ADJUSTMENT DISORDER

Summary

The veteran, who served in the United States Navy from August 2009 to August 2013, appeals the denial of service connection for adjustment disorder and hearing loss. The veteran claimed adjustment disorder was related to military service, citing anxiety and difficulty adjusting to civilian life, but the Board found this claim unsupported due to a lack of in-service treatment and a significant gap between service and seeking mental health care for childhood issues. The Board also noted inconsistencies in the veteran's reported reasons for seeking treatment. For hearing loss, the veteran claimed it was due to aircraft exposure and affected his social interactions. However, service treatment records were silent regarding hearing complaints, and the separation examination noted the veteran was in good health. A November 2024 VA audiological evaluation found no disabling hearing loss according to VA criteria, with normal speech discrimination and low decibel thresholds. The Board denied both claims, finding the evidence did not establish a relationship to service for adjustment disorder and that the criteria for disabling hearing loss were not met.

Rationale

Lack of in-service treatment records for mental health issues.; Significant gap between service and seeking treatment for childhood issues.; VA examiner opined less likely than not related to service.

Full Decision Text

Citation Nr: A26038457
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 250708-563149
DATE: April 24, 2026

ORDER

Entitlement to service connection for adjustment disorder is denied.

Entitlement to service connection for hearing loss is denied.

FINDINGS OF FACT

1. The Veteran has a current diagnosis of adjustment disorder, however, there is no competent evidence showing the Veteran's adjustment disorder is etiologically related to his military service, was incurred in service or was otherwise related to his military service. 

2. The Veteran was exposed to acoustic trauma during service; however, the Veteran's symptoms of hearing loss were not chronic in service and did not manifest to a compensable degree within one year of separation. 

3. There is no competent evidence showing the Veteran's hearing loss was etiologically related to service, was not incurred in service and was not otherwise related to his military service. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for adjustment disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for entitlement to service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from August 2009 to August 2013.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which denied the claims on appeal. 

In the July 2025 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 December 2024 agency of original jurisdiction (AOJ/RO) decision, which was subsequently subject to the March 2025 higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 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 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. 

By way of procedural background, the Veteran initially submitted a claim for service connection in July 2024, which included a claim for hearing loss and adjustment disorder. A rating decision was issued in December 2024, which denied the claim dues because they neither occurred in nor were caused by service. 

In December 2024, the Veteran sought a higher level review seeking service connection for adjustment disorder and hearing loss. A rating decision was issued in March 2025, which denied the claims as they neither occurred in nor were caused by service. 

The Veteran timely submitted a notice of disagreement (10182/NOD) in July 2025, seeking review of the claims. As such, the claims for service connection of adjustment disorder and hearing loss are properly before the Board for adjudication.

Service Connection Laws and Regulations

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 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). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Establishing service connection generally requires (1) medical evidence of a current
.S.C. § 1110; 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). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 

Entitlement to service connection for adjustment disorder.


 a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 

Entitlement to service connection for adjustment disorder.

The Veteran asserts that his adjustment disorder is the result of his military service. Specifically, the Veteran asserted: "The intensity of never being able to stop or have time to breathe while serving has caused me to always feel anxious. I always feel like the pace of the military in where I have to be." See Veteran's July 2024 statement.

A review of the Veteran's service treatment records are silent for any complaint, diagnosis or treatment for any report of anxiety or symptom of mental health. At the Veteran's June 2013 report of medical history at separation, the Veteran' marked "no" to frequent trouble sleeping; depression or excessive worry; attempted suicide; and received counseling of any type. The Veteran marked "yes" to being in good health. Additionally, the medical provider noted the Veteran was "currently in good health." At a June 2013 report of medical assessment at separation, no issues were noted. 

During post-service VA mental health treatment in July 2022, the Veteran reported that he referred himself "because he has had a lot of fights with his girlfriend recently and she thinks he needs to talk to someone. Veteran reports he thinks he is fine but acknowledges he 'had a fucked up childhood' in that both parents were not  present, causing him to feel unloved with 'a lot of abandonment issues.'" The Veteran was diagnosed with adjustment disorder, alcohol use disorder and was referred to mental health for psychotherapy. During a July 2022 mental health consult, the Veteran stated, "I just want to start talking to someone I have never done therapy; I think there are stuff that is unresolved." The Veteran reported having difficulties in his relationships, especially those who he loves and cares for because he comes off as a "dick" and has no filter. Veteran reported that he can come off as belittling and aggressive. The Veteran reported he wants to look at "how I effect people" and "learn more about myself." The Veteran reported a childhood neglect by both parents and at the age of 9/10 his parents divorced, "mom left, dad started drinking... We jumped from family member to family member." The Veteran reported he shielded his brother from things so he would not have to go through what he went through. The Veteran was diagnosed with adjustment disorder and relational disorder. See West LA VAMC.

The Veteran was afforded a November 2024 VA mental disorders examination. The VA examiner noted a diagnosis of adjustment disorder with mixed anxiety and depressed mood. The Veteran reported he was currently in therapy and reported he has had difficulty transitioning out of service and adjusting to civilian life, has had difficulty meeting expectations of civilian life since his expectations meet service life. The Veteran reported daily anxiety, racing thoughts, some low mood, and difficulty getting along with people. The VA examiner noted the Veteran had symptoms of depressed mood; anxiety; chronic sleep impairment; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a work-like setting; and inability to establish and maintain effective relationships.

The November 2024 VA examiner noted that the Veteran reported he started noticing mental health issues after service. The Veteran reported, "I used to be chill and funny but after service I felt like I had to keep up with the intense speed, if you not working for 14 hours then what am I doing and then I am expecting it from others." The Veteran shared he had a lot of anxiety, and at times had periods of depression. "I live with anxiety and then it dips into depression and back into anxiety." The Veteran shared he had difficulty adjusting to civilian life after service. The Veteran reported feeling anxious every day, stated his relationships had been affected: "I tell people to stop bitching about things because in service we did that but I can't communicate like that, I just tell people to tough it out and make it happen but it made me jump from relationships." The Veteran stated he felt that in service there was always the expectation to toughen things out and figure it out on your own. "It's been a culture shock from service to civilian life." The Veteran shared he had a
 Veteran shared he had a lot of anxiety, and at times had periods of depression. "I live with anxiety and then it dips into depression and back into anxiety." The Veteran shared he had difficulty adjusting to civilian life after service. The Veteran reported feeling anxious every day, stated his relationships had been affected: "I tell people to stop bitching about things because in service we did that but I can't communicate like that, I just tell people to tough it out and make it happen but it made me jump from relationships." The Veteran stated he felt that in service there was always the expectation to toughen things out and figure it out on your own. "It's been a culture shock from service to civilian life." The Veteran shared he had a hard time transitioning from service and meeting expectations of civilian life, and sometimes wondered if he should have stayed in service. The Veteran reported that his sleep was "alright," but woke up frequently throughout the night and had racing thoughts. The Veteran shared that he felt overwhelmed often.

In a separate November 2024 medical opinion, the VA examiner opined that the claimed adjustment disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned: "[The] Veteran meets criteria for adjustment disorder with mixed anxiety and depressed mood however its less likely than not caused by adjustment disorder during service. Veteran's file is silent for MH [mental health] issues during his time in service, and it was confirmed with veteran that he did not receive or seek MH services in service. He shared he started to notice his symptoms after service."

The Board notes that the Veteran has been diagnosed with a disability. Therefore, the first prong of service connection has been met. See Shedden, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

However, the Board notes that the Veteran did not seek mental health treatment until July 2022 when he reported he needed someone to talk to due to a problematic childhood and "abandonment issues." The Veteran continued to seek treatment to address "stuff that is unresolved." This lengthy period without treatment for the disorder tends to weigh against a finding of inservice onset. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (holding that service incurrence may be rebutted by the absence of medical treatment of the claimed disorder for many years after the military discharge). As such, the Board does not find that the Veteran had continuous symptoms from service as his reason for seeking treatment was due to his childhood issues rather than issues from his military service. 

The Board also notes that the Veteran reported to the November 2024 VA examiner that he had difficulty transitioning out of service, adjusting to civilian life and difficulty meeting the expectations of civilian life since his expectations met service life. This is contrary to reasons the Veteran reported he first sought treatment in July 2022. Accordingly, the Board finds that the Veteran may be credible to describe his symptoms, but he is not credible for the reasons he began seeking treatment. 

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011), Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Furthermore, the Board finds that the Veteran is competent to report the symptoms the Veteran experienced, as they would be readily apparent. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms).

The Board has also considered the Veteran's statements regarding his belief that his adjustment disorder is related to his military service. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the etiology of the medically complex mental health disorder of adjustment disorder. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Mental health disorders are medically complex processes because of their multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

While the Veteran is competent to report his service experiences and his sincere belief his mental health disorder is related to his military service, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his adjustment disorder, but still concluded that the Veteran's adjustment disorder is not related to
 complex mental health disorder of adjustment disorder. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Mental health disorders are medically complex processes because of their multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

While the Veteran is competent to report his service experiences and his sincere belief his mental health disorder is related to his military service, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his adjustment disorder, but still concluded that the Veteran's adjustment disorder is not related to the Veteran's military service. As the only medical opinion of record addressing the etiology of the Veteran's current adjustment disorder is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102.

For these reasons, and based on the evidence of record, the Board finds that the weight of the competent, credible, and probative evidence is against a finding of a relationship between the Veteran's adjustment disorder and service. Therefore, the claim for service connection for adjustment disorder is denied. 

Entitlement to service connection for hearing loss.

The Veteran asserts that he has hearing loss from his military service and service connection is warranted. Specifically, the Veteran states, "It is hard to hear and I constantly have to ask people to repeat themselves. I feel this is from aircraft exposure. It makes me anxious to talk to people because the hearing loss makes it hard to follow conversations." See Veteran's July 2024 statement.

A review of the Veteran's service treatment records are silent for any complaint, diagnosis or treatment for any report of difficulty hearing or similar symptoms. The A review of the Veteran's STRs show the Veteran was part of a hearing conservation program and had had a reference audiogram in August 2009 with regular monitoring in October 2010, October 2011 and October 2012. At the Veteran's June 2013 report of medical history at separation, the Veteran marked "no" to hearing loss or wear hearing aid. The Veteran marked "yes" to being in good health. Additionally, the medical provider noted the Veteran was "currently in good health." At a June 2013 report of medical assessment at separation, no issues were noted. 

A review of the Veteran's post-service treatment records were silent for any hearing complaints of any complaints of hearing loss. See West LA VAMC.

The Veteran was afforded a November 2024 VA audio examination. The VA examiner noted the Veteran did not have hearing loss that met the VA disability criteria in both ears. The veteran reported a gradual onset of hearing loss due to constant exposure to aircraft engines while on active duty and a gradual decline in hearing sensitivity.

Impaired hearing is considered a disability for VA compensation purposes when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz is 40 decibels or greater; the thresholds for at least three of these frequencies are 26 or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Court has held that a veteran may establish the required nexus between current hearing loss disability and his term of military service if he can show by competent evidence that his hearing loss disability resulted from the in-service acoustic trauma even where the hearing loss disability does not arise in service. Godfrey v. Derwinski, 2 Vet. App. 352 (1992).

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness.  38 C.F.R. § 4.85, Tables VI and VII.  

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more.  38 C.F.R. § 4.86(a).  In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral.  Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and
 tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more.  38 C.F.R. § 4.86(a).  In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral.  Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral.  38 C.F.R. § 4.86(b).

During a November 2024 VA audiological evaluation, pure tone thresholds, in decibels, were as follows:

		HERTZ			

	1000	2000	3000	4000	average

RIGHT	15	20	15	15	16.25

LEFT	15	15	15	15	15

Speech audiometry revealed speech recognition ability scores using the Maryland CNC Test of discrimination score of 100 percent was noted in the right ear and 100 in the left ear. 

The November 2024 VA audiology consult report findings, applied to Table VI, yield a numeric designation of I in the right ear on the basis of 16.25 decibel puretone threshold average and 100 percent speech discrimination, and a numeric designation of I in the left ear on the basis of 15 decibel puretone threshold average, and 100 percent speech discrimination. The numeric designation for the right ear (I) along with the numeric designation for the left ear (I), entered into Table VII, produce a 0 percent evaluation for hearing impairment.

Because auditory thresholds in any of the frequencies of 500, 1,000, 2,000, 3,000, or 4,000 Hertz were not 40 decibels or greater, the thresholds for at least three of these frequencies were not 26 or greater, and speech recognition scores using the Maryland CNC Test were not less than 94 percent, the criteria to establish a current hearing loss disability in the right ear as required by 38 C.F.R. § 3.385 are not met.

The Board notes that puretone thresholds reported on the audiological evaluations discussed above were not 55 decibels or more at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) and were not recorded at 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz in either ear. Thus, the provision of 38 C.F.R. § 4.86 for exceptional patterns of hearing impairment do not apply in this case.

The remaining evidence of record also does not demonstrate hearing loss in either ear as required by 38 C.F.R. § 3.385. The Veteran has not indicated that there are any outstanding VA or private treatment records pertaining to his claimed hearing loss disorder. 

Moreover, and specifically in respect to hearing loss, an audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In this case, the November 2024 VA examiner indicated the Veteran reported his hearing loss affected his social and work like because "I always have to ask people to repeat." The Board finds that these functional effects of his hearing loss disability are adequately considered by the rating criteria for hearing loss.

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?

As the evidence does not show that the Veteran's hearing loss is to a disabling degree according to 38 C.F.R. § 3.385, the weight of the evidence demonstrates that the Veteran's hearing loss has not met the threshold to establish current hearing loss "disability," and the claim must be denied.

 

 

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Melnyk, H.       

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.