POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, who served in the United States Air Force from July 2008 to May 2009 and again from April 2013 to December 2013, appeals the denial of an increased disability rating for his service-connected "other specified trauma- and stressor-related disorder." The Veteran sought a rating higher than the 30 percent initially assigned in March 2021. The Board reviewed evidence of record up to the March 2021 decision, excluding later submissions. The primary issue was whether the Veteran's symptoms warranted a 70 percent rating, which is associated with suicidal ideation, impaired impulse control, and difficulty adapting to stressful circumstances. The Board found the evidence in relative equipoise regarding the Veteran's occupational and social impairment. While VA examiners generally opined milder symptoms, they failed to fully address the Veteran's reported suicidal ideation and sleep disturbances. The Board found the Veteran's reported suicidal ideation and difficulty adapting to stress, as noted in VA treatment records and examinations, persuasive. Applying the benefit of the doubt, the Board granted a 70 percent rating, finding it more appropriate than the existing 30 percent rating but not warranting the 100 percent rating due to a lack of total occupational and social impairment. The Board concluded the Veteran did not meet the criteria for a 100 percent rating, citing his continued employment as a teacher, pursuit of graduate studies, coaching, hobbies, and relationships, and the absence of gross impairment in thought processes or danger to self or others.

Rationale

Evidence in relative equipoise regarding occupational and social impairment; Suicidal ideation, impaired impulse control, and difficulty adapting to stress noted; Benefit of the doubt applied to grant 70% rating

Full Decision Text

Citation Nr: A26032780
Decision Date: 04/09/26	Archive Date: 04/09/26

DOCKET NO. 210901-182412
DATE: April 9, 2026

ORDER

Entitlement to an initial disability rating of 70 percent, but no higher, for other specified trauma- and stressor-related disorder is granted.

FINDING OF FACT

The evidence is in relative equipoise as to whether the severity, frequency, and duration of the Veteran's acquired psychiatric disability symptoms more closely approximated occupational and social impairment with deficiencies in most areas during the period under consideration.  

CONCLUSION OF LAW

The criteria for an initial disability rating of 70 percent, but no higher, for other specified trauma- and stressor related disorder have been met. 38 U.S.C. §§ 1155; 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the United States Air Force from July 2008 to May 2009 and from April 2013 to December 2013. 

The rating decision on appeal was issued in March 2021 by a Department of Veterans Affairs (VA) Regional Office, which serves as the Agency of Original Jurisdiction (AOJ).

A March 2020 rating decision granted the Veteran service connection for other specified trauma- and stressor-related disorder and assigned a 30 percent disability rating from November 1, 2019. The Veteran requested administrative review of the disability rating assigned with a November 2020 supplemental claim. A December 2020 rating decision denied entitlement to a disability rating higher than 30 percent for the service-connected psychiatric disability, and the Veteran filed another supplemental claim in February 2021. The March 2021 rating decision on appeal readjudicated the matter and continued the denial of entitlement to a disability rating higher than 30 percent. Therefore, the Veteran continuously pursued his initial claim, and the Board will consider the issue of entitlement to an initial disability rating higher than 30 percent for the service-connected acquired psychiatric disorder.

In the September 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. On May 12, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the March 2021 decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

1. Entitlement to an initial disability rating higher than 30 percent for other specified trauma- and stressor-related disorder.

The Veteran is seeking an initial disability rating higher than 30 percent for his service-connected other specified trauma- and stressor-related disorder.

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4
atology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3.

The Veteran is currently assigned a 30 percent disability rating pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411, for posttraumatic stress disorder (PTSD).

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. 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, 114-118 (Fed. Cir. 2013). 

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

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

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

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

The evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013).

The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a Veteran may only qualify for a given disability by
.3d 112, 116-117 (Fed. Cir. 2013).

The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a Veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. See Vazquez-Claudio, 713 F.3d at 118. Further, when evaluating a mental disorder, the Board must "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126(a).

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).

After conducting a holistic analysis, the Board concludes the evidence is at least in balance as to whether the symptoms of the Veteran's service-connected other specified trauma- and stressor-related disorder resulted in occupational and social impairment with deficiencies in most areas during the period under consideration. Therefore, an initial 70 percent disability rating, but no higher, is warranted.

Significantly, VA treatment records show the Veteran reported having suicidal ideation, specifically a wish to die, in May 2020. He reported having passive suicidal ideation after finding out he would not deploy with his Air National Guard unit. He denied experiencing current suicidal ideation during a December 2020 VA examination, but reported having fleeting suicidal thoughts in the past. The VA treatment records also note the Veteran had a history of unknowingly hitting his wife while he slept. VA treatment providers believed the behavior to be associated with the service-connected other specified trauma- and stressor-related disorder. The Veteran indicated he was seeking the VA mental health treatment to reduce his irritability and angry outbursts, which he noted occurred about 20 times per week. In addition, a November 2019 VA examiner indicated the Veteran's symptoms included difficulty in adapting to stressful circumstances.

Based on a consideration of the above, the Board finds the evidence is in relative equipoise as to whether the Veteran's service-connected mental disorder resulted in occupational and social impairment with deficiencies in most areas for the entire appeal period. In light of the Veteran's reported suicidal ideation, impaired impulse control, and difficulty in adapting to stressful circumstances, a 70 percent rating is warranted for the other specified trauma- and stressor-related disorder. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017) (finding suicidal ideation alone, even if passive, may cause occupational and social impairment with deficiencies in most areas).

The Board acknowledges November 2019, December 2020, and March 2021 VA examiners opined the Veteran's mental disorder only resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or in occupational and social impairment with an occasional decrease of work efficiency of inability to perform occupational tasks. However, the Board finds these opinions lack probative value because the examiners did not address the Veteran's suicidal ideation or episodes of violence in his sleep as part of that conclusion. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (finding a medical opinion based on an inaccurate factual premise has no probative value). In addition, while the November 2019 examiner opined the service-connected other specified trauma- and stressor-related disorder resulted in only occupational and social impairment due to mild or transient symptoms, she indicated the Veteran's symptoms included a difficulty in adapting to stressful circumstances (including work or a worklike setting),
 an occasional decrease of work efficiency of inability to perform occupational tasks. However, the Board finds these opinions lack probative value because the examiners did not address the Veteran's suicidal ideation or episodes of violence in his sleep as part of that conclusion. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (finding a medical opinion based on an inaccurate factual premise has no probative value). In addition, while the November 2019 examiner opined the service-connected other specified trauma- and stressor-related disorder resulted in only occupational and social impairment due to mild or transient symptoms, she indicated the Veteran's symptoms included a difficulty in adapting to stressful circumstances (including work or a worklike setting), which is associated with a 70 percent disability rating.

The Board concludes, however, that the evidence does not support a total disability rating of 100 percent during the period under consideration. Overall, the Veteran's symptoms do not demonstrate total occupational and social impairment associated with a 100 percent rating. The competent, credible, and probative evidence shows the Veteran did not have gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; a persistent danger of hurting himself or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name.

The evidence shows the Veteran continued to be a high school teacher, pursue a graduate degree, coach multiple sports, have hobbies, and maintain relationships with friends and family throughout the period under consideration. He did report having passive suicidal ideation on two occasions, but denied having specific plans or intent. While he also has a history of unknowingly hitting his wife while sleeping, the March 2021 VA examiner noted the Veteran and his spouse had been sleeping in different beds so he could avoid injuring her during restless sleep. There is no indication there was a danger of the Veteran hurting others outside of his unwitting actions during sleep. Therefore, the Board finds the Veteran was not a persistent danger of hurting himself or others during the period under consideration.

The March 2021 examiner noted the Veteran reported being disoriented at times. Specifically, the Veteran indicated he had let out his high school class earlier than planned on three separate occasions because he was confused when class ended. He also said he had missed three assignment deadlines for his own graduate course work after failing to understand instructions. However, there's no indication the Veteran's confusion resulted from a disorientation to time or place associated with the other specified trauma- and stressor-related disorder. The VA examiner noted the Veteran's thought process was logical, relevant, and goal-directed. His thought content was within normal limits. The examiner also opined the Veteran's reported difficulties with work and school could be attributed to his overcommitment at work and not directly related to the serve-connected acquired psychiatric disorder.

In sum, the Board finds the evidence is in relative equipoise as to whether the Veteran's service-connected acquired psychiatric disability resulted in occupational and social impairment with deficiencies in most areas throughout the period on appeal. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial disability rating of 70 percent, but no higher, for other specified trauma- and stressor-related disorder have been met.

 

William Skowronski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Fields, Ashley N.

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.