POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the United States Army from February 2012 to July 2012 and in various periods of ACDUTRA/INACDUTRA until August 2019, appeals the denial of service connection for a heart condition, hypertension, and a pulmonary condition, and the denial of service connection for an acquired psychiatric condition. The Board granted service connection for an acquired psychiatric condition, including PTSD, adjustment disorder, unspecified personality disorder, depressive disorder, and insomnia disorder. The veteran contended this psychiatric condition stemmed from bullying and harassment during service. Evidence in favor included July 2024 and August 2019 VA examinations linking symptoms to mistreatment, while evidence against included a November 2024 VA opinion finding no treatment for psychiatric conditions during service. The Board found the evidence in approximate balance, resolving doubt in the veteran's favor to grant service connection. Service connection for a heart condition, hypertension, and a pulmonary condition was denied due to a lack of current diagnosis or evidence linking them to service, as the veteran's claims were not supported by competent medical evidence. The Board remanded claims for FSAD, sinusitis, rhinitis, and a back condition due to pre-decisional duty to assist errors, including inadequate VA examinations and failure to obtain private treatment records.

Rationale

Evidence in favor: July 2024 VA exam linking symptoms to mistreatment, August 2019 VA opinion linking condition to abuse.; Evidence against: November 2024 VA exam finding no treatment for psychiatric condition during service.; Board found evidence in approximate balance, granting service connection.

Full Decision Text

Citation Nr: A26038428
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 251118-606733
DATE: April 24, 2026

ORDER

Entitlement to service connection for an acquired psychiatric condition, to include depressive disorder, anxiety disorder, insomnia disorder, posttraumatic stress disorder (PTSD), adjustment disorder, and unspecified personality disorder, is granted.

Entitlement to service connection for a heart condition is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for a pulmonary condition is denied.

REMANDED

Entitlement to service connection for female sexual arousal disorder (FSAD) is remanded.

Entitlement to service connection for sinusitis is remanded. 

Entitlement to service connection for allergic rhinitis (rhinitis) is remanded.

Entitlement to service connection for a lumbar strain (back condition) is remanded.

FINDINGS OF FACT

1. The Veteran's acquired psychiatric condition is related to bullying and harassment during service. 

2. The evidence of record persuasively weighs against finding that the Veteran has had a heart condition at any time during or approximate to the pendency of the claim.

3. The evidence of record persuasively weighs against finding that the Veteran has had hypertension at any time during or approximate to the pendency of the claim.

4. The evidence of record persuasively weighs against finding that the Veteran has had a pulmonary condition at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for service connection for an acquired psychiatric condition are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a heart condition are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for hypertension are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a pulmonary condition are not 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 in the United States Army from February 2012 to July 2012, as well as various periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) until August 2019. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from November 14, 2024 and November 20, 2024 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO), also known as the Agency of Original Jurisdiction (AOJ). In the November 18, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, for the issue of service connection for an acquired psychiatric condition, the Board may only consider the evidence of record at the time of the November 20, 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. For the remaining issues, the Board may only consider the evidence of record at the time of the November 14, 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. Id. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

For the claims being denied, 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
 the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

For the claims being denied, 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. 

For the claims being remanded, 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).

Finally, the Board notes that in the November 2025 VA Form 10182, the Veteran sought to appeal the issue of service connection for chest pain/torn muscle, from the September 2019 rating decision. However, the appeal of that issue and the September 2019 rating decision was not timely, as the November 2025 VA Form 10182 was received by VA more than one year after notification of that rating decision. 

VA regulations unequivocally provide that, except in limited circumstances, a notice of disagreement (NOD, VA Form 10182) must be submitted to the AOJ within one year of the rating decision being appealed. A notice of disagreement must identify the specific decision and issue(s) therein with which the claimant disagrees. 38 C.F.R. § 20.202, 20.203. VA regulations also provide recourse in circumstances when a filing extension is required. An extension may be granted for good cause if the request is offered in writing and submitted to the Board. See 38 C.F.R. § 20.203(c). Examples of good cause can include serious illness or injury of the appellant or their representative, or an inability to access mail services. 84 Fed. Reg. 138, 153.

The Veteran did not submit a good cause reason for an extension to appeal the September 2019 rating decision. Therefore, the Board must unfortunately find that the Veteran did not timely appeal the issue of service connection for chest pain/torn muscle. However, the Veteran may file a supplemental claim for that condition.

Service Connection

Service connection will be granted for a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a pre-existing injury suffered or disease contracted in the line of duty, in the active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires 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 disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Additionally, active military, naval, air, or space service includes active duty, any period of ACDUTRA during which the individual was disabled from a disease or injury incurred in the line of duty, or any period of INACDUTRA during which the individual was disabled from an injury incurred in the line of duty. See 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a).

The Board is responsible for determining whether the evidence persuasively supports the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. 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 to the claimant. 38 U.S.C. § 5107; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

1. Entitlement to service connection for an acquired psychiatric condition.  

As a preliminary matter, the Veteran specifically applied for service connection for PTSD/anxiety/depression. See July 2024 Application for Disability Compensation and Related Compensation Benefits. Consequently, the Veteran was denied service connection for anxiety/depression in the November 2024 rating decision on appeal. However, the
 regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. 38 U.S.C. § 5107; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

1. Entitlement to service connection for an acquired psychiatric condition.  

As a preliminary matter, the Veteran specifically applied for service connection for PTSD/anxiety/depression. See July 2024 Application for Disability Compensation and Related Compensation Benefits. Consequently, the Veteran was denied service connection for anxiety/depression in the November 2024 rating decision on appeal. However, the Veteran has been previously diagnosed with multiple psychiatric conditions, including PTSD, adjustment disorder with anxious mood, unspecified personality disorder, depressive disorder, anxiety disorder, and insomnia disorder. See June 2019, August 2019 and July 2024 VA examinations. 

When a veteran makes a claim, they are seeking service connection for symptoms, regardless of how those symptoms are labeled. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Accordingly, the Board finds it appropriate to recharacterize the Veteran's claim as one for entitlement to service connection for an acquired psychiatric condition, to include PTSD, adjustment disorder with anxious mood, unspecified personality disorder, depressive disorder, anxiety disorder, and insomnia disorder.

The Veteran contends that she is entitled to service connection for an acquired psychiatric condition. Specifically, the Veteran contended that she was bullied and harassed during service. See June 2024 Veteran statement, July 2024 VA examination. 

In the November 2024 rating decision, the AOJ made a favorable finding that the Veteran was diagnosed with an acquired psychiatric condition. Therefore, the current disability element of service connection is met. See 38 C.F.R. § 3.104(c). 

Additionally, the March 2013 service treatment record showed that the Veteran reported suicidal ideations. The Veteran further disclosed that she was being humiliated by her squad leader and unit members. See March 2013 service treatment records. The Board notes that these service treatment records were during a period of active service as an Army Reserve member. See September 2019 information report. As such, the in-service event element of service connection is met. 

Therefore, the question becomes whether there is a nexus between the Veteran's current acquired psychiatric condition and the in-service event. On this question, there is evidence in favor of and against a nexus. 

Evidence against a nexus includes the November 2024 VA medical opinion. The examiner explained that the Veteran's medical records were silent for treatment of an acquired psychiatric condition during service. As such, the examiner opined that the Veteran's acquired psychiatric condition was not related to service. 

Evidence in favor of a nexus includes the July 2024 VA examination and August 2019 VA medical opinion. In the July 2024 VA examination, the examiner explained that the Veteran had depression, anxiety, and insomnia during service. Additionally, the examiner stated that the Veteran's mental health symptoms came from being mistreated during service. Moreover, the August 2019 VA examiner opined that the Veteran's acquired psychiatric condition was related to physical and verbal abuse during service. 

Accordingly, the Board finds that the evidence is in approximate balance as to whether there is a nexus between the in-service event and the current acquired psychiatric condition. Therefore, the nexus element is met and service connection for an acquired psychiatric condition is granted. 

2. Entitlement to service connection for a heart condition. 

3. Entitlement to service connection for hypertension. 

4. Entitlement to service connection for a pulmonary condition. 

The question for the Board is whether the Veteran has a current disability of a heart condition, hypertension, and/or pulmonary condition that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis for those conditions and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

First, regarding service connection for hypertension, the July 2024 VA examiner stated that the Veteran did not have a hypertension diagnosis. Additionally, the examiner stated that the Veteran was not taking medication for hypertension. Moreover, the Veteran's blood pressure readings during the examination were 140/84, 131/85, and 128/83. The Board has also thoroughly reviewed the record, and there is no evidence of a hypertension diagnosis during or approximate to the claim. 

Second, regarding
 to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

First, regarding service connection for hypertension, the July 2024 VA examiner stated that the Veteran did not have a hypertension diagnosis. Additionally, the examiner stated that the Veteran was not taking medication for hypertension. Moreover, the Veteran's blood pressure readings during the examination were 140/84, 131/85, and 128/83. The Board has also thoroughly reviewed the record, and there is no evidence of a hypertension diagnosis during or approximate to the claim. 

Second, regarding service connection for heart and pulmonary conditions, there is no evidence of a heart or pulmonary condition diagnosis during or approximate to the claim. There were no VA or private treatment records in the claims file that showed a heart condition, pulmonary condition, or any other related diagnoses. The Board notes that the Veteran was not afforded VA examinations for heart or pulmonary conditions. However, an examination was not required under McLendon v. Nicholson, 20 Vet. App. 79 (2006), as there was no competent evidence of a current diagnosed heart or pulmonary disability or persistent or recurrent symptoms of a disability. 

While the Veteran believes there is a current diagnosis of hypertension, heart condition, and pulmonary condition, she is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, knowledge, and the ability to interpret diagnostic tests. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Accordingly, since there is no evidence of a current disability of a heart condition, hypertension, or pulmonary condition, service connection for those conditions is denied. 

REASONS FOR REMAND

Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that she is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159.

1. Entitlement to service connection for FSAD. 

The Veteran contends that she is entitled to service connection for FSAD. Specifically, the Veteran contended that her FSAD was caused by mental health symptoms. See June 2024 Veteran statement. Essentially, the Veteran has claimed that her FSAD is secondary to her now service-connected acquired psychiatric condition. 

Secondary service connection may be granted for a disability that is due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

The Veteran has not been afforded a VA examination and medical opinion for FSAD. The Board finds that the Veteran should have been afforded a VA examination and medical opinion pursuant to the McLendon case. The Board finds that the Veteran is competent to describe struggling with FSAD. See Layno v. Brown, 6 Vet. App. 465 (1994). Additionally, the Veteran was granted service connection for an acquired psychiatric condition herein. Finally, the Veteran explained the relationship between her mental health symptoms and FSAD in the June 2024 statement. As such, not affording the Veteran a VA examination and medical opinion for FSAD was a pre-decisional duty to assist error, and the Board must remand to correct that error. See 38 C.F.R. § 20.802(a). 

2. Entitlement to service connection for sinusitis. 

The Veteran contends that she is entitled to service connection for sinusitis. Specifically, the Veteran contended that her sinusitis was caused by exposure to chemicals, fuels, and dust, because of her work as a construction engineer during service. See June 2024 Veteran statement. 

The Veteran was afforded the July 2024 VA examination and medical opinion for her claimed sinusitis. The examiner stated that the Veteran did not have a sinusitis diagnosis, and therefore opined that the claimed sinusitis was not due to service. However, the Board finds that the AOJ committed two pre-decisional duty to assist errors. First, the June 2024 Veteran statement indicates that she was treated at Mississippi Asthma and Allergy for sinusitis. However, there is no indication that the AOJ attempted to obtain those potentially relevant private treatment records
ended that her sinusitis was caused by exposure to chemicals, fuels, and dust, because of her work as a construction engineer during service. See June 2024 Veteran statement. 

The Veteran was afforded the July 2024 VA examination and medical opinion for her claimed sinusitis. The examiner stated that the Veteran did not have a sinusitis diagnosis, and therefore opined that the claimed sinusitis was not due to service. However, the Board finds that the AOJ committed two pre-decisional duty to assist errors. First, the June 2024 Veteran statement indicates that she was treated at Mississippi Asthma and Allergy for sinusitis. However, there is no indication that the AOJ attempted to obtain those potentially relevant private treatment records. Second, the Board finds that the July 2024 VA examination and medical opinion were inadequate because the examiner was unable to access the private treatment records regarding sinusitis. Therefore, the Board will remand to allow the AOJ to obtain the private treatment records and to afford the Veteran another VA examination and medical opinion. See 38 C.F.R. § 20.802(a).

3. Entitlement to service connection for rhinitis. 

Likewise, the Veteran contended that her rhinitis was caused by exposure to chemicals, fuels, and dust, because of her work as a construction engineer during service. See June 2024 Veteran statement. The July 2024 VA examiner diagnosed the Veteran with rhinitis. However, the examiner opined that the Veteran's rhinitis was not related to service because the July 2024 toxic exposure risk activity (TERA) memorandum, stated that the Veteran did not participate in a TERA. 

The Board finds that the July 2024 VA medical opinion is inadequate. First, the examiner relied entirely on the July 2024 TERA memorandum stating that the Veteran experienced no toxic exposures. Second, the examiner did not address the Veteran's contention that her rhinitis was caused by exposure to chemicals, fuels, and dust, because of her work as a construction engineer. Third, the examiner did not address relevant service treatment records. In particular, the December 2012 service treatment record stated that the Veteran had "numerous allergies since basic training." These were pre-decisional duty to assist errors, and the Board must remand for an addendum opinion. See 38 C.F.R. § 20.802(a). 

4. Entitlement to service connection for a back condition. 

The Veteran contends that she is entitled to service connection for a back condition. Specifically, the Veteran contended that her back condition was caused by physical training during service, as well as a fall in 2013. See June 2024 Veteran statement, July 2024 VA examination. 

The Veteran was afforded the July 2024 VA examination and medical opinion. The examiner diagnosed the Veteran with a lumbosacral strain. Additionally, the Veteran reported during the examination that she fell in 2013 and that her back condition had worsened since. The Board notes that the Veteran had a period of active service in 2013. See September 2019 information report. 

The Board finds that the July 2024 VA medical opinion is inadequate. First, the examiner relied entirely on an absence of records to support the negative nexus opinion. Second, in the opinion, the examiner did not address the Veteran's contentions that her back condition was caused by physical training and a fall in 2013. See June 2024 Veteran statement, July 2024 VA examination. These were pre-decisional duty to assist errors, and the Board must remand for an addendum opinion. 38 C.F.R. § 20.802(a). 

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination for the claimed FSAD. The examiner must review the claims file.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion below.

The examiner is asked to provide a response to the following:

Is FSAD at least as likely as not due to service-connected acquired psychiatric condition?

Is FSAD at least as likely as not aggravated, i.e., made worse, by service-connected acquired psychiatric condition?

The examiner is reminded that causation and aggravation are two separate inquiries and both must be addressed in the opinion. Provide a rationale to support the opinion. 

2. Ask the Veteran to complete a VA Form 21-4142 for Mississippi Asthma and Allergy and any other private providers relevant to her sinusitis claim. Make two requests for the authorized records from identified providers and/or facilities, unless it is clear after the first request that a second request would be futile.

3. After completing the first remand directive, schedule
 following:

Is FSAD at least as likely as not due to service-connected acquired psychiatric condition?

Is FSAD at least as likely as not aggravated, i.e., made worse, by service-connected acquired psychiatric condition?

The examiner is reminded that causation and aggravation are two separate inquiries and both must be addressed in the opinion. Provide a rationale to support the opinion. 

2. Ask the Veteran to complete a VA Form 21-4142 for Mississippi Asthma and Allergy and any other private providers relevant to her sinusitis claim. Make two requests for the authorized records from identified providers and/or facilities, unless it is clear after the first request that a second request would be futile.

3. After completing the first remand directive, schedule the Veteran for a VA examination for the claimed sinusitis. The examiner must review the claims file.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below.

The examiner is asked to provide a response to the following:

Is the sinusitis at least as likely as not related to the Veteran's active service, to include exposure to chemicals, fuels, and dust, while working as a construction engineer? 

If sinusitis is not related to a period of active service, then the examiner should provide an opinion on whether the Veteran's sinusitis is at least as likely as not related to (incurred in or aggravated by) a period of ACDUTRA. The examiner must also opine on whether the sinusitis is related to an injury that occurred during, or was aggravated by, ACDUTRA or INACDUTRA.

If the examiner opines that the Veteran's sinusitis is related to a period of INACDUTRA, the examiner must clarify whether the condition was caused by a disease process or injury.

4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's rhinitis is at least as likely as not related to service, including exposure to chemicals, fuels, and dust, while working as a construction engineer. 

In doing so, the examiner must address the December 2012 service treatment record, which states that the Veteran had numerous allergies since basic training. 

If rhinitis is not related to a period of active service, then the examiner should provide an opinion on whether the Veteran's rhinitis is at least as likely as not related to (incurred in or aggravated by) a period of ACDUTRA. The examiner must also opine on whether the rhinitis is related to an injury that occurred during, or was aggravated by, ACDUTRA or INACDUTRA.

If the examiner opines that the Veteran's rhinitis is related to a period of INACDUTRA, the examiner must clarify whether the condition was caused by a disease process or injury.

5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's back condition is at least as likely as not related to service, including from physical training and/or a fall. See June 2024 Veteran statement, July 2024 VA examination.

If the back condition is not related to a period of active service, then the examiner should provide an opinion on whether the Veteran's back condition is at least as likely as not related to (incurred in or aggravated by) a period of ACDUTRA. The examiner must also opine on whether the back condition is related to an injury that occurred during, or was aggravated by, ACDUTRA or INACDUTRA.

(continued on next page)

If the examiner opines that the Veteran's back condition is related to a period of INACDUTRA, the examiner must clarify whether the condition was caused by a disease process or injury.

 

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Brodbeck

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.