POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served from December 1966 to November 1969, appeals the denial of increased disability evaluations for his service-connected unspecified trauma and stressor related disorder with unspecified depressive disorder, coronary artery bypass graft surgery due to coronary artery disease, and bilateral psychogenic myoclonus. The Board denied the claim for an increased evaluation for the psychiatric disorder, finding the veteran's symptoms and impairment consistent with the current 70 percent rating, not the 100 percent criteria, noting his ability to maintain relationships and his retired status. For the coronary artery disease claim, the Board denied an increased evaluation, finding the veteran's reported METs level and lack of acute heart failure episodes did not meet the criteria for a higher rating, and that his claim was filed more than three months post-surgery. The Board remanded claims for increased evaluations of bilateral upper and lower extremity psychogenic myoclonus, as the VA examiner did not provide findings pertinent to the relevant peripheral nerve rating criteria. Additionally, the Board remanded the issues of entitlement to an earlier effective date for TDIU and entitlement to special monthly compensation (SMC) due to conflicting information in the record regarding SMC grant status and the need for further clarification on TDIU's impact on SMC. The Board noted the veteran's current 70% rating for the psychiatric disorder and 60% for the heart condition, and that the myoclonus conditions were rated at 40%, 30%, 20%, and 20% respectively.

Rationale

Symptoms did not meet 100% criteria for total occupational/social impairment; Examiner found occupational and social impairment commensurate with 70% rating; Veteran maintained relationships and was retired

Full Decision Text

Citation Nr: A26018148
Decision Date: 02/27/26	Archive Date: 02/27/26

DOCKET NO. 250909-585026
DATE: February 27, 2026

ORDER

Entitlement to an evaluation in excess of 70 percent for an unspecified trauma and stressor related disorder with unspecified depressive disorder is denied.

Entitlement to an evaluation in excess of 60 percent for coronary artery bypass graft surgery due to coronary artery disease is denied.

REMANDED

Entitlement to an evaluation in excess of 40 percent for right upper extremity psychogenic myoclonus is remanded.

Entitlement to an evaluation in excess of 30 percent for left upper extremity psychogenic myoclonus is remanded.

Entitlement to an evaluation in excess of 20 percent for right lower extremity psychogenic myoclonus is remanded.

Entitlement to an evaluation in excess of 20 percent for left lower extremity psychogenic myoclonus is remanded.

Entitlement to an effective date of April 25, 2016, for the grant of a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded.

Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance is remanded.

FINDINGS OF FACT

1.  The Veteran's service-connected unspecified trauma and stressor related disorder with unspecified depressive disorder has not been productive of total occupational and social impairment.

2.  The Veteran's service-connected coronary artery bypass graft surgery due to coronary artery disease has not been productive of chronic congestive heart failure; a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness or syncope or heart failure symptoms; or, left ventricular dysfunction with an ejection fraction of less than 30 percent.

CONCLUSIONS OF LAW

1.  The criteria for an evaluation in excess of 70 percent for an unspecified trauma and stressor related disorder with unspecified depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.130, Diagnostic Code 9400.

2.  The criteria for an evaluation in excess of 60 percent for coronary artery bypass graft surgery due to coronary artery disease have not been met. 38 C.F.R. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.104, Diagnostic Code 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1966 to November 1969.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2024 rating decision.

The Veteran submitted a VA Form 10182 in September 2025 and elected the direct review docket.  Therefore, the Board may only consider the evidence of record at the time of the September 2024 rating decision. 38 C.F.R. § 20.301.  If any evidence was submitted during the period after the AOJ issued the September 2024 rating decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.  

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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 addressing 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.  However, because the Board is remanding some of the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

Neither the Veteran nor his representative has raised any issues with the pre-decisional duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir.
 the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

Neither the Veteran nor his representative has raised any issues with the pre-decisional duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4.  The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service.  The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7.

In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41.  Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).  While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125- 26 (1999).  Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007); Fenderson, 12 Vet. App. at 126- 27.

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits.  VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

Psychiatric Disorder

The Veteran is currently assigned a 70 percent evaluation for his service-connected unspecified trauma and stressor related disorder with unspecified depressive disorder, pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9400.

Under Diagnostic Code 9400, a 70 percent evaluation is assigned when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); and an inability to establish and maintain
, Diagnostic Code 9400.

Under Diagnostic Code 9400, a 70 percent evaluation is assigned when the psychiatric disorder results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); and an inability to establish and maintain effective relationships.

A 100 percent evaluation is warranted when the psychiatric disorder results in 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; and memory loss for names of close relatives, own occupation, or own name.

The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002).  It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id.  The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Id.

In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration."  It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas."

In considering the evidence of record under the laws and regulations as set forth, the Board finds that the Veteran is not entitled to an evaluation in excess of 70 percent for his service-connected unspecified trauma and stressor related disorder with unspecified depressive disorder.

During the appeal period, the evidence does not show that the Veteran has had 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.  In fact, an August 2024 VA examiner indicated that he was polite, open, and cooperative and had good hygiene and grooming.  It was noted that the Veteran's speech and thought processes were slow as he formed thoughts and sentences, but that he was able to converse appropriately.  He also denied having suicidal and homicidal, ideation, and he did not appear to be responding to internal stimuli. 

Moreover, the August 2024 VA examiner did not find the Veteran to have any of the aforementioned symptoms contemplated in the rating criteria for a 100 percent evaluation.  The VA examiner concluded that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.  Such a finding is commensurate with the currently assigned 70 percent evaluation.

To the extent that any of the symptoms contemplated in the rating criteria for a 100 percent evaluation may be shown or argued, the Board finds that the Veteran's unspecified trauma and stressor related disorder with unspecified depressive disorder is not productive of total occupational and social impairment.  The Board emphasizes that a 100 percent disability evaluation requires both total social and occupational impairment. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met
 any of the symptoms contemplated in the rating criteria for a 100 percent evaluation may be shown or argued, the Board finds that the Veteran's unspecified trauma and stressor related disorder with unspecified depressive disorder is not productive of total occupational and social impairment.  The Board emphasizes that a 100 percent disability evaluation requires both total social and occupational impairment. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met); cf. Johnson v. Brown, 7 Vet. App. 95 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned).

With regard to social impairment, the August 2024 VA examiner noted that the Veteran reported living with his wife, who is his caregiver.  The evidence also shows that they have been married for over 50 years.  In a March 2024 statement, the Veteran's wife indicated that his son and granddaughter lived nearby and that they also care for the Veteran.  Thus, it cannot be said that he has total social impairment, as the evidence indicates that he has been able to maintain relationships.

With regard to occupational impairment, the August 2024 VA examiner noted that the Veteran is retired.

After considering the evidence of record, the Board finds that the symptoms of the Veteran's unspecified trauma and stressor related disorder with unspecified depressive disorder and resulting impairment more closely approximate the criteria for a 70 percent evaluation throughout the appeal.  Overall, the Veteran has not demonstrated a level of impairment consistent with the 100 percent criteria, nor have the Veteran's symptoms caused total occupational and social functioning required by the 100 percent evaluation criteria. Mauerhan, supra, Vazquez-Claudio, supra.  The criteria for the next higher rating of 100 percent have not been met or approximated for this time period. See 38 C.F.R. § 4.130, Diagnostic Code 9400.  Therefore, the Board finds that the Veteran's unspecified trauma and stressor related disorder with unspecified depressive disorder does not warrant an evaluation in excess of 70 percent at any time during the appeal period.

Coronary Artery Disease

The Veteran is currently assigned a 60 percent evaluation for his service-connected coronary artery bypass graft surgery due to coronary artery disease, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7005.

Under Diagnostic Code 7005, arteriosclerotic heart disease (coronary artery disease) is evaluated under the General Rating Formula for Disease of the Heart.

Under the General Rating Formula, a 60 percent evaluation is assigned when a workload of 3.1-5.0 METs results in heart failure symptoms, and a 100 percent evaluation is warranted when a workload of 3.0 METs or less results in heart failure symptoms.

One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute.  When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms. 38 C.F.R. § 4.014, Note 2.

Heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.014, Note 3.

Diagnostic Code 7017 also provides that a 100 percent evaluation will be assigned for coronary bypass surgery for three month following hospital admission for the surgery.  Thereafter, the disability is evaluated under the General Rating Formula.

In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to an increased evaluation for his service-connected coronary artery bypass graft surgery due to coronary artery disease.

An August 2024 VA examiner noted the Veteran's report that, following his 2014 coronary artery bypass graft surgery, his fatigue improved but did not fully resolve.  In an interview-based METs test, the Veteran described experiencing breathlessness, fatigue, and dizziness with physical activities greater than 3-5 METs.  The examination report indicated that this METs level has been found to be consistent with activities such as light yard work (weeding), mowing the lawn (with a power mower), and brisk walking (four miles per hour). 
 laws and regulations as set forth above, the Board finds that the Veteran is not entitled to an increased evaluation for his service-connected coronary artery bypass graft surgery due to coronary artery disease.

An August 2024 VA examiner noted the Veteran's report that, following his 2014 coronary artery bypass graft surgery, his fatigue improved but did not fully resolve.  In an interview-based METs test, the Veteran described experiencing breathlessness, fatigue, and dizziness with physical activities greater than 3-5 METs.  The examination report indicated that this METs level has been found to be consistent with activities such as light yard work (weeding), mowing the lawn (with a power mower), and brisk walking (four miles per hour).  A physical examination also revealed that the Veteran was in no acute distress and that there were no signs of malaise present.  An echocardiogram revealed a left ventricular ejection fraction (LVEF) of 55 to 60 percent.  In the remarks section of the examination report, the examiner further noted that the Veteran has chronic congestive heart failure, but he has not had any episodes of acute congestive heart failure in the past year.

Based on the foregoing, the evidence does not show that an evaluation in excess of 60 percent is warranted during the appeal period.  The evidence does not show that the Veteran has a workload of 3.0 METs or less resulting in heart failure symptoms.  He also filed his claim more than three months following the hospital admission for his coronary bypass surgery.  Therefore, the Board finds that an increased evaluation is not warranted for the Veteran's service-connected coronary artery bypass graft surgery due to coronary artery disease.

Conclusion

Neither the Veteran nor his representative has raised any other issues with regard to the increased evaluation claims, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

REASONS FOR REMAND

Upon review, the Board finds that a remand is needed to correct a pre-decisional duty to assist error for the remaining issues on appeal.

The Veteran is currently assigned a 40 percent evaluation for his service-connected right upper extremity psychogenic myoclonus and a 30 percent evaluation for his service-connected left upper extremity psychogenic myoclonus, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8513.  In addition, he is currently assigned separate 20 percent evaluations for his service-connected right and lower extremity psychogenic myoclonus, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520.

In the September 2024 rating decision on appeal, the agency of original jurisdiction (AOJ) denied the Veteran's claims for increased evaluations for his bilateral upper and lower extremity disabilities based on the rating criteria for diseases of the peripheral nerves. See 38 C.F.R. § 4.124a.  However, a review of the evidence shows that the Veteran was afforded a VA examination in August 2024 in which the examiner completed a VA central nervous system and neuromuscular diseases disability benefits questionnaire (DBQ).  In that report, the VA examiner did not provide findings pertinent to the rating criteria for peripheral nerves.  Thus, the AOJ should have obtained a VA peripheral nerves examination to address the relevant rating criteria.

The Board also finds that the issue of entitlement to and earlier effective date for the grant of TDIU and the issue of entitlement to SMC are inextricably intertwined with the increased rating claims being remanded herein.

In remanding the TDIU issue, the Board notes that the Veteran is currently assigned a combined 100 percent schedular evaluation for his service-connected disabilities since January 13, 2014.  However, the presence of a schedular 100 percent disability rating does not necessarily render the issue of TDIU moot. See Bradley v. Peake, 22 Vet. App. 280, 293-94 (2008) (holding that 100 percent evaluation does not render a TDIU claim moot where there is a possibility that TDIU will impact entitlement to special monthly compensation (SMC) based on receipt of service connection for a disability with a 100 percent rating and another with a separate 60 percent rating).  Therefore, if the Veteran is entitled to TDIU based on a single disability prior to April 25, 2016 (excluding the period from January 13, 2014, to April 1, 2024, for which he has already been granted SMC), he could meet the criteria for a SMC
 v. Peake, 22 Vet. App. 280, 293-94 (2008) (holding that 100 percent evaluation does not render a TDIU claim moot where there is a possibility that TDIU will impact entitlement to special monthly compensation (SMC) based on receipt of service connection for a disability with a 100 percent rating and another with a separate 60 percent rating).  Therefore, if the Veteran is entitled to TDIU based on a single disability prior to April 25, 2016 (excluding the period from January 13, 2014, to April 1, 2024, for which he has already been granted SMC), he could meet the criteria for a SMC based on statutory housebound status if he has another separate disability rated at 60 percent or more.

In addition, the Board finds that clarification is needed, as the September 2024 rating decision denied entitlement to SMC based on the need for regular aid and attendance, whereas the corresponding rating codesheet indicates that the benefit has been granted since March 25, 2024.

The matters are REMANDED for the following action:

1.  The AOJ should clarify whether the Veteran has been granted SMC based on the need for regular aid and attendance.  In this regard, the September 2024 rating decision shows that the benefit was denied, yet the corresponding rating codesheet indicates that the benefit has been granted since March 25, 2024

2.  The Veteran should be afforded a VA examination to ascertain the severity and manifestations of his service-connected right and left upper and lower extremity psychogenic myoclonus.

The examiner is requested to review all pertinent records associated with the claims file.

It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

The examiner should report all signs and symptoms necessary for evaluating the Veteran's bilateral upper and lower extremity disabilities under the rating criteria.  In particular, the examiner should identify and discuss the severity of any neurologic abnormalities and symptoms associated with his service-connected psychogenic myoclonus.  In so doing, he or she should identify the nerve or nerves affected by the psychogenic myoclonus and indicate whether there is mild, moderate, moderately severe, or severe incomplete paralysis.  He or she should also indicate whether there is marked muscular atrophy or whether there is complete paralysis where the foot dangles and drops with no active movement possible of the muscles below the knee and flexion of the knee weakened or lost.

The examiner should identify and describe any additional manifestations associated with the service-connected disabilities.

A clear rationale should be provided for all opinions.

 

 

J.W. ZISSIMOS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Osegueda, 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.