POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the United States Marine Corps from January 2008 to January 2010, appeals the denial of service connection for several conditions. The Board granted service connection for posttraumatic stress disorder (PTSD), to include depression, finding it related to the veteran's combat service in Iraq. The veteran submitted lay statements detailing exposure to improvised explosive devices (IEDs) and enemy attacks, supported by a private psychologist's opinion and the veteran's DD Form 214 confirming combat service and awards. The Board found the private opinion probative and applied the benefit of the doubt, establishing service connection for PTSD and consolidating the depression claim due to intertwined symptoms. However, the Board denied service connection for blisters of bilateral feet, cervical strain, headaches, and right shoulder rotator cuff injury, concluding the veteran failed to demonstrate current diagnoses for these conditions or provide competent evidence to establish them. The veteran conceded the absence of current cervical strain or right shoulder rotator cuff injury, and post-service records did not document the other denied conditions. The case was remanded for a VA examination to determine the nature and etiology of the veteran's chest injury and lumbar strain, and to assess their relationship to service, considering the veteran's in-service complaints and the lack of a prior VA examination for these specific conditions.

Rationale

Medical evidence diagnosing PTSD in accordance with DSM-V; Credible supporting evidence of in-service stressor occurrence; Medical evidence of link between current symptomatology and stressor; Lay testimony alone establishes stressor occurrence due to combat service; No competent evidence to the contrary; Consolidated depression claim due to intertwined symptoms

Full Decision Text

Citation Nr: A26037305
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 210802-177267
DATE: April 21, 2026

ORDER

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

Entitlement to service connection for blisters of bilateral feet is denied.

Entitlement to service connection for cervical strain is denied.

Entitlement to service connection for headaches is denied.

Entitlement to service connection for right shoulder rotator cuff injury is denied.

REMANDED

Entitlement to service connection for chest injury is remanded.	

Entitlement to service connection for lumbar strain is remanded.

FINDINGS OF FACT

1. The Veteran's PTSD, to include depression, is related to his combat service.

2. The evidence weighs persuasively against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of blisters of bilateral feet. 

3. The evidence weighs persuasively against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of cervical strain.

4. The evidence weighs persuasively against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of headaches.

5. The evidence weighs persuasively against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of right shoulder rotator cuff injury.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for PTSD, to include depression, are met.  38 U.S.C. § 1110; 38 C.F.R. § 3.304(f)(2).

2. The criteria for entitlement to service connection for blisters of bilateral feet are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for cervical strain are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for headaches are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for right shoulder rotator cuff injury are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from January 2008 to July 2008 and from December 2008 to January 2010. 

These matters come before the Board of Veterans' Appeals (Board) from the October 2020 rating decision by the Department of Veterans Affairs' (VA) Veterans Benefits Administration (VBA), the agency of original jurisdiction (AOJ). 

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on December 2024.

Therefore, the Board may only consider the evidence of record at the time of the October 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran 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. 

However, because the Board is remanding the claims of entitlement to service connection for a chest injury and lumbar strain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38
 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. 

However, because the Board is remanding the claims of entitlement to service connection for a chest injury and lumbar strain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that the Veteran perfected his appeal concerning separate claims for PTSD and depression. However, as these claims involve similar symptoms and the Veteran claims that his depression is due to his PTSD, the Board finds it's appropriate to consolidate the claims into a single claim characterized as above. See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Lastly, during his December 2024 Board hearing, the Veteran testified that that his original claim for service connection for a right shoulder rotator cuff injury was in error and instead wanted to file a claim for service connection for a left shoulder rotator cuff injury. The Board notes that if the Veteran wishes to file a claim for a left shoulder rotator cuff injury, instead of a right shoulder rotator cuff injury, he must file such a claim with the AOJ.

1. Entitlement to service connection for PTSD to include depression is granted.

The Veteran seeks service connection PTSD. Specifically, the Veteran contends his PTSD is due to his combat service in Iraq where he witnessed military hostile activity to include, improvised explosive device (IED) explosions and enemy attacks. See VA 21-4138 Statement in Support of Claim, March 14, 2025. 

Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a link between current symptomatology and the claimed in-service stressor.  38 C.F.R. § 3.304(f); see also Cohen v. Brown, 10 Vet. App. 128 (1997).

If the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, the Veteran's lay statements alone may establish occurrence of the claimed in-service stressor, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressors.  38 C.F.R. § 3.304(f)(2).

At the outset, the Veteran submitted a February 2025 PTSD Disability Benefits Questionnaire filled out by a private psychologist, Dr. G.L., who diagnosed the Veteran with PTSD in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V).

Second, the Veteran has reported in-service stressors of witnessing multiple deaths and injuries when an IED exploded during an enemy attack when he was deployed to Iraq. See VA 21-4138 Statement in Support of Claim, March 14, 2025. His DD Form 214 confirms his military occupational specialty (MOS) as an Rifleman, and show that he was awarded the Iraqi Campaign Medal, Global War on Terrorism Service Medal and Sea Service Deployment Ribbon amongst others. See also Chronological Record. 

Lastly, the Veteran submitted a private nexus opinion from Dr. G.L. who conducted a full mental health assessment, diagnosed the Veteran with PTSD based on his reported stressors and stated his wartime experiences were the cause of his PTSD.  See Dr. G.L., Psy. D. Private Medical Opinion, March 7, 2025. Moreover, as these stressors are consistent with the circumstances of his combat service, his lay testimony alone establishes their occurrence.  38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f)(2).  There is no competent evidence to the contrary. Therefore, as the elements for service connection for are met, service connection for PTSD, to include depression is established.

As a brief final matter for purposes of clarity, given that the Veteran's depressive symptoms are now being compensated for through his now-service-connected PTSD, to rate the Veteran's depression and PTSD separately would be considered impermissible pyramiding. 38 C
. D. Private Medical Opinion, March 7, 2025. Moreover, as these stressors are consistent with the circumstances of his combat service, his lay testimony alone establishes their occurrence.  38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(f)(2).  There is no competent evidence to the contrary. Therefore, as the elements for service connection for are met, service connection for PTSD, to include depression is established.

As a brief final matter for purposes of clarity, given that the Veteran's depressive symptoms are now being compensated for through his now-service-connected PTSD, to rate the Veteran's depression and PTSD separately would be considered impermissible pyramiding. 38 C.F.R. § 4.14. As it is not possible to distinguish between the respective symptoms here because they are so intertwined, the whole of the Veteran's mental health symptoms is attributed to his now-service-connected PTSD disability. See 38 C.F.R. §§ 3.102, 4.14; Mittleider v. West, 11 Vet. App. 181, 182 (1998). Thus, service connection for PTSD, to include his depression symptomology, is warranted, and this grant herein fully resolves the Veteran's pursuit of a mental health claim.

2. Entitlement to service connection for blisters of bilateral feet is denied.

3. Entitlement to service connection for cervical strain is denied.

4. Entitlement to service connection for headaches is denied.

5. Entitlement to service connection for right shoulder rotator cuff injury is denied.

The Veteran seeks service connection for blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury. 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 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).

The existence of a current disability is the cornerstone of a claim for VA disability compensation.  See Degmetich v. Brown, 104 F.3d 1328 (1997).  Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.  In the absence of proof of a present disability there can be no valid claim.  See Brammer v. Brown, 3 Vet. App. 223 (1992); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (agreeing that the requirement that a claimant have a current disability before service connection may be awarded is satisfied when a claimant has a disability at the time a VA claim is filed or during the pendency of that claim).

The Board concludes that the Veteran has not had a diagnosis of a blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury at any time during the pendency of the claim. The Board acknowledges that during his Board hearing, the Veteran had complaints of blisters on his feet during service and complaints of headaches about a year after discharge from service. However, the Veteran has testified that these conditions has resolved. In addition, the Veteran also conceded during his Board hearing that he does not have cervical strain nor right shoulder rotator cuff injury.  See Board Hearing Transcript, December 16, 2024. Finally, post service medical records contain no diagnosis of, or treatment for blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury.

The Board has also considered the applicability of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held 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." Id. at 1367-69. Here, there is no indication that the Veteran has symptoms that amount to pain or cause any functional impairment.

To the extent the Veteran believes that he has a blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury, he is not competent to provide a diagnosis in the case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). However, a diagnosis of a blisters of bilateral feet, cervical strain, headaches and
 the Federal Circuit held 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." Id. at 1367-69. Here, there is no indication that the Veteran has symptoms that amount to pain or cause any functional impairment.

To the extent the Veteran believes that he has a blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury, he is not competent to provide a diagnosis in the case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). However, a diagnosis of a blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury requires the expertise that the Veteran has not established. Therefore, the Board gives more probative weight to the medical evidence of record which does not document such conditions. The Board finds that the VA examiner's opinion is more probative as it was provided by a medical professional with knowledge, training, and expertise and is supported by a rationale.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328, 1332 (1997). In the absence of evidence of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, in the absence of competent evidence showing the Veteran has a blisters of bilateral feet, cervical strain, headaches and right shoulder rotator cuff injury during the pendency of the claim, the persuasive weight of the evidence supports a finding that the first Shedden requirement has not been met. The claims are therefore denied. 38 C.F.R. § 3.303. 

REASONS FOR REMAND

1. Entitlement to service connection for a chest injury is remanded.

2. Entitlement to service connection for a lumbar strain is remanded.

The Veteran seeks service connection for a chest injury and lumbar strain. 

With respect to the Veteran's claim of service connection// for chest injury, the Veteran contends he was diagnosed with costochondritis in service and continues to have chest pressure. The Veteran also contends he injured his back in service while carrying a heavy pack and weapons on his back. He contends his condition have progressively gotten worse.  See Board Hearing Transcript, December 16, 2024.

A review of the Veteran's service treatment records show that he complained of chest pain in service and was diagnosed with costochondritis. See Service Treatment Records, May 21, 2009. 

The record reflects that the Veteran has not been afforded a VA examination for his chest injury and lumbar strain. The Board therefore finds that it was a predecisional duty to assist error not to provide an examination or obtain a medical opinion whether the Veteran's chest injury and lumbar strain is related to active-duty service. Considering the Veteran's statements generally asserting that his chest injury and lumbar strain are related to his active-duty service, he should be afforded a VA examination with an opinion on this issue. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, a remand is necessary to correct the error.

On remand, the VA examiner should consider Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) when providing an opinion as to whether the Veteran has a chest injury and lumbar strain that results in functional impairment of earning capacity, and if so, whether such disability is due to active-duty service.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of his (a) chest injury, and (b) lumbar strain. The entire claims file should be made available to and should be reviewed by the examiner. The clinician should provide an opinion as to the following: 

(a.) Does the Veteran have any current diagnoses of a (i) chest injury and (ii) lumbar strain, to include pain that rises to the level of functional impairment?

In making this determination, the examiner is asked to address to consider the following records: May 21, 2009 diagnosis of costochondritis.

(Continued on the next page)

?

(b.) If the Veteran is diagnosed with (i) chest injury and (ii) lumbar strain, the examiner must opine whether each diagnosed condition is related (an approximate balance of positive and negative evidence), to an in-service injury, event, or disease

A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate.

 

 

M. MILLS

Veterans Law Judge

Board of