POSTTRAUMATIC STRESS DISORDER (PTSD)

THOMAS H. O'SHAY · 2026 · Case ID: A26035835

MIXED

Summary

The Veteran, a veteran who served from May 1999 to August 2003, including combat operations in Iraq and Kuwait, appeals the denial of service connection for a psychiatric disorder, a lower back disability, and erectile dysfunction (ED). The Board granted service connection for an acquired psychiatric disorder, recharacterizing the PTSD claim due to overlapping symptoms and diagnoses across multiple examinations. The Board found the Veteran had a current psychiatric disability, a verified combat stressor supported by service memos and a post-deployment assessment, and multiple favorable private nexus opinions, outweighing a single negative VA exam and the lack of combat decorations. Service connection for a lower back disability was also granted. The Board found the Veteran's claimed combat stressor occurred, supported by multiple nexus opinions linking it to his current back pain, which the Veteran credibly testified to self-treating initially. The Board denied service connection for ED, finding the Veteran had not established a current diagnosis of ED, despite being prescribed medication and submitting a private opinion that assumed the diagnosis. The Board noted the lack of a pre-decisional duty to assist error regarding the ED claim, as the record at the time of the initial rating decision did not sufficiently establish a current disability to warrant a VA exam. The claim for acquired psychiatric disorder was granted, and the claim for lower back disability was granted. The claim for ED was denied.

Rationale

Current acquired psychiatric disability confirmed; Multiple favorable private nexus opinions; Verified combat stressor supported by service memos and post-deployment assessment

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210624-168448

Full Decision Text

Citation Nr: A26035835
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210624-168448
DATE: April 16, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder is granted.

Entitlement to service connection for a lower back disability is granted.

Entitlement to service connection for erectile dysfunction (ED) is denied.

FINDINGS OF FACT

1. The Veteran's acquired psychiatric disorder is related to an in-service combat-related stressor.

2. The Veteran's lower back disability is related to an in-service injury incurred while deployed.

3. The Veteran does not have a current ED diagnosis.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. U.S.C. §§ 1110; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a lower back disability have been met. U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for ED due to service or an acquired psychiatric disorder have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1999 to August 2003. These matters come to the Board on appeal of a June 2021 rating decision by the agency of original jurisdiction (AOJ) denying service connection on all three issues. The Veteran appealed that decision via a June 2021 notice of disagreement (NOD) in which he selected the Hearing docket. A hearing was held with this Veterans Law Judge in March 2025.

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

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

The Veteran and his representative contended that his acquired psychiatric disorder was caused by service.

Factual Background

The Veteran's service entrance exam and report of medical history, from March 1999, and his separation exam and report of medical history, from February 2003, are silent for any then-current or historical psychiatric complaints.

The Veterans DD Form 214 does not reflect any combat decorations. However, memoranda generated while the Veteran was still in active duty, in March and May 2003, reflect that the Veteran was deployed to Iraq and Kuwait, and participated in Operation Iraqi Freedom, including combat operations.

Also of record is a May 2003 post-deployment health assessment in which the Veteran reported mental health difficulties following his deployment to Kuwait and Iraq. The Veteran reported that he did not use his weapon in combat, but did feel in danger of being killed, that he saw individuals wounded and killed, and was referred for mental health treatment due to a combat/operational stress reaction.

In connection with his claim - originally for PTSD - the Veteran submitted a statement in March 2021 which detailed his claimed stressor - combat in Iraq, including witnessing casualties, and particularly one incident where an explosive threw him from a vehicle.

In April 2021, the Veteran was provided with a VA examination for his claimed PTSD. The examiner declined to endorse a PTSD diagnosis, but diagnosed the Veteran with Unspecified Anxiety Disorder and Unspecified Depressive Disorder, whose symptoms could not be differentiated. However, the examiner opined that there was no nexus between the Veteran's service and his mental health symptoms because of a lack of in-service treatment or reports of mental health issues.

In the June
due to a combat/operational stress reaction.

In the June 2021 rating decision denying service connection, the AOJ made the favorable findings that the Veteran had a current disability - in the form of the anxiety and depressive disorders - as well as an in-service event - the combat stressor - using an eased PTSD standard to verify the stressor. However, the AOJ denied service connection for PTSD because there was no PTSD diagnosis.

Of record is a September 2021 veteran-submitted examination for his claimed PTSD, which had been conducted by a VA provider. In this exam, the Veteran was diagnosed with both PTSD and Major Depressive Disorder. The examiner indicated that the symptoms of these disabilities could be differentiated - attributing flashbacks to PTSD and a lack of interest and depressed mood to depression. However, in differentiating the social and occupational impacts for these diagnoses - which the examiner again indicated could be differentiated - the examiner did not differentiate diagnoses and symptoms, and instead listed symptoms. Further, the examiner endorsed more symptoms than had been differentiated. The complete symptoms indicated were: depressed mood, anxiety, suspiciousness, and impaired abstract thinking. There was no associated nexus statement submitted with this exam.

The Veteran also submitted a separate, private exam and opinion, dated in February 2024 which is of record. In this exam and opinion, the Veteran was diagnosed with PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder with panic attacks. This examiner opined that these diagnoses were more likely than not related to the Veteran's military service. This report discussed several symptoms affecting the Veteran and did not differentiate these based on diagnosis.

The Veteran also submitted another private exam and opinion in April 2025. This examiner described the Veteran's disability - only describing without providing a formal diagnosis - as PTSD and Generalized Anxiety Disorder, which the examiner opined was at least as likely caused by the Veteran's service. In discussing these diagnoses impacts on the Veteran, they are described as overlapping and exacerbating each other.

The Veteran attended a hearing in March 2025 and testified as to his in-service stressor. The description of the Veteran's deployment given at his hearing is reflected in the supporting statement he had previously provided. The Veteran stated that his symptoms had continued from the time of his deployment, but that he had delayed treatment because he felt he had been adequately addressing his issues with peers, and because he did not think it was a major issue until later.

Analysis

At the outset, the Board notes that it has recharacterized the Veteran's PTSD claim as one for an acquired psychiatric disorder. In comparing the exams and opinions as to the Veteran's mental health, the Board finds that it is at least as likely as not that the Veteran's symptoms cannot be adequately differentiated. Only one exam explicitly notes that the Veteran's symptoms can be differentiated between diagnoses, but then lists incomplete symptomatology as differentiable, and identifies other symptoms which were not attributed to one diagnosis or another. Further, there are two exams and opinions which discuss the Veteran's diagnoses but describe the impact in terms of their overlap and feedback upon each other. Thus, the Board finds that it is proper to recharacterize the claim as one for an acquired psychiatric disorder to include PTSD and Generalized Anxiety Disorder, and Major Depressive Disorder. Therefore, the scope of the Veteran's claim is broadened to include any mental health symptomatology and recharacterized as one for an acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009).

Given that the claim has been expanded beyond simple PTSD, the Board applies general service connection principles to the claim, rather than those particular to PTSD as represented by 38 C.F.R. § 3.304(f).

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Here, the Board finds that the record is sufficient to show entitlement to service connection.

First, the Veteran has a current acquired psychiatric disability, with diagnoses of at least PTSD and depressive and anxiety disorders confirmed by multiple examiners. Further, there are three positive nexus opinions in the record - those from September 2021, February 2024, and April 2025. These are balanced against only one nexus opinion - from April 2021 - which incorrectly found that there were no in-service symptoms, although the May 2003 post-deployment assessment did note mental health symptoms. The April 2021 exam, then, carries no probative value, and the evidence persuasively establishes a current disability as well as a nexus to service.

This leaves only the question of an in-service event. The AOJ made the favorable finding that there was an in-service event, based on the reduced evidentiary threshold for PTSD claims, which allows for finding an event based only on the Veteran's lay reporting. 38 C.F.R. § 3.304(f)(2). However, the Board does not find that reliance on this reduced standard is necessary. True, the Veteran is competent to report on his in-service stressors and is credible in his reporting as it has remained consistent, but the Board does not rely on the Veteran's lay testimony alone. Instead, service memos in the record show that the Veteran was deployed, participated in combat, and was granted entitlement to wear any combat decorations later awarded. Additionally, the May 2003 post-deployment assessment offers compelling evidence that the Veteran was placed in a situation in which he feared for his life and saw wounded and killed individuals, even if he did not personally fire his weapon, and he was referred for combat stress care. The only piece of evidence to weigh against a finding that the claimed combat occurred is the lack of any combat decorations in the Veteran's DD Form 214. However, the other evidence of record - the Veteran's lay descriptions, the memos confirming deployment and combat action, and the post-deployment assessment - all outweigh this to persuasively show that the combat stressor occurred. Thus, the Veteran's claim for an acquired psychiatric disorder meets all three Shedden elements described above.

The evidence of record persuasively weighs in favor of the claim for service connection, and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The claim is granted.

2. Entitlement to service connection for lower back condition

The Veteran and his representative contended that he is entitled to service connection for a lower back disability based on his claimed combat.

Factual Background

As found above, the Board finds that it is at least as likely as not that the Veteran's claimed psychiatric stressor - a combat experience in which he was thrown from a vehicle - occurred. The Veteran's service treatment records are otherwise silent for, or affirmatively deny, complaints of low back pain, including his May 2003 post-deployment assessment, as well entrance and separation exams and reports of medical history.

The Veteran submitted private chiropractic treatment records which show intermittent treatment for lower back pain ranging from as early as March 2006 through at least May 2023. These records also include several lower back diagnoses, sometimes identified only by numeric code, but other times by name. In December 2022, a chiropractic care provider diagnosed the Veteran as having segmental and somatic dysfunction of cervical region, segmental and somatic dysfunction of thoracic region, segmental and somatic dysfunction of lumbar region, cervicalgia, and other low back pain.

At
, or affirmatively deny, complaints of low back pain, including his May 2003 post-deployment assessment, as well entrance and separation exams and reports of medical history.

At his March 2025 hearing, the Veteran testified that while deployed to Iraq, he was thrown from a vehicle by a nearby blast and this caused his lower back injury, which he sought treatment for after service, and which still bothers him now. He also stated that at first, the back pain was represented by a small number of flare-ups which he treated himself by laying on his back and "popping" it as well as with over-the-counter pain medication. He sought care when the back pain became more frequent.

Also of record is a letter from a private chiropractor who confirmed multiple back diagnoses and opined that the Veteran's lower back disability was at least as likely as not caused or aggravated by his service. The Veteran submitted another private opinion in April 2025 which concluded, based on a review of the Veteran's record, his symptoms, and the medical literature, that his lower back disability was at least as likely as not caused by service.

Analysis

The Veteran's lower back claim is subject to the same analytical requirements as the psychiatric claim above. That is, the record must show a current disability, an in-service event, and a nexus between the two. See Shedden, supra.

Here, the record shows entitlement to service connection for a lower back disability. As found above, the Board finds it is at least as likely as not that the Veteran's claimed in-service event occurred, in which he was thrown from a vehicle and injured his back.

Second, the record shows several diagnoses related to the Veteran's back as provided by competent and credible private chiropractic care providers. Further, the Veteran has testified that his lower back pain has a functional impact on him, and in that circumstance, pain alone can be considered a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018) (holding that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability" if it "reaches the level of a functional impairment of earning capacity.").

Finally, the Veteran has provided two competent and credible nexus opinions linking his in-service event to his current back disability. Although these are of somewhat diminished probative value because they are based more on general statements of the Veteran's current condition and medical literature rather than on specific findings which reach a conclusion based on this particular Veteran's circumstances, it is still determinative. First, there are no negative opinions to weigh against even the diminished value of these positive opinions. Second, given that the Veteran has received lower back care since shortly after his separation from service - represented by chiropractic care notes from as early as 2006 - the Board believes that the general character of the evidence supports that his current back disability was caused by the in-service event, especially as it involved combat. See 38 U.S.C. § 1154; 38 C.F.R. § 3.303(d).

This is true despite the fact that the Veteran denied back pain on his post-deployment assessment, and waited, even a small gap relatively, three years before seeking treatment. As the Veteran testified at his hearing, he sought to self-treat until his back pain became more frequent over time and he finally got professional care. The Board finds that testimony competent and credible in explaining the gap in care and earlier denials of back pain.

Given all of this, it is at least as likely as not that there is a positive nexus between the Veteran's in-service event and his current lower back disability, thus satisfying all three required Shedden elements.

3. Entitlement to service connection for ED is denied.

The Veteran contended that his ED is secondary to his psychiatric disorder.

Factual Background

The Veteran's service treatment records are silent for any complaints of ED.

At his March
not that there is a positive nexus between the Veteran's in-service event and his current lower back disability, thus satisfying all three required Shedden elements.

3. Entitlement to service connection for ED is denied.

The Veteran contended that his ED is secondary to his psychiatric disorder.

Factual Background

The Veteran's service treatment records are silent for any complaints of ED.

At his March 2025 hearing, the Veteran testified that he had been prescribed ED medication, but had never been actually diagnosed with ED. There are no medical records which show a diagnosis of ED.

The Veteran submitted an article which discussed the connection between ED and PTSD. The Veteran also submitted a private nexus opinion, dated April 2025, which linked the Veteran's ED to his service. That opinion takes as a given, without providing a separate confirmation, an ED diagnosis and opines that the Veteran's claimed ED was at least as likely as not caused or aggravated by the Veteran's PTSD and his medication for the same, relying largely on information in medical literature which shows that PTSD and its medication can exacerbate sexual dysfunction.

Analysis

Service connection may be granted on a secondary basis for a disability which is due to, or the result of, a service-connected disorder. 38 C.F.R. § 3.310(a). Secondary service connection may be found in certain instances in which a service-connected disability aggravates another disorder. 38 C.F.R. § 3.310(b).

To grant service connection under any theory of entitlement, there must be a current disability. Degmetich v. Brown, 104 F.3d 1328, 1332 (1997); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Absent a diagnosis, a symptom significant enough to result in functional impairment in earning capacity qualifies as a disability. Saunders v. Wilkie, 886 F.3d 1356, 1367-1368 (Fed. Cir. 2018) (concerning the symptom of pain).

Here, there is insufficient evidence to show a current disability for service connection. Although the Veteran has been prescribed medication to treat ED, the record does not actually reflect a current diagnosis. Further, at the March 2025 hearing, the Veteran confirmed that although he was prescribed ED medication, he had never been diagnosed with that disability. He is competent and credible to report on his medical history, including whether a doctor had previously diagnosed him with a disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007); see also Layno v. Brown, 6 Vet. App. 465 (1994). Further, the Board does not read the April 2025 private opinion as independently providing or confirming an ED diagnosis. Instead, the opinion appears to take the ED diagnosis as a given, and proceeds from that point. Additionally, nothing in the record suggests an occupational functional impairment caused by his ED to separately find a current disability.

Without a current disability, the Board is unable to grant service-connection under any theory of entitlement. Citation to caselaw as to general principles of secondary service connection - as the private opinion provided - does not cure this defect of the claim.

Finally, the Board notes that the Veteran was not provided with a VA examination to determine the nature and etiology of the Veteran's claimed ED. However, this was not a pre-decisional duty to assist error as the record before the AOJ at the time of initial rating decision did not have sufficient evidence - beyond the implicit statement of a current disability in the Veteran's claim itself - of a current disability to require an exam related to general service connection principles or based on the Veteran's presumed toxic exposure, at the time of the original rating decision shown by his service in Kuwait and Iraq. See 38 U.S.C. §§ 1168(a), 5103A(d); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). At the time of the June 2021 rating decision, the record had not yet established that the Veteran had been prescribed ED medication or suffered any symptoms, again, beyond the fact of the Veteran's claim itself. Although the record now may support a requirement to provide a VA exam, the Board can only remand for pre-decisional duty to assist errors, of which there were none here.
or based on the Veteran's presumed toxic exposure, at the time of the original rating decision shown by his service in Kuwait and Iraq. See 38 U.S.C. §§ 1168(a), 5103A(d); see also McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). At the time of the June 2021 rating decision, the record had not yet established that the Veteran had been prescribed ED medication or suffered any symptoms, again, beyond the fact of the Veteran's claim itself. Although the record now may support a requirement to provide a VA exam, the Board can only remand for pre-decisional duty to assist errors, of which there were none here. 38 U.S.C. § 5103A(f)(2)(A); 38 C.F.R. § 20.802(a).

The evidence of record persuasively weighs against the claim for service connection, and the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The claim is denied.

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Kronick

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.

Analyze in VA Law Explorer