POSTTRAUMATIC STRESS DISORDER (PTSD)

D. MARTZ AMES · 2026 · Case ID: A26038059

MIXED

Summary

The Veteran served from June 1989 to September 1989, with additional Reserve service. The Veteran appealed the denial of service connection for PTSD and sought service connection for an acquired psychiatric disorder, including generalized anxiety disorder, as secondary to service-connected back conditions. The Board denied the PTSD claim, finding no current diagnosis of PTSD in the record and that the Veteran's symptoms did not meet the diagnostic criteria. The Board also found clear and unmistakable evidence that the Veteran's psychiatric disorder predated service and was not aggravated by it, thus rebutting the presumption of soundness. However, the Board granted service connection for an acquired psychiatric disorder on a secondary basis. This was based on a January 2025 VA medical opinion which, while denying direct service connection, found a link between the Veteran's psychiatric disability and the worsening of his service-connected back issues. The Board found this opinion persuasive for secondary aggravation, concluding that the psychiatric disorder was aggravated by the service-connected degenerative disc disease, IVDS, spinal stenosis, and spondylosis.

Rationale

No current diagnosis of PTSD; Symptoms do not meet DSM-5 criteria for PTSD; No evidence of in-service stressor or link to current symptoms

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251028-602470

Full Decision Text

Citation Nr: A26038059
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 251028-602470
DATE: April 23, 2026

ORDER

Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied.

Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder, as secondary to service-connected degenerative disc disease with arthritis, IVDS, spinal stenosis, and spondylosis is granted.

FINDINGS OF FACT

1. The Veteran does not have a current diagnosis of PTSD.

2. The Veteran's acquired psychiatric disorder clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated by service.

3. The Veteran's acquired psychiatric disorder is aggravated by his service-connected back disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.304(f), 4.125(a).

2. The criteria for entitlement to service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § § 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1989 to September 1989 with additional service in the Reserves.

Relevant to this appeal, in a February 2025 rating decision, the Agency of Original Jurisdiction (AOJ) denied entitlement to service connection for generalized anxiety disorder and PTSD. In October 2025 the Veteran submitted a supplemental claim seeking service connection for generalized anxiety disorder. In an October 27, 2025 rating decision, the AOJ denied entitlement to service connection for generalized anxiety disorder. On October 28, 2025, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) citing the February 2025 rating decision and selected the direct review docket.

In Terry v. McDonough, the United States Court of Appeals for Veterans Claims discussed simultaneous actions with respect to the same underlying request for benefits, noting that 38 U.S.C. § 5104C(a)(2)(A) "prevents claimants from taking simultaneous actions 'with respect to the same claim or same issue within the claim.'" See Terry v. McDonough, 37 Vet. App. 1, 13 (2023).

Here, there is no concurrent election issue because there was no pending administrative review request when the October 2025 VA Form 10182 was received by VA. The October 2025 supplemental claim was addressed in the October 2025 rating decision. 38 C.F.R. § 3.2500(b); see generally Terry, 37 Vet. App. at 1 (indicating that a claimant may file more than one administrative review request within one year of an initial AOJ decision on a claim, provided that such an administrative review request is not pending concurrently with another administrative review request). Therefore, interpreting the October 2025 VA Form 10182 in the light most favorable to the Veteran, the Board finds that the October 2025 rating decision is the decision on appeal with regard to the issue of entitlement to service connection for an acquired psychiatric disorder as the AOJ conducted additional development following the February 2025 rating decision. See 38 U.S.C. § 5107(b) and 38 C.F.R. § 3.102.

In the October 2025 VA Form 10182, the Veteran elected the Direct Review docket.

Therefore, for the PTSD claim, the Board may only consider the evidence of record at the time of the February 2025 AOJ decision on appeal. For the acquired psychiatric disorder claim, the Board may only consider the evidence of record at the time of the October 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Evidence submitted after the AOJ decisions on appeal was not considered by the Board in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed, specifically after the February 2025 and October 2025 rating decisions. As the Board is deciding the claims, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence.
the time of the October 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Evidence submitted after the AOJ decisions on appeal was not considered by the Board in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Evidence was added to the claims file during a period of time when new evidence was not allowed, specifically after the February 2025 and October 2025 rating decisions. As the Board is deciding the claims, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim 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.

The Veteran's record contains diagnoses of multiple psychiatric disorders, including generalized anxiety disorder and adjustment disorder. A claim for service connection for a psychiatric disability is deemed to encompass all psychiatric diagnoses reasonably presented in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the Board has broadened and recharacterized the claims as an acquired psychiatric disorder, which may encompass all possible diagnoses.

1. Entitlement to service connection for PTSD.

Service connection may be established for PTSD when there is (1) medical evidence diagnosing the disorder in accordance with 38 C.F.R. § 4.125(a); (2) a link, established by medical evidence, between current symptoms and an in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

A thorough review of the Veteran's VA treatment records and private treatment records does not show a diagnosis of PTSD. An August 2020 VA treatment record noted a negative PTSD screening, and in a January 2025 VA examination the examiner noted that the Veteran's symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria.

Based on the above, the Board finds that the Veteran does not have a diagnosis of PTSD during the appeal periods. Accordingly, entitlement to service connection for PTSD is not warranted. The claim is denied.

2. Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Direct service connection may not be granted without evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Preexisting Condition

A veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b).

If the disorder was not "noted" at the time of induction, VA must show by clear and unmistakable evidence both that (1) the disease or injury existed prior to service and (2) that the disease or injury was not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304; Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

Clear and unmistakable evidence is defined as obvious or manifest. 38 C.F.R. § 3.306(b). Clear and unmistakable evidence means that the evidence "'cannot be misinterpreted and misunderstood, i.e., it is undebatable.'" Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009) (citing Vanerson v. West, 12 Vet. App. 254, 258-59
not aggravated by service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304; Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

In a February 2025 rating decision, the AOJ found that the Veteran has a currently diagnosed psychiatric disability (i.e., generalized anxiety disorder). The Board is bound by this favorable finding. 38 C.F.R. § 3.104 (c). Therefore, the first element of direct service connection has been met.

A review of the record raises a question as to whether the Veteran's acquired psychiatric disorder preexisted service.

The Veteran's March 1988 enlistment examination does not contain a notation relating to an acquired psychiatric disorder. Therefore, the Veteran is presumed to have been sound at the time he entered service, and the burden shifts to VA to show by clear and unmistakable evidence that the Veteran's acquired psychiatric disorder existed prior to service and was not aggravated by service.

Regarding the first prong, on the Veteran's March 1988 enlistment report of medical history he endorsed symptoms of depression or excessive worry. The examiner noted that the Veteran reported that he "never was treated for depression" but felt depressed sometimes and took vitamin pills for it. In a September 2017 VA treatment record the Veteran reported the first time he saw a doctor for his anxiety was in high school. He reported taking several medications. He also reported that he only saw a primary care provider, not a mental health care professional. In an August 2020 private medical record, the Veteran was noted to be seeking relief from "lifelong anxiety." Therefore, the Board finds that the Veteran's psychiatric disability clearly and unmistakably existed prior to service.

Regarding the second prong, the government may show a lack of aggravation by establishing by clear and unmistakable evidence that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the preexisting condition." Wagner, 370 F.3d at 1096 (quoting 38 U.S.C. § 1153). This burden of proof must be met by affirmative evidence demonstrating that there was no aggravation. The burden is not met by finding "that the record contains insufficient evidence of aggravation." Horn v. Shinseki, 25 Vet. App. 231, 236-37 (2012).

In a September 2023 VA medical opinion, the examiner opined that the Veteran's psychiatric disability, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated by service. The examiner noted that the Veteran did not relate any incident that occurred in service that would account for his anxiety being aggravated beyond its natural progression. The examiner also noted that the Veteran described his anxiety as gradually progressing over the years, which is inconsistent with an in-service event causing the increase in anxiety.

In a February 2025 VA opinion, the examiner opined that the Veteran's psychiatric disability, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated by service. The examiner noted that the Veteran was maintained on psychiatric medications across high school and had self-reported consistent anxiety as a teenager. The examiner noted that before, during, and after the military the Veteran has been maintained on various psychiatric medications. The examiner noted that the Veteran has continued to report daily anxiety and denied depression, suicidal ideation, irritability, mania, or psychosis. The examiner opined that there is no evidence that the Veteran's anxiety or impairment from it has worsened beyond its natural progression due to service.

The Board finds the September 2023 and February 2025 VA opinions as to whether the Veteran's psychiatric disability was clearly and unmistakably not aggravated by service highly persuasive. The examiners considered the relevant evidence of record, to include the Veteran's lay statements and medical history. The examiners, both of whom were psychologists, provided thorough rationale for their opinions. Further, there is no medical opinion to the contrary.

Based on the foregoing, the Board finds that there is clear and unmistakable evidence that a psychiatric disorder both preexisted the Veteran's active service and was not aggravated therein. As the presumption of soundness has been rebutted, the Veteran is not entitled to service-connected benefits under
beyond its natural progression due to service.

Secondary Service Connection

The Veteran also asserts that the ongoing pain from his service-connected back and neck disabilities contribute to his anxiety. See June 2025 Correspondence.

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310.

Secondary causation exists when, "but for" the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability, although not caused by a service-connected disability, would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the nonservice-connected disability could have been arrested or improved but for the service-connected disability. Id. If a disability is service connected via secondary aggravation, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995).

The Veteran has a currently diagnosed psychiatric disability and is service connected for degenerative disc disease. Therefore, the first two elements of secondary service connection have been met.

In a January 2025 medical opinion, the examiner provided a negative opinion regarding direct service connection. The examiner noted that symptoms of generalized anxiety disorder existed prior to service. The examiner also noted that the Veteran is not able to cope with chronic pain associated with his service-connected back issues. The examiner noted that the Veteran's mental health symptoms, diagnosed as adjustment disorder with anxiety, developed then intensified as his back conditions worsened. The examiner opined that there is a link between the Veteran's psychiatric disability and the worsening of his service-connected back issues.

Upon review of the record, the Board finds that the evidence weighs in favor of service connection for an acquired psychiatric disorder as secondary to the Veteran's back disability.

Although the January 2025 VA medical opinion provided a negative nexus for direct service connection, the examiner explained that the Veteran's acquired psychiatric disorder intensified as his service-connected back disability worsened. The Board finds the January 2025 opinion supports finding that the Veteran's psychiatric disability is aggravated by his service-connected back disability.

Therefore, the Board finds that the third and final element of secondary service connection has been met. Accordingly, entitlement to service connection for an acquired psychiatric disorder as aggravated by his service-connected degenerative disc disease is warranted. To this extent only, the claim is granted.

D. Martz Ames

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Dennis, Associate 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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