POSTTRAUMATIC STRESS DISORDER (PTSD)

PAUL R. CASEY · 2026 · Case ID: A26038722

MIXED

Summary

The veteran, who served in the U.S. Army from April 2009 to January 2013, appeals a November 2020 rating decision concerning his service-connected posttraumatic stress disorder (PTSD) and left hip condition. The veteran sought an increased rating for PTSD, arguing his symptoms caused significant occupational and social impairment. He also sought increased ratings for his left hip condition, specifically for extension, flexion, and general impairment. The Board reviewed evidence including a November 2020 VA examination, a December 2024 private examination, lay statements, and hearing testimony. The VA examiner initially assessed PTSD as causing mild or transient symptoms, which the Board found erroneous given the veteran's 50% rating and subsequent evidence. The private examiner assessed total occupational and social impairment from PTSD, which the Board also found erroneous, noting the absence of the most severe symptoms required for a 100% rating. However, affording the veteran the benefit of the doubt, the Board found that from July 2, 2020, onward, the veteran's PTSD symptoms, including near-continuous panic attacks and difficulty adapting to stressful circumstances, warranted a 70% rating. The Board denied an increased rating for the left hip's extension, as the veteran already received the maximum 10% rating and did not demonstrate entitlement to extraschedular consideration. For flexion and impairment, the Board granted a 10% rating, finding evidence of functional loss due to fatigue and instability, but denied higher ratings as the range of motion measurements did not meet the criteria for increased evaluations. The Board noted that a remand for consideration of medication effects on the hip condition would not provide a greater benefit, as the combined ratings would still result in 100% total disability.

Rationale

November 2020 VA examination and December 2024 private examination found adequate for adjudication despite erroneous overall assessments.; November 2020 VA examiner's assessment of mild/transient symptoms deemed erroneous given prior 50% rating and subsequent evidence.; December 2024 private examiner's assessment of total occupational/social impairment deemed erroneous due to lack of most severe symptoms.; Benefit of the doubt afforded due to near-continuous panic attacks, difficulty adapting to stress, and inability to maintain relationships.; Evidence prior to July 2, 2020, did not support a rating higher than 50% due to less frequent panic attacks and better social/work functioning.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210310-145808

Full Decision Text

Citation Nr: A26038722
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210310-145808
DATE: April 24, 2026

ORDER

Entitlement to an increased rating of 70 percent, but no higher, for service-connected posttraumatic stress disorder (PTSD) from July 2, 2020, but no earlier, is granted.

Entitlement to an increased rating in excess of 10 percent for a left hip condition as to extension is denied.

Entitlement to an increased rating of 10 percent, but no higher, for a left hip condition as to flexion is granted.

Entitlement to an increased rating of 10 percent, but no higher, for a left hip condition as to impairment is granted.

FINDINGS OF FACT

1. The evidence of record persuasively establishes that the severity, frequency, and duration of the Veteran's symptomology associated with his PTSD causes occupational and social impairment in most areas from August 19, 2022, but no earlier.

2. The evidence of record falls short of persuasively establishing that the severity, frequency, and duration of Veteran's symptomology associated with his PTSD caused occupational and social impairment in most areas prior to August 19, 2022.

3. The evidence of record falls short of persuasively establishing that the severity, frequency, and duration of his symptomology associated with his anxiety disorder causes total occupational and social impairment at any point in the period on review.

4. The evidence of record persuasively establishes that the Veteran's left hip manifests in fatigue and instability that causes functional loss distinct from the pain in his left hip joint.

5. The evidence of record does not establish that the Veteran experiences any symptomology concerning his left hip as to extension warranting extraschedular consideration.

6. The evidence of record establishes that, at its worst, the Veteran experiences 90 degrees limitation for flexion as to his left hip.

7. The evidence of record establishes that, at its worst, the Veteran experiences 30 degrees limitation for abduction as to his left hip.

CONCLUSIONS OF LAW

1. The criteria for an increased rating of 70 percent, but no higher, for PTSD from August 19, 2022, but no earlier, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411.

2. The criteria for entitlement to an increased rating of in excess of 10 percent for the left hip as to extension have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.27, 4.59, C.F.R. § 4.71a, DC 5251.

3. The criteria for entitlement to an increased rating of 10 percent, but no higher, for the left hip as to flexion have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.27, 4.59, C.F.R. § 4.71a, DC 5252.

4. The criteria for entitlement to an increased rating of 10 percent, but no higher, for the left hip as to impairment have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.27, 4.59, C.F.R. § 4.71a, DC 5253.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Army from April 2009 to January 2013.

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a November 2020 rating decision issued by a Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ).

The Veteran initiated this appeal by submitting a March 2021 VA Form
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Army from April 2009 to January 2013.

The Veteran initiated this appeal by submitting a March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time the AOJ issued the decision on appeal (i.e., November 2020 rating decision), as well as any evidence submitted by the Veteran and/or his representative at the hearing or within 90 days following the hearing (i.e., until January 22, 2025). 38 C.F.R. §?20.302(a).

In October 2024, the Veteran, with his representative in attendance, testified before a Veterans Law Judge during a Board hearing. A transcript of the hearing has been associated with the claims file.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in the adjudication of this claim. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a VA Form 20-0995, Decision Review Request: 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a VA Form 20-0995 are included with this decision.

Because the Board is remanding the claims as to the left hip condition, 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).

The Board evaluated whether there was any evidence that the Veteran's service-connected PTSD and left hip conditions caused him to be unemployable, warranting consideration of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (a claim for TDIU is not a separate claim for benefits but is "part of the claim for benefits of the underlying disability" regardless of whether the claim is raised expressly or reasonably raised by the record); see also A.B. v. Brown, 6 Vet. App. 35 (1992) (holding that in all claims for increased ratings, the veteran is presumed to be seeking the maximum possible evaluation). In the instant appeal, the Veteran has not expressly raised the issue of entitlement to a TDIU in argument, statement, or a filed VA Form 21-8940 Veterans Application for Increased Compensation based on Unemployability. While there is evidence of record indicating that the Veteran's PTSD and left hip conditions negatively affect his ability to work, see, e.g., October 2024 Hearing Transcript, there is no lay or medical evidence in the record that reasonably raises that the Veteran's service-connected acquired PTSD and left hip conditions caused unemployability. Therefore, the Board does not find the issue of entitlement to a TDIU has been raised under Rice.

VA regulations provide that, "[u]pon request, a claimant is entitled to a hearing on any issue involved in a claim [. . .] before VA issues notice of a decision on an initial or supplemental claim." 38 C.F.R. § 3.103(d)(1). That regulation does not indicate that the claimant is entitled to pre-decisional notice of this optional hearing. In fact, 38 C.F.R. § 3.103(b)(1) provides that, following a decision, "[c]laimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief [. . . including] the right to a hearing on any issue involved in the claim as provided in [38 C.F.R. § 3.103(d)." Read together with 38 C.F.R. § 3.103(d), the only notice 38 C.F.R. §
38 C.F.R. § 3.103(d)(1). That regulation does not indicate that the claimant is entitled to pre-decisional notice of this optional hearing. In fact, 38 C.F.R. § 3.103(b)(1) provides that, following a decision, "[c]laimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief [. . . including] the right to a hearing on any issue involved in the claim as provided in [38 C.F.R. § 3.103(d)." Read together with 38 C.F.R. § 3.103(d), the only notice 38 C.F.R. § 3.103(b) requires is that a claimant be provided notice of the right for a hearing with notification of the decision (by definition, a post-decisional notice).

In November 2022, the VA amended VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ), and, in May 2024, the VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. The claim in this appeal was filed on a July 2020 VA Form 21-526EZ prior to the amended version, and therefore the Veteran was not notified of the right to a pre-decisional hearing before the AOJ.

In Bowen v. Shinseki, 25 Vet. App. 250, 253-4 (2012), a veteran was erroneously denied a requested hearing before the AOJ, but because the veteran was afforded due process by notification of his right to appeal and the offer to be heard before the Board, the veteran was not prejudiced by the AOJ's failure to hold a hearing. In the instant appeal, the Veteran neither requested a hearing before the AOJ nor has raised the lack of notice as an issue, and the Veteran was provided notice of his right to a hearing before the Board in the notification letter for the November 2020 rating decision. The Veteran exercised that right during the November 2024 Board hearing. The Board is unable to identify or infer what, if any, prejudice was suffered upon the Veteran by the failure to notice. In light of the above, the Board cannot find that the AOJ committed a prejudicial error by failing to notify the Veteran of the right to a pre-decisional hearing. See Shinseki v. Sanders, 556 U.S. 396, 409 (2009) (internal citations omitted) (a party that seeks to have a judgment set aside because of an erroneous ruling carries the burden of showing that prejudice resulted).

Increased Rating

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Board acknowledges that the Veteran is competent to describe the symptoms he is experiencing and has experienced in the past, but there is no evidence of record demonstrating that he has the necessary medical expertise to establish the severity of his condition. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007). Thus, the Veteran's lay statements are not competent to establish the severity of his PTSD. For that reason, the Board must rely on the medical evidence of record. The Board clarifies it is not disregarding the Veteran's lay statements, but rather, the Veteran's lay statements alone are not competent to establish the severity of his PTSD. See Miller v. Wilkie, 32 Vet. App. 249 (2020).

1. The issue of entitlement to an increased rating in excess of 50 percent for PTSD.

The Veteran contends that he is entitled to an increased rating for PTSD. See October 2024 Hearing Transcript.

General Rating Formula for Mental Disorders

Under the General Rating Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers
competent to establish the severity of his PTSD. For that reason, the Board must rely on the medical evidence of record. The Board clarifies it is not disregarding the Veteran's lay statements, but rather, the Veteran's lay statements alone are not competent to establish the severity of his PTSD. See Miller v. Wilkie, 32 Vet. App. 249 (2020).

1. The issue of entitlement to an increased rating in excess of 50 percent for PTSD.

The Veteran contends that he is entitled to an increased rating for PTSD. See October 2024 Hearing Transcript.

General Rating Formula for Mental Disorders

Under the General Rating Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas. Bankhead, 29 Vet. App. at 20. There are no descriptors, modifiers, or indicators as to suicidal ideation. Id. The presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria is not necessarily dispositive of any particular disability level. Id. at 22.

The General Formula provides for a 10 percent rating when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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 worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for 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; or memory loss for names of close relatives, own occupation, or own name.

The Veteran was granted entitlement to service connection for PTSD in a November 2016 rating decision, assigning an initial rating of 50 percent. Within one year of that rating decision, the VA received a January 2017 VA Form 21-526EZ claiming entitlement to an increased rating for PTSD. The AOJ denied that claim in a June 2017 rating decision, continuing the 50 percent rating for service-connected PTSD. He did not appeal the rating assigned in that decision within one year of the issuance of the June 2017 rating decision nor did he submit new and material evidence. 38 C.F.R. §§ 3.156(b), 19.21, 19.52. Thus, the June 2017 rating decision became final as to the initial rating assigned for
in a November 2016 rating decision, assigning an initial rating of 50 percent. Within one year of that rating decision, the VA received a January 2017 VA Form 21-526EZ claiming entitlement to an increased rating for PTSD. The AOJ denied that claim in a June 2017 rating decision, continuing the 50 percent rating for service-connected PTSD. He did not appeal the rating assigned in that decision within one year of the issuance of the June 2017 rating decision nor did he submit new and material evidence. 38 C.F.R. §§ 3.156(b), 19.21, 19.52. Thus, the June 2017 rating decision became final as to the initial rating assigned for PTSD. See Beraud v. McDonald, 766 F.3d 1402, 1405 (Fed. Cir. 2014); Bond v. Shinseki, 659 F.3d 1362, 1367-68 (Fed. Cir. 2011).

On July 2, 2020, the VA received the Veteran's VA Form 21-526EZ seeking an increased rating for PTSD. The November 2020 rating decision on appeal was issued in response to that claim. Consequently, the period on review extends back to July 2, 2020, with consideration of the one-year look back period, to the present. See 38 U.S.C. § 5110 (b)(3); Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010).

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Evidence of Record

November 2020 VA Examination for PTSD

During a November 2020 VA examination for PTSD, a VA examiner noted the Veteran's PTSD diagnosis as well as his traumatic brain injury (TBI), noting that his PTSD caused recurring distressing thoughts and dreams, anxiety, hypervigilance, insomnia, irritability, and fatigue; his TBI caused vertigo, sleep disturbance, fatigue, agitation, and irritation; and both conditions caused agitation, irritability, sleep disturbance, and fatigue. The VA examiner assessed the Veteran's PTSD caused him occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medications. They noted it was not possible to differentiate whether that impairment was caused by the TBI or PTSD.

The Veteran denied any changes to his social, marital, and family history since the last VA examination, noting he maintained relationships with his parents but only one of his six siblings, and that he was married for five years and had one young son. He noted he had some strain in his marriage, but it had been improving despite his issues with PTSD and angry outbursts.

The Veteran denied any changes to his occupational and educational history since the last VA examination, noting he was employed as a sales manager and operations manager. He stated he experienced some mood swings that affected his performance, though he denied any disciplinary issues at his job, and his supervisors have not noticed, reprimanded, or fired him.

The Veteran denied any changes to his military mental health history since his last VA examination. He recalled having distressing dreams for years and could go 2-3 weeks without a dream. He stated he was a light sleeper, he slept with a firearm next to his bed, and he woke up tense. He avoided large crowds and did not trust people. The Veteran stated his overall mood was generally euthymic, but he was using medication, and he had distant relationships with many people, feeling some guilt. He stated he felt a sense of hypervigilance and an exaggerated startled response. He denied suicidal or homicidal ideation and denied any self-injurious behavior (SIB). He denied having any hospitalizations, emergency room visits, past suicide attempts, legal problems, excessive alcohol use, or illicit substance use.

The VA examiner noted the following symptoms: recurrent, involuntary, and intrusive distressing memories of the traumatic event(s); recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s); avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame); feelings of detachment or estrangement from others; hypervigilance; exaggerated startle response; anxiety; suspiciousness; and chronic sleep impairment.

The VA examiner observed the Veteran was on time and well-groomed; was orientated to time, place,
of the dream are related to the traumatic event(s); avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s); persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame); feelings of detachment or estrangement from others; hypervigilance; exaggerated startle response; anxiety; suspiciousness; and chronic sleep impairment.

The VA examiner observed the Veteran was on time and well-groomed; was orientated to time, place, person, and situation; was forthcoming, answered all questions thoroughly, and made appropriate eye contact throughout the examination; had a rate, tone, and speech rhythm with normal range, including being responsive and talkative through the exam process; his thought content, process, insight, and judgment appeared within normal limits; his mood was euthymic; displayed affect within normal limits congruent to his mood; reported sleep was poor and appetite within normal limits; and there was no evidence of suicidal or homicidal ideation, including planning or intent. They assessed the Veteran was capable of managing his own financial affairs.

October 2024 Board Hearing

During the October 2024 Board hearing, the Veteran stated he was still going through a divorce with his spouse. He stated that he had some "issues" in previous jobs, noting his coworkers found he was "strict and harsh" and did not understand his background. He stated he had a small circle of friends but did not really associate with people outside that circle. The Veteran stated he used different medications over the years, including to treat depression and panic attacks, noting he had developed a heavy anxiety and panic attacks which "happen[ed] randomly all the time," including noting he was feeling anxious prior to the hearing. He stated he had to keep anti-anxiety medication in his pockets at all times, noting having panic attacks when he was driving. The Veteran stated he had worked in the past 3-4 years in a sales position at two different companies, working full-time, and he was about to go into a different position. He stated he had used the VA crisis line before.

December 2024 Private Examination for PTSD

During a December 2024 private examination for PTSD conducted by Dr. A.H., Psy.D, the private provider noted the Veteran had diagnoses of PTSD, unspecified depressive disorder, and a TBI history, noting it was not possible to different what symptoms were attributable to the PTSD and depressive disorder diagnoses. They noted the Veteran's symptoms of lightheadedness, dizziness, headaches, fatigue, deficits in concentration and memory, and agitation were attributable to his TBI, and "all other symptoms" were attributable to his PTSD.

The VA examiner assessed the Veteran's PTSD caused him total occupational and social impairment. They noted it was not possible to differentiate whether that impairment was caused by the TBI or PTSD.

As to the Veteran's social, marital, and family history, the Veteran stated his PTSD had become worse over the years, noting panic attacks. He stated he and his wife separated in 2022 and were going through a divorce, and he lived by himself. The Veteran stated his child lived in a large city and he visits once per month, but he could not handle living in that city, noting "full blown panic attacks" and carrying medications for an emergency. He stated he kept to himself and did not do much socially, though he had 2-3 childhood friends he spoke to on occasion and spoke to his brothers and mother on occasion, but otherwise he did not socialize with people anymore, worked remotely, and no hobbies or religious participation.

As to the Veteran's occupational and educational history, the Veteran stated he worked in sales operations for a technology company, noting that he has worked remotely for 7-8 years, which kept him from "yelling at people" and having outbursts. He stated he had the current job for the past six weeks, but, since his last discharge from active duty, he had seven different jobs.

As to the Veteran's mental health history, the Veteran stated he had tried a variety of treatment and nothing had really worked, though he was still had emergency medication for whenever he experienced panic attacks. He stated he felt depressed but denied suicidal ideation, noting he wanted to be here for his son. The Veteran reiterated his isolation, detachment, and distrust of people, and "[h]e cannot maintain a relationship." The private provider noted the Veteran was irritable, prone to outburst, very hypervigilant, has frequent panic attacks, poor sleep, poor concentration and memory. The Veteran stated he had a DUI and abused alcohol after redeployment, but since then he
since his last discharge from active duty, he had seven different jobs.

As to the Veteran's mental health history, the Veteran stated he had tried a variety of treatment and nothing had really worked, though he was still had emergency medication for whenever he experienced panic attacks. He stated he felt depressed but denied suicidal ideation, noting he wanted to be here for his son. The Veteran reiterated his isolation, detachment, and distrust of people, and "[h]e cannot maintain a relationship." The private provider noted the Veteran was irritable, prone to outburst, very hypervigilant, has frequent panic attacks, poor sleep, poor concentration and memory. The Veteran stated he had a DUI and abused alcohol after redeployment, but since then he did not drink alcohol to that extent and sought help with the VA and counseling.

As to symptoms, the private provider noted the following: recurrent involuntary, and intrusive memories of the traumatic events; recurring distressing dreams in which the content and or affect of the dream are related to the traumatic events; dissociative reactions in which the individual fields are accessed if the traumatic events were recurring; intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic events; marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic events; avoidance of or efforts to avoid distressing memories thoughts or feelings about or closely associated with the traumatic events; avoidance or efforts to avoid external reminders that arouse distressing memories thoughts or feelings about or closely associated with the traumatic events; persistent exaggerated negative beliefs or expectations about oneself others or the world; persistent negative emotional state; markedly diminished interests or participation in significant activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions; irritable behavior and angry outbursts; hypervigilance; exaggerated startle response; problems with concentration; sleep disturbances; depressed mood; anxiety; suspiciousness; panic attacks more than once a week; near continuous panic or depression affecting the ability to function independently appropriately and effectively; chronic sleep impairments; impairment of short term and long term memory; flattened affect; impaired judgment; disturbances of motivation and mood; difficulty in adapting to stressful circumstances including work or awork-like setting; inability to establish and maintain effective relationships; impaired impulse control; and intermittent inability to perform activities of daily living.

VA Treatment Records

In a November 2019 VA appointment, the Veteran stated to a VA social worker that he was "constantly worrying" and discussed having racing, intrusive thoughts and a startled response, noting his heart was palpitating and had hallucinations. The VA social worker noted they discussed the medication with the Veteran to include possible side effects and would follow up with his VA primary care doctor, but they noted no hallucinations were observed on a mental status examination. The evidence of record indicates that the Veteran has otherwise consistently denied, and VA providers had not observed, any suicidal or homicidal ideation, hallucinations, delusions, substance abuse, alcohol abuse, or hospitalizations for mental health reasons on the part of the Veteran. See, e.g., May 2020, June 2020, October 2022, and December 2022 VA treatment records.

During a May 2020 VA social worker appointment, the Veteran reported he was married, had supportive parents, was currently employment full-time and was enrolled in college for his bachelor's degree, and "did not seem overwhelmed by the current situation." They noted the Veteran was independent with activities of daily living (ADLs) and independent activities of daily living (IADLs), though he used a walking stick occasionally due to his hip and ankle pain.

During a June 2020 VA pharmacotherapy outpatient appointment, the Veteran discussed issues with his medication, including heart palpitations, vivid dreams, and feeling like "a zombie and subdued." The Veteran described having an anxiety with "an overwhelming impending feeling of doom with poor concentration." He stated he had anxiety attacks that occurred about 6-7 times per month, noting he became anxious when he became involved in "emotional situations" related to his family or friends, or when he was around crows or malls or "places with 'ethnic' people" that triggered past traumatic memories and made him feel guilty. The Veteran reported depressive episodes with and without anxiety that would last for days at a time.

During a September 2022 VA pharmacotherapy outpatient appointment (submitted into the record in January 2025), a VA provider noted the Veteran was "affectively bright, had a pleasant demeanor, and converse[d] freely throughout the appointment." They noted the June 2020 VA pharmacotherapy outpatient appointment and an August 19, 2022 VA appointment where the Veteran reported panic attacks multiple times per week for the past two weeks, noting symptoms of vertigo prior to a panic and use of medication with success. The Veteran reported that the anxiety attacks occurred on planes, in the middle of the night, and at random times. They noted the Veteran's current stresses included legal proceedings and marriage difficulties, noting his felony arrest and his separation from his spouse. He stated his anxiety lasted anywhere from a typical 15-30 minutes or up to 45 minutes. See also October 2022 VA psychiatry note (the Veteran reported the same stressors - divorce, felony arrest, and also working and moving - and he sought medication for a treatment of an increase in panic attacks); October 2022 VA psychology notes (the Veteran had a history panic attacks exacerbated by recent life stressors but stated his last panic attack was three weeks prior and "minor," noting he did not need medication).

In a December 2022 VA psychology note, the Veteran reported his anxiety had decreased, and he had no panic attacks for the past month, noting he was sleeping better and discontinued his medications. But see December 2022 VA mental health telephone note (the Veteran reported the same stressors and had a "recent[]" increase in panic attacks related to the stressors and requested medication for treatment of panic attacks).

Analysis

Turning to the Veteran's appeal, the Board finds the November 2020 VA examination and December 2024 private examination adequate to adjudicate the appeal to the extent they describe the severity of the Veteran's symptomology at that time. They considered the Veteran's medical history and his lay statements, and, other than the overall assessment of the Veteran's occupational and social impairment, the description of the Veteran's symptoms is not contradicted by the record.

The Board finds issue with both examiners' overall assessments of his occupational and social impairment. The November 2020 VA examination found his PTSD caused occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medications. This assessment correlates with the 10 percent evaluation criteria under the General Formula, but the initial rating of the Veteran's service-connected PTSD was 50 percent due to the occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. See November 2016 rating decision. None of the symptomology within the period on review warrants a 10 percent rating. Further, the Veteran is not subject to reduction procedures pursuant to 38 C.F.R. § 3.105, and it would be a violation of the Veteran's due process rights for the Board to consider a reduction at this juncture. Rather, the Board finds the November 2020 VA examination's overall assessment erroneous. Despite the VA examiner's erroneous overall assessment, the Board finds that the November 2020 VA examination otherwise is adequate to adjudicate the claim and retains probative value.

Likewise, the December 2024 private examination also came to an erroneous overall assessment that the Veteran's service-connected PTSD caused total occupational and social impairment, given the evidence of record indicates that the Veteran's PTSD symptomology falls short of "total" occupational and social impairment. Other than a single instance of hallucinations reported in November 2019, the evidence of record consistently indicates that the Veteran denied or otherwise did not demonstrate the severity, frequency, and duration of the type of symptoms associated with the 100 percent "total" occupational and social impairment, specifically suicidal or homicidal ideation (i.e. persistent danger to self or others), hallucinations, delusions, intermittent inability to perform ADLs, and otherwise grossly inappropriate behavior. As with the November 2020 VA examination, the Board finds that despite the erroneous overall assessment, the Board finds that the December 2024 private examination otherwise is adequate to adjudicate the claim and retains probative value.

Affording the Veteran the benefit of the doubt, the Board finds that the evidence of record persuasively establishes that from July 2, 2020, but no earlier, the severity, frequency, and duration of Veteran's PTSD symptomology, especially his near-continuous panic attacks, caused occupational and social impairment in most areas. Though there was some evidence that the frequency of the Veteran's panic attacks had waned, he did return to the
intermittent inability to perform ADLs, and otherwise grossly inappropriate behavior. As with the November 2020 VA examination, the Board finds that despite the erroneous overall assessment, the Board finds that the December 2024 private examination otherwise is adequate to adjudicate the claim and retains probative value.

Affording the Veteran the benefit of the doubt, the Board finds that the evidence of record persuasively establishes that from July 2, 2020, but no earlier, the severity, frequency, and duration of Veteran's PTSD symptomology, especially his near-continuous panic attacks, caused occupational and social impairment in most areas. Though there was some evidence that the frequency of the Veteran's panic attacks had waned, he did return to the VA to seek additional medication, and the October 2024 Board hearing and December 2024 private medical examination indicated that those panic attacks have continued to manifest. Further, the Veteran's symptoms caused difficulty adapting to stressful circumstances, indicated by his issues with coworkers and need to work remotely to avoid conflict, and his continued isolation indicates an inability to establish and maintain effective relationships as contemplated under the 70 percent rating criteria.

The Board finds that the evidence of record prior to July 2, 2020 does not persuasively establish that the Veteran's symptomology increased in such severity, frequency, and duration warranting a rating higher than 50 percent. The evidence of record indicates that he had panic attacks no more than 6-7 times per month, which falls short of "near-continuous" as contemplated under the 70 percent rating criteria. Further, the evidence of record indicates that he maintained some work and social relationships and otherwise did not demonstrate the severity, frequency, and duration of symptomology contemplated by the 70 percent rating criteria, such as impaired impulse control, obsessional rituals, suicidal ideation, neglect of appearance and hygiene, or near-continuous panic.

Further, as described above, the severity, frequency, and duration of the Veteran's symptomology fell short of total occupational and social impairment as contemplated by the 100 percent rating criteria, given his continued maintenance of some relationships, his full-time employment, the lack of evidence indicating the most severe symptoms - suicidal or homicidal ideation (i.e. persistent danger to self or others), hallucinations, delusions, intermittent inability to perform ADLs, and otherwise grossly inappropriate behavior - and that the November 2020 VA examination and December 2024 private examiner found he could manage his financial affairs.

In light of the above, the Board grants entitlement to an increased rating of 70 percent, but no higher, for service-connected PTSD from July 2, 2020, but no earlier.

2. The issue of entitlement to an increased rating in excess of 10 percent for a left hip condition as to extension.

3. The issue of entitlement to a compensable rating for a left hip condition as to flexion.

4. The issue of entitlement to a compensable rating for a left hip condition as to impairment.

The Veteran contends that he is entitled to an increased rating in excess of 10 percent for his left hip condition as to extension and compensable ratings for his left hip conditions considering flexion and impairment.

The Veteran's left hip is rated under 38 C.F.R. § 4.71a, DC 5251, for limitation of extension of the thigh. Under DC 5251, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a, DC 5251.

The Veteran's left hip is rated under 38 C.F.R. § 4.71a, DC 5252, for limitation of flexion of the thigh. Under DC 5252, a 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252.

The Veteran's left hip is rated under 38 C.F.R. § 4.71a, DC 5253, for impairment of the thigh. Under DC 5253, a 10 percent rating is warranted for limitation of rotation of affected leg, cannot toe out more than 15 degrees. A 10 percent rating is also warranted for limitation of adduction, cannot cross legs. A maximum 20 percent rating is warranted for limitation of abduction, motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, DC 5253.

The rating criteria were modified in February 2021; however, DCs 5251, 5252, and
a, DC 5252.

The rating criteria were modified in February 2021; however, DCs 5251, 5252, and 5253 remained unchanged after February 2021.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

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Evidence of Record

October 2020 VA Examination

Turning to the evidence of record, there is one VA examination as to the left hip within the period on review, the October 2020 VA examination. A VA examiner noted diagnoses of trochanteris pain syndrome, femoral acetabular impingement syndrome, and hip strain. They noted the Veteran's report of functional loss and impairment, including inability to walk, run, or stand for prolonged periods of time, pain, a throbbing sensation, and a clicking sensation while walking. They noted flare-ups of the left hip that occurred weekly, that were moderate to severe, lasting less than one day, precipitated by exertion, running, and standing, and alleviated by rest and lidocaine.

The VA examiner conducted range of motion (ROM) testing as to the left hip, noting flexion of 100 degrees, extension of 30 degrees, abduction of 35 degrees, adduction of 20 degrees, external rotation of 30 degrees, and internal rotation of 30 degrees. They marked "No" as to whether adduction was limited that the Veteran could not cross his legs and "No" as to whether the ROM itself contributed to functional loss. They noted the Veteran exhibited pain on examination that caused functional loss on all ROM tests; that there was objective evidence of localized tenderness or pain on the joint, noting the trochanter joint with a moderate severity and directly related to the Veteran's left hip; and that there was
The VA examiner conducted range of motion (ROM) testing as to the left hip, noting flexion of 100 degrees, extension of 30 degrees, abduction of 35 degrees, adduction of 20 degrees, external rotation of 30 degrees, and internal rotation of 30 degrees. They marked "No" as to whether adduction was limited that the Veteran could not cross his legs and "No" as to whether the ROM itself contributed to functional loss. They noted the Veteran exhibited pain on examination that caused functional loss on all ROM tests; that there was objective evidence of localized tenderness or pain on the joint, noting the trochanter joint with a moderate severity and directly related to the Veteran's left hip; and that there was evidence of pain with weight bearing and objective evidence of crepitus. For observed repetitive use ROM testing, the VA examiner noted there was no additional loss of function or ROM after three repetitions.

For repeated use over time ROM testing, the VA examiner noted the Veteran was not being examined immediately after repetitive use over time, but the examination was otherwise medically consistent with the Veteran's statements describing functional loss with repetitive use over time. They noted the Veteran experienced pain that significantly limited his functional ability with repeated use over a period of time. For ROM testing, they noted flexion of 125 degrees, extension of 30 degrees, abduction of 35 degrees, adduction of 20 degrees, external rotation of 30 degrees, and internal rotation of 40 degrees. They marked "No" as to whether adduction was limited that the Veteran could not cross his legs.

For flare-ups ROM testing, the VA examiner noted the examination was being conducted during a flareup, and that pain and fatigue contributed "significantly" to limiting his functional ability with flareups. For ROM testing, they noted flexion of 90 degrees, extension of 30 degrees, abduction of 30 degrees, adduction of 20 degrees, external rotation of 25 degrees, and internal rotation of 30 degrees. They marked "No" as to whether adduction was limited that the Veteran could not cross his legs.

The VA examiner marked "None" or "No" as to the following: any additional contribution factors of disability; any reduction in muscle strength; muscle atrophy; ankylosis; malunion or nonunion of femur, flail hip joint or leg length discrepancy; and any other pertinent physical findings, complications, conditions, signs, symptoms or scars. They noted the Veteran used assistive devices, including occasional use of cane and regular use of a hip strain brace and Spandex thigh sleeve. As to functional impact, the VA examiner reported he was unable to bend, twist, and stand for prolonged periods of time without pain post aggravation.

October 2024 Board Hearing

During the October 2024 Board hearing, the Veteran stated he tried to keep his weight off his left hip due to instability, noting that with flare-ups he gets a "false sense of balance" and had vertigo, and he sometimes taken spills and falls multiple times.

Analysis

Turning to the Veteran's appeal, considering the Veteran's left hip condition concerning extension under DC 5251, the Veteran is already in receipt of the maximum schedular rating of 10 percent under DC 5251. The Veteran has not asserted that the schedular rating is inadequate, nor has the Board found that the evidence of record shows such exceptional or unusual circumstances to consider whether the Veteran is entitled to extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111, 115-116 (2008); 38 C.F.R. § 3.321(b)(1).

The Board finds the evidence of record supports additional functional loss in his left hips due to fatigue and instability, warranting a 10 percent rating for a left hip condition as to flexion (considering the fatigue the VA examiner noted during flareups ROM testing) and a 10 percent rating for a left hip condition as to impairment (considering the instability in his left hip the Veteran testified about and his ongoing use of assistive devices). These manifestations of functional loss contribute to his functional loss in sitting, walking, running, and standing for prolonged periods of time.

These manifestations of functional loss are distinct from the painful left hip joint motion as reflected in his 10 percent rating for a left hip condition as to extension (DC 5251), given that 38 C.F.R. § 4.59 allows for a single 10 percent rating for painful motion of a joint when no compensable rating is warranted, not for painful motion under each of the limitation of motion DCs pertaining to a joint. See, e.g., Swanbeck v. McDonough, No. 22-0350, 2022 U.S. App. Vet. Claims LEXIS 1859, at *4 (Nov. 22
in sitting, walking, running, and standing for prolonged periods of time.

These manifestations of functional loss are distinct from the painful left hip joint motion as reflected in his 10 percent rating for a left hip condition as to extension (DC 5251), given that 38 C.F.R. § 4.59 allows for a single 10 percent rating for painful motion of a joint when no compensable rating is warranted, not for painful motion under each of the limitation of motion DCs pertaining to a joint. See, e.g., Swanbeck v. McDonough, No. 22-0350, 2022 U.S. App. Vet. Claims LEXIS 1859, at *4 (Nov. 22, 2022) (denying the Veteran's claim for separating ratings for painful motion as to flexion and extension in his knees relying on 38 C.F.R. § 4.59).

The Board finds the evidence of record does not support an increased rating in excess of 10 percent for the left hip condition as to flexion or impairment. For an increased rating as to flexion, the Veteran's ROM testing would have had to yield a flexion limitation of 30 degrees or less, but the Veteran's ROM testing yielded, at worst, 90 degrees limitation for flexion. For an increased rating as to impairment, the Veteran's ROM testing would have had to yield an abduction limitation of or motion lost beyond 10 degrees, but the Veteran's ROM testing yielded, at worst, 30 degrees limitation of abduction.

The Board notes that the evidence of record indicates the Veteran uses medication, implicating Ingram v. Collins 38 Vet. App. 130, 138 (2025). However, in this instance, the Board finds that remand to consider the ameliorative effects of the Veteran's medication on his left hip condition would have no benefit to the Veteran. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). This is because with the Board's granting of the claims within this appeal concerning his PTSD and left hip condition (concerning flexion and impairment) combined with his current service-connected disability ratings results in a total disability rating of 100 percent. No evidence of record suggests that a remand as to his left hip conditions would result in a greater benefit, including consideration of special monthly compensation.

In light of the above, the Board denies entitlement to an increased rating in excess of 10 percent for the left hip as to extension; grants entitlement to an increased rating of 10 percent, but no higher, for the left hip as to flexion; and grants an increased rating of 10 percent, but no higher, for the left hip as to impairment.

Paul R. Casey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Peña, Alan M.

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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