POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, an Army Veteran who served from April 2007 to June 2008, including service in Iraq, appeals the denial of service connection for an acquired psychiatric disorder (PTSD), migraine headaches, sleep apnea, cervical spine disorder, lumbar spine disorder, and bilateral ankle disorders. The Board granted service connection for an acquired psychiatric disorder, including PTSD, finding the Veteran's claimed stressor in Iraq was corroborated and consistent with service. The Board found the private medical opinion diagnosing PTSD to be highly probative, while the VA examiner's opinion was deemed conclusory and lacking in rationale. The claims for migraine headaches, sleep apnea, cervical and lumbar spine disorders, and bilateral ankle disorders were remanded for additional development. The migraine claim was remanded for a new VA examination to assess severity without medication's ameliorating effects. The sleep apnea claim was remanded due to a duty to assist error, requiring a VA examination considering toxic exposure risk activities (TERA) and the Veteran's reported sleep difficulties. The spine and ankle claims were remanded because the existing VA medical opinions failed to consider the Veteran's specific theories of service connection, including in-service strain and a specific injury during a tank incident in Iraq, and the private chiropractor's opinion lacked sufficient rationale. The Board noted the Veteran's service treatment records were silent regarding some of these conditions, but this silence alone would not be a basis for denial if continuity of symptoms or other evidence supported service connection.

Rationale

Credible private opinion diagnosed PTSD and linked it to in-service stressor.; VA examiner's opinion lacked rationale and was conclusory.; Stressor in Iraq was corroborated and consistent with service.

Full Decision Text

Citation Nr: A26027554
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 251114-607053
DATE: March 26, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted.

REMANDED

Entitlement to an initial disability rating higher than 30 percent for migraine headaches is remanded.

Entitlement to service connection for sleep apnea is remanded.

Entitlement to service connection for a cervical spine disability is remanded.

Entitlement to service connection for a lumbar spine disability is remanded.

Entitlement to service connection for a left ankle disability is remanded.

Entitlement to service connection for a right ankle disability is remanded.

FINDING OF FACT

The Veteran has an acquired psychiatric disorder, including PTSD, that is related to a corroborated in-service stressor.

CONCLUSION OF LAW

The criteria for entitlement to service connection for an acquired psychiatric disorder, including PTSD, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3,304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from April 2007 to June 2008. He served in Iraq and received the Meritorious Service Medal among other awards and decorations. He had additional service in the United States Army Reserve, including a period of active duty for training from September to November 2004.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2024 by a Department of Veterans Affairs (VA) Regional Office, which serves as the Agency of Original Jurisdiction (AOJ). In November 2025, the Veteran timely appealed the December 2024 rating decision by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182). He selected the evidence submission docket.

Therefore, the Board may only consider the evidence of record at the time of the December 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. However, based on the evidence the Board may consider, service connection for a psychiatric disorder, namely PTSD, is awarded herein, which is a full grant of the related benefit sought on appeal.  Further, with regard to the claims remanded by the Board, any evidence the Board could not consider will be considered by the AOJ in the adjudication of such claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to service connection for an acquired psychiatric disorder.

The Veteran is seeking service connection for an acquired psychiatric disorder, to include PTSD, which he attributes to stressors that occurred during active service.

In his March 2024 claim for service connection, the Veteran listed anxiety, insomnia, and PTSD as separate disabilities, and the December 2024 rating decision denied service connection for those disabilities individually. As will be explained further below, a private examiner diagnosed the Veteran with PTSD and noted the symptoms include anxiety and sleep disturbances. Accordingly, the Board has recharacterized the matter as entitlement to service connection for an acquired psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App.
 a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) [(table)].

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a), which requires a diagnosis that conforms to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a link, established by medical evidence between current symptoms and an in-service stressor, and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails.  Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other.  Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

In the December 2024 rating decision, the AOJ made the favorably found the Veteran experienced his claimed stressor of experiencing insurgent attacks, both direct and indirect, in Iraq. The Board finds the claimed stressor is consistent with the place, type, and circumstances of the Veteran's ten-month period of service in Iraq, and given that there is no evidence of record contradicting the Veteran's reports, the Board will not disturb the AOJ's finding. 

Accordingly, the remaining question is whether the Veteran has a current diagnosis of PTSD etiologically related to the in-service stressor.

The Veteran was provided VA PTSD and mental disorders examinations in August 2024. The examiner did not diagnose PTSD or any other mental disorder after finding the Veteran did not have any symptoms of such disabilities.  

In January 2026, the Veteran submitted a November 2025 non-VA examination report and medical opinion. After a review of the medical evidence and interview of the Veteran, the psychologist diagnosed PTSD opined it was most likely caused by the Veteran's reported experiences in Iraq. Significantly, the examiner summarized the Veteran's reported experiences and current symptoms, including hypervigilance, anxiety, and sleep difficulties, in detail. The Veteran's spouse was also present during the evaluation and reported she witnessed him experience his described symptoms. The examiner noted the Veteran's responses indicated "significant and pervasive emotional distress."

The United States Court of Appeals for Veterans Claims (Court) has stated that the probative value of a medical opinion is based on the expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. Further, the credibility and weight to be attached to these opinions are within the province of the adjudicator. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). As such, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).

The Board finds the November 2025 private examination report and opinion to be highly probative. The examiner's report shows she performed a thorough evaluation and based the PTSD diagnosis on the Veteran's claimed stressor, which VA concedes occurred, and in-depth interviews with the Veteran and his spouse. The examiner also explained the symptoms the Veteran experiences in detail. In sum, the opinion is well-considered and supported by the examiner's report.

Conversely, the Board finds the August 2024 VA examiner's opinion that the Veteran does not have PTSD or symptoms of any
. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001).

The Board finds the November 2025 private examination report and opinion to be highly probative. The examiner's report shows she performed a thorough evaluation and based the PTSD diagnosis on the Veteran's claimed stressor, which VA concedes occurred, and in-depth interviews with the Veteran and his spouse. The examiner also explained the symptoms the Veteran experiences in detail. In sum, the opinion is well-considered and supported by the examiner's report.

Conversely, the Board finds the August 2024 VA examiner's opinion that the Veteran does not have PTSD or symptoms of any acquired psychiatric disorder is of limited probative value. Significantly, the examiner failed to explain the significance of the Veteran's reported symptoms in her determination that he did not experience any symptoms associated with a mental disorder. In other words, the examiner's opinion was conclusory and unaccompanied by a sufficient explanation of rationale. It is therefore of limited probative value.

For these reasons, the Board finds the probative evidence persuasively demonstrates the Veteran's diagnosed PTSD is related to an in-service stressor that credible evidence supports occurred. Accordingly, service connection for an acquired psychiatric disorder, including PTSD, is warranted.  

REASONS FOR REMAND

2. Entitlement to an initial disability rating higher than 30 percent for migraine headaches.

The Veteran is seeking a higher initial disability rating for his service-connected migraine headaches.  

The Veteran's headaches are rated under DC 8100, for migraines. When applying rating criteria that do not expressly account for medication, such as DC 8100, the Board must rate the disability based on the symptoms without the ameliorating effects of any medication taken. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012): Ingram v. Collins, 38 Vet. App. 130 (2025).

The Veteran was provided a VA headaches examination in November 2024. The examiner found the Veteran experienced prostrating attacks of headache pain once every month and indicated he was prescribed pain medication, including ibuprofen and Tylenol, for the migraine headaches.

Unfortunately, the examination is inadequate for adjudication purposes. The exam fails to account for the severity of the Veteran's current headache symptoms after discounting any ameliorating effects of the medication the Veteran uses to alleviate his symptoms. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). The examiner noted the Veteran was prescribed ibuprofen and Tylenol for his migraine headaches, but did not address the severity, frequency, and duration of the Veteran's symptoms without consideration of any beneficial effects of the medication. 

Therefore, the Boards a new VA examination is warranted to adequately evaluate the severity of the Veteran's headaches without the ameliorating effects of any medication before the claim be adjudicated on its merits. 38 U.S.C. § 5103A. 

3. Entitlement to service connection for sleep apnea.

The Veteran is seeking service connection for sleep apnea, which he asserts manifested during service.  

Unfortunately, the issue of entitlement to service connection for the claimed sleep apnea must be remanded to correct a pre-decisional duty to assist error. The Veteran has not yet been afforded a VA examination in connection with his claim seeking service connection for obstructive sleep apnea.

When an examination not been obtained by the AOJ, the VA must obtain an examination when there is, 1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; 2) evidence of an in-service event, injury, or disease; 3) an indication that the current disability may be associated with the in-service event (or to an already service-connected disability); and 4) there is otherwise insufficient evidence to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 80-81 (2006).

An April 2008 post-deployment health assessment shows the Veteran affirmed he still felt tired after sleeping during his deployment to Iraq. As noted above, he was provided a VA PTSD examination in August 2024. While the examiner did not diagnose a mental disorder, she noted the Veteran reported symptoms were possible symptoms of sleep apnea. 

The Board notes that in January 2026, the Veteran submitted a November 2025 examination report and opinion from a private chiropractor. She, Dr. M.T., provisionally diagnosed obstructive sleep apnea and opined it manifested during the Veteran's active service based on the Veteran's reported history and symptoms. Significantly, however, she noted a sleep study to confirm the diagnosis had not been performed.  

Given the Veteran's report of sleep difficulties during service and the August
 still felt tired after sleeping during his deployment to Iraq. As noted above, he was provided a VA PTSD examination in August 2024. While the examiner did not diagnose a mental disorder, she noted the Veteran reported symptoms were possible symptoms of sleep apnea. 

The Board notes that in January 2026, the Veteran submitted a November 2025 examination report and opinion from a private chiropractor. She, Dr. M.T., provisionally diagnosed obstructive sleep apnea and opined it manifested during the Veteran's active service based on the Veteran's reported history and symptoms. Significantly, however, she noted a sleep study to confirm the diagnosis had not been performed.  

Given the Veteran's report of sleep difficulties during service and the August 2024 VA examiner's opinion that the Veteran had possible symptoms of sleep apnea, the Board finds remand is warranted to provide the Veteran a VA examination for his claimed sleep apnea.

In addition, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act provides that, when a veteran submits a claim for compensation with evidence of a disability and evidence of a TERA during active military service and such evidence is not sufficient to establish service connection for the disability, VA shall provide the veteran with a medical examination and obtain a medical opinion as to whether there is a nexus between the disability and the toxic exposure risk activity. See 38 U.S.C. § 1168. The PACT Act further provides that, when providing a medical opinion under this provision, the health care provider shall consider the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. Id.

April 2024 and July 2024 memoranda show the Veteran participated in TERA. Accordingly, the VA examiner should provide an opinion on whether there is a nexus between the claimed sleep and the toxic exposure risk activity.

4. Entitlement to service connection for a cervical spine disorder.

5. Entitlement to service connection for a lumbar spine disorder.

The Veteran is seeking service connection for his currently diagnosed cervical and lumbar spine disorders on the premise that he developed these disorders as a result of the cumulative effect of the strain placed on his spine when performing training and other service related duties while wearing over 40 pounds of protective gear and/or as a result of an injury sustained during his deployment to Iraq in which his body was jarred when the military tank in which he was being transported fell into a significant pothole in an unpaved road.  

However, the VA medical opinions of record at the time of the issuance of the AOJ decision on appeal, obtained in conjunction with the November 2024 VA cervical and lumbar spine examinations, do not consider the Veteran's reported in-service injury nor his theory that his spinal disorders resulted from strain incurred during service.  As such, the medical opinions are not predicated on consideration of a complete medical history, and new medical opinions must be obtained considering this relevant evidence of record.  See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). 

Likewise, the November 2025 private chiropractor's opinion likewise does not specifically consider the Veteran's reports of in-service strain and injury, but rather broadly concluded the Veteran's spinal disabilities are symptomatic of Gulf War syndrome, without providing any kind of cogent rationale or squaring this seeming reference to Gulf War undiagnosed illnesses with the fact that the veteran is affirmatively diagnosed with specific cervical and lumbar spine disabilities. As such, this opinion cannot be used to establish service connection, and the claims must be remanded to cure the pre-decisional duty to assist error with regard to obtaining adequate VA medical opinions.

6. Entitlement to service connection for a left ankle disorder.

7. Entitlement to service connection for a right ankle disorder.

The Veteran is seeking service connection for his current bilateral ankle disorders, diagnosed during a November 2024 VA ankle examination as bilateral ankle strains, on the premise that he developed these impairments as a result of the cumulative impact of his in-service physical training and service-related duties. However, the AOJ denied the Veteran's claims relying on the November 2024 VA medical opinion addressing the etiology of the Veteran's bilateral ankle disorders, which does not consider the Veteran's theory of service connection, but rather vaguely states that the Veteran's ankle disorders are of a common variety frequently linked to physical activity. Given the inadequacy of this rationale and its failure to address whether the physical activity referenced by the VA examiner included the Veteran's in-service activities, the Board finds that the medical opinion is legally insufficient to decide the claim. See Barr v. Nicholson, 21 Vet. App.
, on the premise that he developed these impairments as a result of the cumulative impact of his in-service physical training and service-related duties. However, the AOJ denied the Veteran's claims relying on the November 2024 VA medical opinion addressing the etiology of the Veteran's bilateral ankle disorders, which does not consider the Veteran's theory of service connection, but rather vaguely states that the Veteran's ankle disorders are of a common variety frequently linked to physical activity. Given the inadequacy of this rationale and its failure to address whether the physical activity referenced by the VA examiner included the Veteran's in-service activities, the Board finds that the medical opinion is legally insufficient to decide the claim. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Accordingly, a new medical opinion must be obtained to correct this pre-decisional duty to assist error.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected migraine headache disorder. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  

In this regard, the examiner should offer an opinion as to the functional impairment associated with headache episodes without consideration of the beneficial effects of medication.

2. Schedule the Veteran for an appropriate toxic exposure risk activity examination to determine the nature and etiology of the claimed sleep apnea.

If no sleep study has been conducted, such should be scheduled.

The clinician should be advised of all toxic exposure risk activities that the Veteran is known to have engaged in during his military service and the condition(s) for which service connection is being sought. After reviewing the file, the examiner should address the following:

(a) Identify any current respiratory disabilities, to include sleep apnea.

(b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the any such respiratory disability, including sleep apnea, is related to service, including his toxic exposure risk activity and complaints of sleep difficulties therein?

The opinion must address "the synergistic, combined effect of all toxic exposure risk activities of the veteran." See 38 U.S.C. § 1168(a)(2)(B).

The examiner should provide a complete rationale for any opinion provided. If the examiner cannot provide any requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation.

A rationale for any opinion offered must be provided.

3. Forward the record, to include a copy of this remand, to an appropriate VA examiner to obtain an addendum opinion addressing the etiology of the Veteran's cervical and lumbar spine disabilities. 

Following a full review of the record, the examiner should opine wither it is at least as likely as not that the Veteran's currently diagnosed cervical strain, segmental and somatic dysfunction of cervical region, lumbosacral strain, bilateral lower extremity lumbar radiculopathy, and segmental and somatic dysfunction of lumbar region, had their onset in, or are otherwise related to the Veteran's periods of ACDUTRA/active service, to include his assertion that such disorders resulted from an injury sustained when a tank in which he was traveling hit a significant pot hole on an unpaved road, jarring him significantly, and as a result of the cumulative strain from performing his training exercises and duties, all while wearing over 40 pounds of protective gear, in addition to carrying weapons.

The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran's service treatment records are silent as to a specific diagnosis of neck or back disorders, unless it is determined that such diagnoses were definitively ruled out, or the lack of post-service treatment records demonstrating a continuity of care. In seeking such opinion, the Board makes no determination as to the credibility of the Veteran's reports regarding the onset of symptomatology, or the continuity thereof.

A rationale for any opinion offered must be provided.

4. Forward the record, to include a copy of this remand, to an appropriate VA examiner so as to obtain an addendum opinion addressing the etiology of the Veteran's bilateral ankle disorders. 

Following a full review of the record, the examiner should opine wither it is at least as likely as not that the Veteran's currently diagnosed bilateral ankle strains had their onset in, or are otherwise related to the Veteran's periods of ACDUTRA/active service, to include his assertion that such disorders resulted from the cumulative strain from performing his training exercises and duties, all while wearing over 40 pounds of protective gear, in
 regarding the onset of symptomatology, or the continuity thereof.

A rationale for any opinion offered must be provided.

4. Forward the record, to include a copy of this remand, to an appropriate VA examiner so as to obtain an addendum opinion addressing the etiology of the Veteran's bilateral ankle disorders. 

Following a full review of the record, the examiner should opine wither it is at least as likely as not that the Veteran's currently diagnosed bilateral ankle strains had their onset in, or are otherwise related to the Veteran's periods of ACDUTRA/active service, to include his assertion that such disorders resulted from the cumulative strain from performing his training exercises and duties, all while wearing over 40 pounds of protective gear, in addition to carrying weapons.

The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran's service treatment records are silent as to a specific diagnosis of ankle disorders, unless it is determined that such diagnoses were definitively ruled out, or the lack of post-service treatment records demonstrating a continuity of care. In seeking such opinion, the Board makes no determination as to the credibility of the Veteran's reports regarding the onset of symptomatology, or the continuity thereof.

A rationale for any opinion offered must be provided.

 

 

William Skowronski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Northcutt

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.