SOMATIC SYMPTOM DISORDER

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26031274

MIXED

Summary

The Veteran, a Navy Veteran who served from January 1994 to February 1996, including during the Gulf War Era, appeals the denial of service connection for somatic symptom disorder and seeks an increased rating for his acquired psychiatric disorder. The Veteran claimed somatic symptom disorder as secondary to his service-connected patellofemoral pain syndrome. The Board found that while the Veteran has a current diagnosis of somatic symptom disorder, its symptoms could not be differentiated from his service-connected acquired psychiatric disorder, as supported by his private examiner's opinion and the Veteran's own testimony. The Board applied the benefit of the doubt and found that the Veteran's acquired psychiatric disorder warranted a 70 percent rating from November 13, 2019, due to significant occupational and social impairment, including anxiety, depressed mood, impaired impulse control, and difficulty maintaining relationships. The Board denied separate service connection for somatic symptom disorder, concluding its manifestations were encompassed within the 70 percent rating for the acquired psychiatric disorder. The Board also considered and denied an inferred claim for TDIU, as the Veteran has been gainfully employed throughout the period on appeal and did not allege unemployability.

Rationale

Veteran has current diagnosis of somatic symptom disorder.; Symptoms cannot be differentiated from acquired psychiatric disorder.; Somatic symptom disorder manifestations are contemplated in the 70 percent rating for acquired psychiatric disorder.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210717-172815

Full Decision Text

Citation Nr: A26031274
Decision Date: 04/06/26 Archive Date: 04/06/26

DOCKET NO. 210717-172815
DATE: April 6, 2026

ORDER

Entitlement to service connection for somatic symptom disorder is denied.

Entitlement to 70 percent rating, but no higher, for an acquired psychiatric disorder from November 13, 2019, is granted.

FINDINGS OF FACT

1. The Veteran's somatic symptom disorder is compensated for as part of the 70 percent disability rating for an acquired psychiatric disorder.

2. From November 13, 2019, the Veteran's acquired psychiatric disorder manifests with occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for somatic symptom disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. From November 13, 2019, the criteria for entitlement to a rating of 70 percent, but no higher, for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9433.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from January 1994 to February 1996, to include service during the Gulf War Era.

Procedural History

On November 22, 2019, the Veteran filed a VA Form 21-526EZ requesting service connection of somatic symptom disorder as secondary to patellofemoral pain syndrome (right knee) and an increased rating for service-connected persistent depressive disorder (hereinafter an acquired psychiatric disorder). In a May 2020 Rating Decision, the Department of Veterans Affairs (VA) Regional Office (RO) denied the claims upon finding no current somatic symptom disorder disability and no worsening of his psychiatric symptomology.

In March 2021, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), in response to the May 2020 agency decision. In a May 2021 HLR Rating Decision, the claims were again denied upon finding no current somatic symptom disorder disability and no worsening of psychiatric symptoms.

In a July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. As an appeal in which the Veteran requested, on the Notice of Disagreement, a Board hearing, the Board's decision is based on a review of the evidence of record at the time of the May 2020 decision on the issues on appeal, evidence submitted by the Veteran or his representative at the hearing, to include testimony provided at the hearing, and evidence submitted by the Veteran or his representative within 90 days following the hearing. 38 C.F.R. § 20.302(a).

Upon review of the record, the Board finds that relevant evidence, including VA mental health treatment notes, was added during the time frame which the Board may not consider. See Cook v. McDonough, 36 Vet. App. 175 (2023). If the Veteran would like VA to consider any evidence 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.

In March 2025, the Veteran testified at a hearing before the undersigned. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of the hearing is in the claims file.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury.
the Veteran testified at a hearing before the undersigned. This decision reflects the Board's consideration of the testimony, evidence, and information presented at the hearing, and a transcript of the hearing is in the claims file.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application).

The VA Rating Schedule generally prohibits pyramiding, i.e., evaluating the same disability under different diagnostic codes, and the Court has emphasized that a claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." See 38 C.F.R. § 4.14; Brady v. Brown, 4 Vet. App. 203, 206 (1993).

Somatic Symptom Disorder

The Veteran seeks service connection of somatic symptom disorder, as secondary to service-connected patellofemoral pain syndrome (knee disability). See November 2019 VA Form 21-526EZ; March 2025 Hearing Transcript. At the March 2025 Board hearing, the Veteran testified to experiencing excessive focus on pain, including phantom pain, pressure in his head, and lightheadedness seemingly triggered by anxiety and depressive symptoms.

The record contains conflicting evidence of a diagnosis of somatic symptom disorder. See December 2019 Private Disability Benefits Questionnaire (DBQ), January and May 2020 VA Examinations. Resolving doubt in his favor, the Board finds the Veteran has a current diagnosis of somatic syndrome disorder and element one has been established.

The record, however, confirms that the symptoms of the Veteran's somatic symptom disorder cannot be differentiated from his service-connected acquired psychiatric disorder. The Veteran's private examiner opined that "there is significant overlap in the diagnoses made and it would be impossible and artificial to attempt to attribute psychiatric impairment to one or the other diagnosis." See December 2019 DBQ; see also Mittleider v. West, 11 Vet. App. 181, 182 (1998), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to different disabilities in the absence of medical evidence which does so).

At the March 2025 hearing, the Veteran's representative conceded that the Veteran's two disabilities should be merged together, rather than having separate disabilities. If so, the impact of the somatic symptom disorder would therefore raise the level of impairment. Indeed, the record reflects that together the Veteran's somatic symptom disorder and acquired psychiatric disorder are manifested by anxiety, depressed mood, suspiciousness, panic attacks, impaired impulse control which are contemplated in the 70 percent rating assigned below. See 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders (showing that a 70 percent rating is assigned when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, 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 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 inability to establish and maintain effective relationships). The January and May 2020 VA examination reports did not find a current diagnosis of somatic symptom disorder. Given the findings in the Veteran's private DBQ, the Board concludes that his somatic symptom disorder is encompassed by the symptoms described above and is therefore contemplated in the 70 percent rating an acquired psychiatric disorder as awarded below. 38 C.F.R. § 4.14.

The medical evidence does not establish that the Veteran exhibits separate symptomatology associated with his somatic symptom disorder, other than what he is herein compensated for under his service-connected acquired psychiatric disorder rating. Accordingly, the Board concludes that the evidence does not support an award of a separate claim for service connection of somatic symptom disorder.

In reaching this conclusion, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch, 21 F.4th at 776; see also Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Here, the record persuasive establishes that the Veteran's somatic symptom disorder manifestations are compensated for as part of the 70 percent disability rating assigned for an acquired psychiatric disorder. Accordingly, service connection of somatic symptom disorder is not warranted.

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating many accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity. See 38 C.F.R. § 4.10; Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

A veteran may experience multiple distinct degrees
. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity. See 38 C.F.R. § 4.10; Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

A veteran may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Acquired Psychiatric Disorder

In a December 2016 Rating Decision, the Veteran was awarded service connection of depressive disorder and assigned a 50 percent rating from June 16, 2016, under DC 9434 (now DC 9433).

Under the General Schedule for Mental Disorders found at 38 C.F.R. § 4.130, the Board must conduct an "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). The symptoms listed in the VA's general rating formula for mental disorders are not intended to constitute an exhaustive list but rather serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114 (Fed. Cir. 2013).

VA is precluded from differentiating between the symptoms of a service-connected disability and those of any other disorders in the absence of clinical evidence that clearly shows such a distinction. See Mittleider, 11 Vet. App. at 182.

The pertinent sections for evaluation in this instance (DC 9433) are as follows:

50 percent: Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-term 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. 38 C.F.R. § 4.130.

70 percent: 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 that is 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); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130.

100 percent: 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, for the Veteran's own occupation, or own name. 38 C.F.R. § 4.130.

When rating psychiatric disorders, the use of the term "such as" 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 the symptoms, or their
, 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, for the Veteran's own occupation, or own name. 38 C.F.R. § 4.130.

Evidence and Analysis

The Veteran contends that his psychiatric symptoms warrant a 70 percent rating. See July 2021 VA Form 10182. VA received the Veteran's VA Form 21-526EZ claim for increased rating on November 22, 2019. Therefore, the current period on appeal runs from that date plus the one year "look back" period preceding the submission of the claim. See 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

At the March 2025 Board hearing, the Veteran testified that his depressive symptoms have progressively worsened. He explained that his depression and anxiety kind of play off of each other wherein one makes the other one worse setting off a spiral out of control.

In a November 2019 Private DBQ, the examiner noted that the Veteran had depressed mood, anxiety, suspiciousness, weekly panic attacks, chronic sleep impairment, mild memory loss, flattened effect, impaired judgment, impaired abstract thinking, disturbances of mood and motivation, difficult understanding complex tasks, gross impairment in thought processes and communication, obsessional rituals, spatial disorientation, difficulty in adapting to stressful circumstances (including work or a worklike setting), agitation, difficulty in establishing and maintaining effective work and social relationships, an inability to establish and maintain effective relationships, and disorientation to time and place.

The Veteran reported being irritable, quick to anger and struggling with social interactions. He reported taking psychotropic medication for symptom control and self-isolating to avoid triggers. He noted that there are few people in his life outside family and chronicled impulse control, irritability, demonstrated minimal eye contact, and moderate psychomotor agitation.

In January and May 2020 VA Examinations, the VA examiner reported the Veteran demonstrated depressed mood, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran reported continued issues with anger and rage noting he has punched walls and screamed during outbursts at home, also at times has homicidal thoughts at work under stress. Notwithstanding his reports, the examiner found his symptoms were moderate.

Upon review of the record, the Board concludes that, upon affording the Veteran the benefit of the doubt, his acquired psychiatric disorder more nearly approximates the level of impairment required for a 70 percent rating. As assigned, the Veteran's 70 percent rating is premised on chronic sleep impairment, depressed mood, anxiety, difficulty in adapting to stressful circumstances, difficulty in establishing and maintaining effective work and social relationships, disturbances of motivation and mood, impaired impulse control, obsessional rituals, spatial disorientation, agitation, suspiciousness, and inability to establish and maintain effective relationships.

Affording the Veteran the benefit of the doubt, the evidence supports that the symptomatology of his acquired psychiatric disorder approximates occupational and social impairment with deficiencies in most areas from November 13, 2019, the date he was prescribed an SSRI based on worsening symptoms of depression and anxiety. See VA Treatment Notes. The Board finds the Veteran's private DBQ, and testimony provides the fullest detail of his symptoms. These records reveal a Veteran suffering from symptoms and impairment that more nearly approximate occupational and social impairment with deficiencies in most areas. Thus, even though not all the listed symptoms compatible with a 70 percent rating are shown, the type and degrees of symptomatology contemplated for a 70 percent rating are demonstrated from November 13, 2019.

The evidence does not support a 100 percent rating criteria or other symptoms indicative of total impairment. Neither the Veteran nor his representative have put forth any argument that a 100 percent rating should be assigned. Therefore, the Board finds that a rating
and anxiety. See VA Treatment Notes. The Board finds the Veteran's private DBQ, and testimony provides the fullest detail of his symptoms. These records reveal a Veteran suffering from symptoms and impairment that more nearly approximate occupational and social impairment with deficiencies in most areas. Thus, even though not all the listed symptoms compatible with a 70 percent rating are shown, the type and degrees of symptomatology contemplated for a 70 percent rating are demonstrated from November 13, 2019.

In reaching the above conclusion, the Board has considered and applied the benefit of the doubt rule. As the evidence for and against the claim is in approximate balance, the benefit of the doubt is resolved in favor of the Veteran, and entitlement to a 70 percent rating, but no higher, for an acquired psychiatric disorder from November 13, 2019, but no earlier, is warranted. 38 U.S.C. § 5107(b).

Finally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran has not specifically alleged that he is unable to secure and maintain substantially gainful employment. Indeed, the record and testimony reflect that he has been gainfully employed throughout the majority of the period on appeal. While the Veteran has experienced intermittent unemployment, evidence during the current period on appeal does not suggest he is unable to secure or maintain substantially gainful employment. The issue of a TDIU does not arise in the context of an increased rating claim when there is no allegation or evidence of unemployability. See Jackson v. Shinseki, 587 F.3d 1106 (Fed. Cir. 2009) (no evidence indicating unemployability, i.e. veteran was employed, a TDIU claim was not raised.) As such, a Rice claim is not raised.

The Veteran has not specifically raised any other issues, nor have any other issues been reasonably raised by the evidence of record. See Doucette v. Shulkin, 28 Vet. App. 366, 370 (2017).

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Regnart, Glenda M.

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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