POSTTRAUMATIC STRESS DISORDER (PTSD)

TIMOTHY COTHREL · 2026 · Case ID: A26031631

GRANTED

Summary

The Veteran, who served in the U.S. Navy from March 1986 to March 1990, appeals the denial of service connection for PTSD and major depressive disorder (MDD). The Veteran claims PTSD resulted from in-service events, including a ship explosion and a shipmate's death, and seeks service connection for MDD as secondary to PTSD. The Board reviewed evidence including the Veteran's testimony from an October 2024 hearing, a May 2024 VA examination, and statements submitted by the Veteran. Although some evidence post-dated the initial rating decision, the Board considered it based on recent court precedent allowing leeway for unjust procedural limitations. The VA examiner diagnosed PTSD and MDD, finding both conditions related to service. The examiner opined that the PTSD was caused by combat trauma and the shipmate's death, and that the MDD was caused by the Veteran's inability to cope with PTSD symptoms. The Board found the examiner's opinion provided a positive nexus for both conditions, treating them as separate disabilities despite their causal relationship, and granted service connection for both. The Board noted that any pyramiding concerns regarding the assignment of ratings would be a downstream issue for the RO.

Rationale

VA examiner found PTSD met DSM-5 criteria; Examiner opined PTSD caused by combat trauma and shipmate's death; Examiner provided positive nexus to service

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201106-120089

Full Decision Text

Citation Nr: A26031631
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 201106-120089
DATE: April 7, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) is granted.

FINDINGS OF FACT

1. The Veteran's PTSD was caused by traumatic events during service.

2. The Veteran's major depressive disorder is related to events during service, including as secondary to his PTSD, which the Board finds to be service connected.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the U.S. Navy from March 1986 until his honorable discharge in March 1990. The Board recognizes his service to our country, and the sacrifices it entailed.

This matter is before the?Board of Veterans' Appeals?(Board) from an October 2020 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ).

On the November 2020 Notice of Disagreement (NOD or VA Form 10182), the Veteran elected the Hearing docket. In October 2024, the Veteran testified before the undersigned Veterans Law Judge; the hearing transcript is in the record.

Therefore, the Board may consider only the evidence of record at the time of the October 2020 rating decision, as well as any evidence submitted during (including via testimony) or within 90 days after the October 25, 2024 hearing. 38 C.F.R. §§ 20.301 and?20.302.

The Board notes that subsequent to the Veteran's November 2020 NOD seeking a Board hearing on the denial of service connection of his PTSD, but prior to the October 2024 Board hearing, the Veteran also filed a Supplemental Claim (VA Form 21-0995) with the AOJ seeking the same relief. The Veteran also submitted statements supporting his claim for service connection and underwent another VA examination. In May 2024, the AOJ informed the Veteran that it would take no further action on the claim, due to this pending claim before the Board.

Thus, there has been additional development of the PTSD and depression claims, which is beneficial to the Veteran but post-dates the October 2020 rating decision on appeal.

The Board is generally precluded from considering evidence submitted after the AOJ rating decision when adjudicating an appeal. 38 U.S.C. § 7113; 38 C.F.R. §§ 20.300, 20.303, 20.801. However, the Court recently held that rules governing evidence submission limits are non-jurisdictional claim processing rules subject to waiver, giving the Board some leeway to consider evidence submitted during a period when submission was technically prohibited if the circumstances make those limitations unjust or force the Board into creating an unnecessary inefficiency. Bolds v. McDonough, 37 Vet. App. 359, 362 (2024). See also, Hall v. McDonough, 34 Vet. App. 329, 333 (2021) (claims-processing rules "govern the orderly processing of cases but do not implicate jurisdiction"); Henderson v. Shinseki, 562 U.S. 428, 435 (2011) (rules are "jurisdictional" only if they govern "adjudicatory capacity"); Kontrick v. Ryan, 540 U.S. 443, 455 (2004) ("jurisdiction" refers to the classes of cases or persons within the tribunal's adjudicatory domain).

Therefore, the Board will not burden the VA nor the Veteran by engaging in the bureaucratic ritual of remanding an issue so the RO can readjudicate it based on evidence already in the record when the issue is already before the Board, and the Board is convinced the new evidence warrants a grant of the appeal.

Service Connection Background

Service connection can be established by showing the claimed disability manifested while the Veteran was in service. 38 C.F.R. § 3.303(a). If the claimed disability did not manifest until after service, direct service connection is established by showing the disability was incurred in service. 38 C.F.R. § 3.303(d). Showing in-service incurrence generally boils down to establishing three essential elements: (1) the claimed disability exists; (2) an in-service injury, disease,
ritual of remanding an issue so the RO can readjudicate it based on evidence already in the record when the issue is already before the Board, and the Board is convinced the new evidence warrants a grant of the appeal.

Service Connection Background

Service connection can be established by showing the claimed disability manifested while the Veteran was in service. 38 C.F.R. § 3.303(a). If the claimed disability did not manifest until after service, direct service connection is established by showing the disability was incurred in service. 38 C.F.R. § 3.303(d). Showing in-service incurrence generally boils down to establishing three essential elements: (1) the claimed disability exists; (2) an in-service injury, disease, or event occurred; and, (3) there was a causal relationship, or nexus, between the first two elements. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

"Secondary" service connection is also warranted for a disability caused by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing secondary service connection requires evidence of: (1) the existence of the claimed secondary disability; (2) the existence of a service-connected primary disability; and, (3) a causal relationship between the two disabilities. Id; see also, Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Notably, to establish a causal relationship, the evidence need support only simple "but-for" causation. As a result, the primary disability need not be the sole cause or even the chief cause of the claimed secondary disability provided it is an essential factor in its onset. Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023); see also, Burrage v. United States, 571 U.S. 204, 211-12 (2014).

Thus, regardless of the complexity of the causal relationship between the two disabilities, but-for causation ultimately hinges on the finding that if the claimant did not have the service-connected primary disability, they would not have the claimed secondary disability.

Determining whether service connection applies in a particular case is a question of fact. See, e.g., Wood v. Derwinski, 1 Vet. App. 190, 191 (1991). Thus, the Board carefully considers input from medical professionals and other experts along with all other competent, material, probative evidence, but it does not "outsource" its responsibility or its authority as the finder of fact. See, e.g., Sizemore v. Principi, 18 Vet. App. 264 (2004); Delrio v. Wilkie, 32 Vet. App. 232, 242 (2019); Miller v. Wilkie, 32 Vet. App. 249, 259 (2020).

As a result, when the issue on appeal is whether a disability is service connected, the ultimate answer is the exclusive province of the Board. See, e.g., Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997); Owens v. Brown, 7 Vet. App. 429, 433 (1995); Washington v. Nicholson, 19 Vet. App. 362, 367-68 (2005); Webster v. Derwinski, 1 Vet. App. 155, 159 (1991).

Under the benefit of the doubt doctrine, service connection is warranted when the evidence supporting the claim is at least approximately balanced with or nearly equal to the evidence against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 131, 1365 (Fed. Cir. 2001).

1. Entitlement to service connection for an acquired psychiatric disorder post-traumatic stress disorder (PTSD) is granted.

2. Entitlement to service connection for major depressive disorder is granted, including as secondary to PTSD.

The Veteran contends that his PTSD was caused by events during service on the USS Starck in the Indian Ocean, including when another vessel in the fleet had an explosion, and when a shipmate was swept overboard and never recovered. See May 2024 Correspondence and October 2024 Hearing Transcript.

1. Entitlement to service connection for an acquired psychiatric disorder post-traumatic stress disorder (PTSD) is granted.

2. Entitlement to service connection for major depressive disorder is granted, including as secondary to PTSD.

The Veteran framed his PTSD claim to include symptoms of irritability, sleeping difficulty and depression, and claimed anxiety as a separate disability. The Board has recharacterized the anxiety claim as MDD to better align the claims with the evidence. See Murphy v. Wilkie, 983 F.3d 1313, 1318 (Fed. Cir. 2020) ("VA shall afford lenity to a veteran's filings that fail to enumerate precisely the disabilities included within the bounds of a claim" and "[d]etermining the scope of a claim is best accomplished by looking to the veteran's reasonable expectations in filing the claim and the evidence developed in processing that claim"); see also Clemons v. Shinseki, 23 Vet. App. 1 (2009).

The Veteran has current diagnoses of both PTSD and MDD. See May 2024 VA examination. The Veteran was initially diagnosed with PTSD in 2016, and has had a long history of psychiatric and medical treatment for it. The examiner found that the Veteran's PTSD resulted from the fear of being bombed and the trauma of watching his shipmate lose his life. The Veteran's PTSD met the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but his stressor events cannot be independently corroborated, and thus the Board has recharacterized his PTSD claim as being for an acquired psychiatric disorder including PTSD. The examiner also found the Veteran suffered from MDD in accordance with the DSM 5 criteria.

Frequently, when a second mental health condition is comorbid with PTSD, and the PTSD is incorporated into an acquired psychiatric disorder, the second mental health condition is similarly incorporated into the newly recharacterized disability because the symptoms of one cannot readily be distinguished from the symptoms of the other, and therefore, granting two separate disabilities may result in "pyramiding," which is the practice of compensating the same impairment or symptom multiple times under different disabilities or diagnostic codes. Pyramiding is prohibited by VA regulations because it results in overcompensation. 38 C.F.R. § 4.14; see also, Brady v. Brown, 4 Vet. App. 203, 206 (1993) (pyramiding is prohibited because it compensates a veteran beyond the actual degree of impairment suffered).

However, the rules against pyramiding do not preclude the VA from separately evaluating different impairments even when they are manifestations of a single disease or injury. See Walleman v. McDonough, 35 Vet. App. 294 (2022). Thus, if there is clinical evidence that the symptoms and impairments of different mental health conditions can be distinguished, then it is appropriate to grant service connection for both, and sort out any pyramiding concerns in the assignment of ratings by ensuring the same symptoms compensated under one disability are not also compensation under the other. Mittleider v. West, 11 Vet. Ap. 181, 182 (1998).

Here, the VA examiner segregated the symptoms of the two disabilities as PTSD-related trauma, anxiety, poor sleep, nightmares, hyperarousal, hypervigilance, irritability, isolation, and attention problems, coupled with MDD-related depressed mood, poor concentration, hopelessness, anhedonia, flat affect, and passive suicidal ideation. He also found the Veteran's MDD was caused by his inability to cope with symptoms of his PTSD.

The Board finds the VA examiner's opinion is tantamount to a positive nexus opinion for both disabilities, and a finding that each is a separate condition, even though they are causally related.

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As a result, service connection is warranted for both disabilities at this stage, and this appeal is granted as to both disabilities. However, if during the rating process the AOJ determines a higher overall rating would result by combining the two disabilities and their respective symptoms, as far as the Board is concerned, that is a downstream issue. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (disability rating and effective date are issues separate from service connection). And, as far as the Veteran is concerned, if the two disabilities are combined and he disagrees that such a decision
, even though they are causally related.

(Continued on the next page)

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jaeger, L

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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