a 30 or 50 percent rating with only a single symptom relevant to a 70 percent rating being reported. No symptoms of indicative of a 100 percent rating were found. The highly probative conclusion of the examiner endorsed a 50 percent rating as well. The evidence of record therefore persuasively weighs in favor of a finding that the Veteran's symptoms most closely approximate those of a 50 percent rating rather than a 70 or 100 percent rating.

For the above reasons, the Board finds that the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to a rating in excess of 50 percent for PTSD is warranted. Rather, the evidence persuasively weighs against entitlement to a higher rating. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. 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). The appeal is hereby DENIED.

7. The claim for entitlement to service connection for asthma has been withdrawn. The appeal is dismissed.

8. The claim for entitlement to service connection for attention deficit disorder has been withdrawn. The appeal is dismissed.

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205.

In the present case the Veteran's representative submitted a July 26, 2024, communication that stated the appeals for attention deficit disorder and asthma were withdrawn.

Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.205. In the present case, the appellant's representative has withdrawn this appeal and, hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review this appeal, and it is hereby DISMISSED.

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Arner, Jonathan T.

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.

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