POSTTRAUMATIC STRESS DISORDER (PTSD) DUE TO COMBAT

P.M. DILORENZO · 2026 · Case ID: A26038186

DENIED

Summary

The veteran, who served from November 1967 to December 1971, appeals the denial of an increased disability rating for his service-connected "other specified stressor and trauma related disorder" and the denial of service connection for alopecia areata. The veteran sought a 100% rating for his mental health condition, citing symptoms such as intermittent inability to perform daily living activities, disorientation, and memory loss. However, the Board found that while the veteran experienced some symptoms listed for a 100% rating, his overall occupational and social impairment did not rise to the level of total impairment required. The Board noted the veteran maintained relationships with his former partner and children and had a history of employment, concluding the evidence weighed against a 100% rating. For the alopecia areata claim, the Board found the veteran failed to establish a current disability. Although service treatment records from 1971 documented episodes of alopecia areata and a provisional diagnosis, a March 2025 VA examination found no current condition. The Board found the veteran's lay testimony regarding the diagnosis incompetent, as it required specialized medical knowledge. The evidence persuasively weighed against the claim, making the benefit of the doubt doctrine inapplicable. Service connection for alopecia areata was denied, and the increased rating for the mental health condition was denied.

Rationale

Veteran sought 100% rating based on symptoms like intermittent inability to perform daily living activities and memory loss.; Board found symptoms did not cause total occupational and social impairment.; Veteran maintained relationships and had employment history.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260402-643828

Full Decision Text

Citation Nr: A26038186
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 260402-643828
DATE: April 23, 2026

ORDER

Entitlement to an initial disability rating in excess of 70 percent for other specified stressor and trauma related disorder is denied.

Entitlement to service connection for alopecia areata is denied.

FINDINGS OF FACT

1. The severity, frequency, and duration of the Veteran's other specified stressor and trauma related disorder symptomatology did not manifest as total occupational and social impairment.

2. The evidence of record persuasively weighs against finding that the Veteran has had a diagnosis of alopecia areata at any time during or proximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for an initial disability rating in excess of 70 percent for other specified stressor and trauma related have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.27, 4.126, 4.130, Diagnostic Codes 9499-9410.

2. The criteria for entitlement to service connection for alopecia areata have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1967 to December 1971.

The Rating Decision on appeal was issued in April 2025; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the April 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2025 Agency of Original Jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 Veteran's claim for an increased disability rating for other specified stressor and trauma related disorder and service connection for alopecia areata, 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 interprets the Veteran's statements as reflecting an intent to have this matter reviewed in an expeditious manner, which the Board finds to be an implicit waiver of the Veteran's right to change Board dockets under Williams v. McDonough, 37 Vet. App. 305 (2024).

Increased Disability Rating

VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R., Part IV. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule for Rating Disabilities represent, as far as practicably can be determined, the average impairment in earning capacity resulting from service-connected disabilities in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

Diagnostic codes in the rating schedule identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. All reasonable doubt regarding the degree of disability will be resolved
§ 1155; 38 C.F.R. § 4.1.

During the relevant time period, the Veteran's service-connected other specified stressor and trauma related disorder has been rated as 70 percent disabling under Diagnostic Codes 89499-9410. The hyphenated diagnostic code indicates an unlisted disorder under Diagnostic Code 9499 which is rated, by analogy, under the criteria for other specified anxiety disorder. 38 C.F.R. §§ 4.27, 4.130, Diagnostic Code 9410.

Almost all mental health disorders (with exceptions not applicable here) are evaluated under the General Rating Formula for Mental Disorders (General Rating Formula), which assigns ratings based on particular symptoms and the resulting functional impairment. Id.

Under the General Rating Formula, a 70 percent disability rating requires:

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); inability to establish and maintain effective relationships.

A 100 percent disability rating requires:

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; memory loss for names of close relatives, own occupation, or own name. Id.

The symptoms associated with each evaluation under the General Rating Formula for Mental Disorders do not constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Thus, the evidence considered in determining the appropriate evaluation of a psychiatric disorder is not restricted to the symptoms set forth in the revised (post-1996) General Rating Formula for Mental Disorders. See id.

If the evidence demonstrates that the claimant's psychiatric disorder produces symptoms and resulting occupational and social impairment equivalent to that set forth in the criteria for a given rating in the General Rating Formula, then the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. In this regard, the Board must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013) (noting that the "frequency, severity, and duration" of a veteran's symptoms "play an important role" in determining the disability level).

The severity of the symptoms and the degree of occupational and social impairment they cause are independent factors. See Vazquez-Claudio, 713 F.3d at 116 (rejecting an interpretation of § 4.130 that would allow "a veteran whose symptoms correspond[ed] exactly to a 30 percent rating" to be granted a 70-percent rating solely because they affected most areas). In other words, there are two elements that must be met to assign a particular rating under the General Rating Formula: (1) symptoms equivalent in severity, frequency, and duration to the symptoms corresponding to a given rating, and (2) a level of occupational and social impairment corresponding to that rating that results from those symptoms. See id. at 118 (holding that, in determining whether a 70 percent rating is warranted, VA must
quez-Claudio, 713 F.3d at 116 (rejecting an interpretation of § 4.130 that would allow "a veteran whose symptoms correspond[ed] exactly to a 30 percent rating" to be granted a 70-percent rating solely because they affected most areas). In other words, there are two elements that must be met to assign a particular rating under the General Rating Formula: (1) symptoms equivalent in severity, frequency, and duration to the symptoms corresponding to a given rating, and (2) a level of occupational and social impairment corresponding to that rating that results from those symptoms. See id. at 118 (holding that, in determining whether a 70 percent rating is warranted, VA must make "an initial assessment of the symptoms displayed by the veteran, and if they are of the kind enumerated in the regulation, an assessment of whether those symptoms result in occupational and social impairment with deficiencies in most areas"). While VA considers the level of social impairment, it shall not assign an evaluation based solely on social impairment. 38 C.F.R. § 4.126.

Because the level of disability may have varied over the course of the claim, the rating may be "staged" higher or lower for segments of time during the period under review in accordance with such variations, to the extent the evidence shows distinct time periods where the service-connected disability has exhibited signs or symptoms that would warrant different ratings under the rating criteria. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999).

In initial-rating cases, where the appeal stems from a granted claim of service connection with respect to the initial evaluation assigned, VA assesses the level of disability from the effective date of service connection. See Fenderson, 12 Vet. App. at 126.

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the positive and negative evidence is in approximate balance, which includes but is not limited to equipoise, the claimant receives the benefit of the doubt. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply. Lynch, 21 F.4th at 781-82.

1. Entitlement to an initial disability rating in excess of 70 percent for other specified stressor and trauma related disorder is denied.

The AOJ decision on appeal granted service connection for other specified stressor and trauma related disorder and assigned a 70 percent disability rating, effective December 5, 2024, the date the Veteran filed his claim for service connection. See December 5, 2024, VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. The Veteran seeks an increased disability rating for his service-connected other specified stressor and trauma related disorder. In particular, the Veteran maintains that a 100 percent disability rating is warranted because his other specified stressor and trauma related disorder manifests as an intermittent inability to perform activities of daily living, including maintenance of minimum personal hygiene, disorientation to time or place, and memory loss that consists of forgetting names, directions, and recent events. See April 2026 VA Form 10182. For the reasons discussed below, the Board finds that an increased disability rating is not warranted.

The Veteran was afforded a March 2025 VA Initial Posttraumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, which states that he has a diagnosis of other specified stressor and trauma related disorder. The examination report provides that his other specified stressor and trauma related disorder causes occupational and social impairment with reduced reliability and productivity.

Regarding the Veteran's social and occupational history, the March 2025 VA examination report states that he sees his former partner on special occasions. The Veteran lived with his former partner for more than 20 years and she is the mother of his children. He advised that his relationship with his children is estranged, but that he sees them at birthday celebrations. The Veteran reported that he does not have any friends and that his best friend passed away a couple of years ago. The examination report explains that the Veteran worked as a weather forecaster for approximately 25 years before he retired.

Concerning the Veteran's mental health history, the March 2025 VA examination report states that the Veteran described himself as "an aloner
productivity.

Concerning the Veteran's mental health history, the March 2025 VA examination report states that the Veteran described himself as "an aloner." The Veteran indicated that he is reluctant to join groups and to interact with others. He advised that he used to spend his time in bookstores when he was younger. He mostly worked, except for when he had a relationship with the woman with whom he cohabitated for more than 20 years. He feels that he was a good father even if his children do not feel that way. The examination report states that the Veteran rarely sees his family, and he feels like there has been a dark cloud over him since he has been aging. He said he has difficulty sleeping and wakes up every couple of hours.

The March 2025 VA examination report states that the Veteran has symptoms of depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work-like setting; inability to establish and maintain effective relationships; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene associated with his other specified stressor and trauma related disorder.

The March 2025 VA examiner noted that the Veteran was polite, open, and cooperative during the examination. He was dressed casually and appropriately and he exhibited good hygiene. His affect was blunted and his thought process was logical and organized. The examiner indicated that there were no delusional thought content and no evidence of responding to internal stimuli. The Veteran's speech and motor activity were slow and his memory, attention, and concentration appeared intact. The Veteran was alert and oriented to person, place, time, and situation per the examination report.

The Veteran's claims file does not contain VA treatment records describing the severity, frequency, and duration of his other specified stressor and trauma related disorder.

The Board notes that the March 2025 VA examiner indicated the Veteran experiences intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene, which is a symptom listed for a 100 percent disability rating. 38 C.F.R. § 4.130. However, the presence of this symptom alone is not sufficient to warrant a 100 percent disability rating. See Vazquez-Claudio, 713 F.3d at 117-18. To assign a 100 percent disability rating, the Veteran's symptoms must be shown to cause total occupational and social impairment. See id.

The evidence of record does not demonstrate that the severity of the Veteran's other specified stressor and trauma related disorder has manifested in total occupational and social impairment so as to warrant a 100 percent disability rating. Regardless of the severity, frequency, and duration of the Veteran's psychiatric symptoms, they have not manifested in total occupational and social impairment. The Veteran maintains a relationship with his former partner who is also the mother of his children. He also sees his children on their birthdays. Further, the March 2025 VA examination report provides that the examiner concluded that the Veteran's other specified stressor and trauma related disorder resulted in difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work-like setting; and an inability to establish and maintain effective relationships, as opposed to total occupational and social impairment.

Based on the above, the evidence is neither evenly balanced nor approximately so with regard to whether a 100 percent disability rating is warranted for the Veteran's service-connected other specified stressor and trauma related disorder. Rather, the evidence persuasively weighs against the assignment of a 100 percent disability rating. The benefit of the doubt doctrine is therefore not for application as to this issue. 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82.

Service Connection

Service connection generally will be awarded when a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1112; 38 C.F.R. § 3.303(a). Service
with regard to whether a 100 percent disability rating is warranted for the Veteran's service-connected other specified stressor and trauma related disorder. Rather, the evidence persuasively weighs against the assignment of a 100 percent disability rating. The benefit of the doubt doctrine is therefore not for application as to this issue. 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82.

Service Connection

Service connection generally will be awarded when a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1112; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

To establish service connection on a direct basis, the evidence must show: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link between the current disability and the disease or injury incurred or aggravated in service (the "nexus" element). See Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

The threshold requirement for the grant of service connection, in essence, the first requirement for direct service connection, is that the disability claimed must be shown present. 38 U.S.C. § 1110. Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. Id. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during or contemporary to the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319 (2007).

Again, a claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply. Lynch, 21 F.4th at 781-82.

2. Entitlement to service connection for alopecia areata is denied.

In the AOJ decision on appeal, service connection for the above claimed disability was denied as the evidence of record showed that the Veteran did not have a current disability. The December 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, indicates that he is seeking service connection for alopecia areata. At the time of filing, the Veteran advised that his hair fell out in patches as a result of in-service radiation exposure. For the reasons discussed below, the Board finds that service connection is not warranted.

First, VA has conceded that the Veteran was exposed to ionizing radiation during his service. Cancers, such as skin cancer, are generally considered to be a "radiogenic disease." See 38 C.F.R. §§ 3.309, 3.311. Under 38 C.F.R. § 3.311, the mere contention by a veteran that they were exposed to ionizing radiation during service where they have a diagnosis of a "radiogenic disease" triggers certain development. Specifically, the regulation requires that all relevant information be forwarded to the Under Secretary of Health for preparation of a dose estimate of the Veteran's specific occupational radiation exposure, to the extent possible. 38 C.F.R. § 3.311(a)(2)(iii). The record does not reflect that the Veteran has a radiogenic disease or is seeking service connection for a radiogenic disease. As such, the development prescribed under 38 C.F.R. § 3.311 was not completed. The Board finds that the AOJ did not commit a pre-decisional duty to assist error in not completing this development. 38 C.F.R. § 20.802.

A March 3, 1971, service treatment record states that the Veteran complains of two instances of his hair falling out on a single spot on the left parietal area. He stated that for both times, his hair fell out when he was near the nuclear reactor. A physical examination
iii). The record does not reflect that the Veteran has a radiogenic disease or is seeking service connection for a radiogenic disease. As such, the development prescribed under 38 C.F.R. § 3.311 was not completed. The Board finds that the AOJ did not commit a pre-decisional duty to assist error in not completing this development. 38 C.F.R. § 20.802.

A March 3, 1971, service treatment record states that the Veteran complains of two instances of his hair falling out on a single spot on the left parietal area. He stated that for both times, his hair fell out when he was near the nuclear reactor. A physical examination of the Veteran was normal, and he was diagnosed with alopecia areata. The Veteran was prescribed medication for treatment. The service treatment record states that the Veteran should return for care if needed and that a dermatology consult may be necessary.

A March 4, 1971, Clinical Record Consultation Sheet contained in the Veteran's service treatment records states that he has had two episodes of alopecia areata in submarine school and on the submarine. The Clinical Record provides that the Veteran "relates this to the 'atmosphere' and the proximity to the reactor. He gives a strong impression of repressed anger." The Veteran was provided with a provisional diagnosis of situational depressive reaction with anger and paranoid ideation.

The March 16, 1971, Consultation Report contained within the Clinical Record states that the Veteran had two episodes of psychophysiological alopecia. The Veteran was diagnosed with situational anxiety secondary to the closed submarine environment and alopecia areata secondary to his anxiety.

The Veteran's November 9, 1971, Report of Medical Examination at his separation from active service shows that the clinical evaluation of his skin was normal.

To determine the nature and etiology of the Veteran's claimed alopecia areata, he was afforded a March 2025 VA Skin Diseases Disability Benefits Questionnaire. An in-person examination of the Veteran was conducted. The examination report states that the Veteran does not have a current skin condition, including alopecia areata. The examination report provides that the Veteran reported that his alopecia areata and symptoms of hair loss on the left side of his scalp began in 1970 as a result of working near a nuclear plant. The examination report states that the Veteran does not have any current alopecia areata symptoms, nor does he have any current treatment. The examination report states that the Veteran's alopecia areata has resolved.

The Veteran maintains that he has alopecia areata and that his bald hairstyle does not allow for his disability to be viewed. See April 2026 VA Form 10182. The Board notes that the Veteran, as a layperson, maintains that he has alopecia areata, however, he is not competent to diagnose alopecia areata, as such a determination requires specialized medical knowledge or expertise. While lay testimony is competent to establish the presence of observable symptomatology, it is generally not competent to establish facts which require specialized medical knowledge or expertise. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (noting that while "an appellant who has no special medical expertise may testify as to the symptoms he can observe, he generally is not competent to provide a diagnosis that requires the application of medical expertise to the facts presented"); but see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (recognizing circumstances where lay evidence may be used to establish a diagnosis). Because a diagnosis of alopecia areata is not a symptom that can be determined through observation, but requires the application of medical expertise to the facts presented, the Veteran's statement is not competent to establish such a diagnosis. Clemons, 23 Vet. App at 4-5.

Accordingly, the Board finds that the first element of service connection, a current disability, has not been met with regard to the Veteran's claim for entitlement to service connection for alopecia areata. In so finding, the Board notes that the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, however, the evidence does not establish that the Veteran currently has a diagnosis of alopecia
to the Veteran's claim for entitlement to service connection for alopecia areata. In so finding, the Board notes that the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed. Here, however, the evidence does not establish that the Veteran currently has a diagnosis of alopecia areata.

In the absence of a current diagnosis of alopecia areata, the criteria for service connection have not been met. See Holton, 557 F.3d at 1366; Degmetich, 104 F.3d at 1332. As the persuasive evidence is against the Veteran's claim for service connection, the evidence is not in approximate balance or nearly equal; therefore, the benefit of the doubt rule does not apply. 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82.

P.M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mussey, Sean

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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