PSYCHOSIS

REBECCA N. POULSON · 2026 · Case ID: A26037917

DENIED

Summary

The veteran, who served from February 1977 to February 1997, including service in Saudi Arabia during Desert Storm, appeals the denial of service connection for an acquired psychiatric disability and a sleep disturbance. The Board reviewed the evidence of record at the time of the September 2024 rating decision, as the veteran's subsequent appeal attempts were deemed ambiguous or untimely. For the psychiatric disability claim, the Board found no current diagnosis meeting DSM-5 criteria, noting the absence of mental health symptoms or treatment in service records and a lack of diagnosis from a social worker during a post-service evaluation. The VA examiner in September 2024 also found no current symptoms meeting diagnostic criteria. The Board concluded that the evidence persuasively weighed against a current mental health disability, denying service connection. For the sleep disturbance claim, the Board found no evidence of a current disability. While civilian treatment records from 2009 noted primary snoring and a referral for a sleep study, the Veteran's service records were silent on sleep issues. The September 2024 VA examiner found the Veteran did not meet DSM-5 criteria for insomnia disorder due to reporting feeling energized during the day. The Board found the evidence persuasively weighed against a current sleep disturbance disability, denying service connection. The Board also dismissed as untimely any appeal regarding neuropathy of the left lower extremity.

Rationale

No current mental health disability established; Service treatment records negative for mental health issues; VA examiner found no current symptoms meeting DSM-5 criteria

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250224-521562

Full Decision Text

Citation Nr: A26037917
Decision Date: 04/22/26 Archive Date: 04/22/26

DOCKET NO. 250224-521562
DATE: April 22, 2026

ORDER

Service connection for an acquired psychiatric disability is denied.

Service connection for a sleep disturbance is denied.

FINDINGS OF FACT

1. The Veteran does not meet the DSM-5 criteria for current diagnosis of a mental health disability.

2. The Veteran does not have a current sleep disturbance disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for an acquired psychiatric disability are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 4.125, 4.130 (2025).

2. The criteria for service connection for a sleep disturbance are not met. 38 U.S.C. §§ 1101, 1110, 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.317 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1977 to February 1997, including service in Saudi Arabia.

This appeal is before the Board of Veterans' Appeals (Board) from a February 2025 higher-level review (HLR) decision of the agency of original jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO).

Service connection for depression and a sleep disturbance were denied in a September 2024 rating decision. In January 2025, the Veteran requested HLR of these denials. In February 2025, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior September 2024 decision.

In his February 2025 notice of disagreement, the Veteran elected the Direct Review docket. In April 2025, the Veteran submitted another notice of disagreement which appeared to exercise his right to switch dockets under 38 C.F.R. § 20.202(c)(2). In the form, the Veteran indicated an intent to elect the Evidence Submission docket but also requested a virtual hearing. As hearings are only available under the Hearing docket, the Board found the election ambiguous and sent the Veteran a May 2025 letter requesting clarification. The letter explained that if a new form was not submitted prior to the expiration of the one-year appeal period, the April 2025 appeal would not be considered valid. No response was received from the Veteran, and as such the Board finds that his initial February 2025 notice of disagreement electing the Direct Review docket remains active. Therefore, the Board may only consider the evidence of record at the time of the September 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the September 2024 decision, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

The Veteran submitted pertinent evidence outside the evidence window described above. If he would like VA to consider any evidence that was submitted that the Board could not consider, he 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

The Board notes that both the valid February 2025 notice of disagreement and invalid April 2025 notice of disagreement purport to appeal the issue of entitlement to service connection for neuropathy of the left lower extremity as denied in the February 2025 HLR decision. The February 2025 HLR decision, however, did not address this issue, which was last adjudicated in an August 2023 HLR decision. A claimant or his or her representative must file a properly completed notice of disagreement with a decision by the AOJ within one year of the date that the agency mails notice of the decision. Extensions may be granted on written motions showing good cause. 38 C.F.R. § 20.203. The Veteran has neither requested an extension nor shown why his appeal should be accepted more than a year after its most recent denial in the August
to service connection for neuropathy of the left lower extremity as denied in the February 2025 HLR decision. The February 2025 HLR decision, however, did not address this issue, which was last adjudicated in an August 2023 HLR decision. A claimant or his or her representative must file a properly completed notice of disagreement with a decision by the AOJ within one year of the date that the agency mails notice of the decision. Extensions may be granted on written motions showing good cause. 38 C.F.R. § 20.203. The Veteran has neither requested an extension nor shown why his appeal should be accepted more than a year after its most recent denial in the August 2023 HLR decision. As such, any appeal as to this issue is dismissed as untimely.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury." See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023). For "aggravation of non-service-connected disabilities" it is enough to show that a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.

Service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest after active service in the Southwest Asia theater of operations during the Persian Gulf War. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. Unlike service connection on a direct basis, the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 do not require competent medical nexus of a link between the qualifying chronic disability and military service. Service connection is presumed unless there is affirmative evidence to the contrary, where the criteria are met. See 38 C.F.R. § 3.317(c); Gutierrez v. Principi, 19 Vet. App. 1 (2004).

The term "Persian Gulf Veteran" means a Veteran who, during the Persian Gulf War, served on active military, naval, or air service in the Southwest Asia theater of operations. 38 C.F.R. § 3.317(e)(2). As discussed above, the Veteran served in Saudi Arabia.

The term "qualifying chronic disability" means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) a medically unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms, such as: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) functional gastrointestinal disorders (excluding structural gastrointestinal disorders). 38 C.F.R. § 3.317(a)(2)(i).

A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 C.F.R. § 3.317(a)(2).

"Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of und
diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 C.F.R. § 3.317(a)(2).

"Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness or medically unexplained chronic multisymptom illness include, but are not limited to: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b).

For the purposes of 38 C.F.R. § 3.317, disabilities that have existed for six months or more or that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

1. Entitlement to service connection for an acquired psychiatric disability

The Veteran claims service connection for depression and anxiety. See July 2024 VA Form 21-526EZ. The February 2025 HLR decision on appeal denied service connection for both depression and anxiety. The February 2025 10182 only lists depression. However, the Board has construed the claim broadly to encompass any acquired psychiatric disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board notes that a July 2025 rating decision denied service connection for PTSD. The one year appeal period has not yet lapsed.

Service treatment records do not reflect any symptoms of or treatment for any mental health disability. No such abnormality was noted at the Veteran's August 1996 separation examination, and in the accompanying report of medical history he expressly denied having ever experienced depression or excessive worry.

VA treatment records reflect that in October 2023 the Veteran screened positive for depression with suicidal ideation and was referred for mental health evaluation. He stated that he sometimes gets depressed whenever he has to come into medical appointments and wait. He denied current suicidal ideation, stating that he sometimes thinks about it but would never do anything to hurt or harm himself. He described passive thoughts for about three to four months with no intent on acting on them. He stated that he gets depressed at times due to financial problems. He denied any history of mental health treatment. His social worker did not diagnose any mental health disability and determined that he was of a low acute suicidal risk and intermediate chronic suicidal risk.

In his July 2024 claim, the Veteran attributed depression and anxiety to service in Southwest Asia, specifically in 1990 to 1991.

The Veteran underwent a VA examination in September 2024. He denied ever taking psychiatric medications or working with a mental health therapist. The examiner found no current symptoms and stated that the Veteran did not meet the criteria for a mental health diagnosis under the DSM-5.

In an April 2025 informal hearing presentation, the Veteran's representative reiterated the facts and procedural history and provided a summary of service connection principles. The representative attributed the Veteran's claimed depression to seeing dead bodies while stationed in Southwest Asia during Desert Storm.

The Board finds that the evidence persuasively weighs against a finding of a current mental health disability. While the Veteran's
depression and anxiety to service in Southwest Asia, specifically in 1990 to 1991.

The Board finds that the evidence persuasively weighs against a finding of a current mental health disability. While the Veteran's representative argued for an in-service cause to his reported depression, the evidence does not establish the threshold requirement of a current disability. Regulations require a medical diagnosis under the DSM-5 before service connection can be awarded. 38 C.F.R. §§ 4.125, 4.130; see Martinez-Bodon v. McDonough, 28 F.4th 1241 (Fed. Cir. 2022). The evidence in the file at the time of the rating decision on appeal does not establish such a diagnosis. The September 2024 VA examiner found that the Veteran's symptoms did not meet the criteria for a DSM-5 diagnosis. The remaining competent evidence does not contradict this finding. His VA treatment records show a single October 2023 session with a social worker after a positive depression screen in which he reported passive suicidal ideation without intent or a plan. He was given no DSM-5 diagnosis by the social worker, nor was he diagnosed at any other time. Evidence of a current disability is a fundamental requirement for a grant of service connection. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). For these reasons, the Board finds that the evidence persuasively weighs against a finding of a current mental health disability, and service connection is therefore denied.

2. Entitlement to service connection for a sleep disturbance

The Veteran claims service connection for a sleep disturbance.

Service treatment records do not reflect any symptoms of or treatment for any sleep disability. No such abnormality was noted at the Veteran's August 1996 separation examination, and in the accompanying report of medical history he expressly denied having ever experienced frequent trouble sleeping.

Civilian military treatment records reflect that in January 2009 the Veteran was diagnosed with primary snoring and was referred for a sleep study. It is unclear if the study was ever conducted.

In his May 2024 claim, the Veteran claimed service connection for a sleep disturbance. He did not specify his diagnosis or symptoms and did not explain how it was related to service.

The Veteran underwent a VA Gulf War examination in July 2024. When asked about current disabilities related to Gulf War service, he answered "chronic obstructive pulmonary disorder (COPD)", for which he is already service connected.

The Veteran underwent a VA examination in September 2024. The examiner found that he did not meet the criteria for a mental health diagnosis under the DSM-5. The examiner explained that he was assessed for insomnia disorder but did not meet the DSM-5 criteria because he reported feeling energized during the day most days of the week. The examiner further found that the Veteran's reported sleep disturbance did not meet the criteria for chronic disability under 38 C.F.R. § 3.317 as there was no evidence of persistent or recurrent symptoms.

In his January 2025 request for HLR, the Veteran for the first time raised the theory that his claimed sleep disturbance was secondary to his service-connected tinnitus.

In an April 2025 informal hearing presentation, the Veteran's representative reiterated the facts and procedural history and provided a summary of service connection principles. The representative attributed the Veteran's claimed sleep disturbance to seeing dead bodies while stationed in Southwest Asia during Desert Storm.

The Board finds that the evidence persuasively weighs against a finding of a current sleep disturbance disability. While the Veteran and his representative argued for both an in-service cause and a theory of secondary service connection, the evidence does not establish the threshold requirement of a current disability. The September 2024 VA examiner explained that the Veteran's reported symptoms did not meet the DSM-5 criteria for an insomnia disorder diagnosis because he did not report a lack of energy on most days. There is no evidence in the record to contradict this finding. His treatment records do not include any diagnosis related to a sleep disorder. While 38 C.F.R. § 3.317 allows for presumptive service connection for an undiagnosed disability, there remains a requirement for some functional impairment. The Veteran's statements at the examination, however, indicate that his claimed sleep disturbance does not lead to a significant lack of energy. Indeed, the Veteran has not at any time described the nature or consequences of claimed sleep disturbance, and as such there is no competent and credible evidence of functional impairment of earning capacity from sleep issues during the pendency of the claim or recent to the filing of the claim. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Romanowsky v. Shinseki, 26 Vet. App. 289 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). As such, the Board finds that the evidence persuasively weighs against a finding of a current disability and service connection must therefore be denied.

Rebecca N. Poulson

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Gallagher, Counsel

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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