PSYCHOSIS

JENNIFER HWA · 2026 · Case ID: A26039054

MIXED

Summary

The Veteran, a Veteran who served from January 1984 to January 2004, appeals the denial of service connection for an acquired psychiatric disorder and prostate cancer. The Veteran claims PTSD related to combat experiences, including threats of missile attacks and transporting injured service members. The Board found the Veteran had a current psychiatric diagnosis, with conflicting opinions from a private psychologist diagnosing PTSD and a VA examiner diagnosing unspecified anxiety disorder. The VA examiner's opinion was deemed conclusory and lacking adequate rationale, failing to consider the Veteran's reported symptoms and overseas experiences. The Board found the private opinion more probative, citing its detailed reasoning and consideration of the Veteran's circumstances. Applying the benefit of the doubt, service connection for the acquired psychiatric disorder was granted. The claim for prostate cancer was remanded due to a pre-decisional duty to assist error. The Board found the VA examination inadequate because it did not consider the combined effects of the Veteran's toxic exposure risk activities (TERA), including burn pits and Persian Gulf service, and failed to provide a clear nexus opinion. The case was remanded for a new examination to address the nature and etiology of the prostate cancer, considering all TERAs and their synergistic effects.

Rationale

Favorable finding of current psychiatric disorder by AOJ; Conflicting opinions from private and VA examiners; VA opinion deemed conclusory and lacking adequate rationale; Private opinion found more probative due to detailed reasoning; Benefit of the doubt applied to resolve approximate balance of evidence

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250304-519251

Full Decision Text

Citation Nr: A26039054
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250304-519251
DATE: April 27, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder is granted.

REMANDED

Entitlement to service connection for prostate cancer is remanded.

FINDING OF FACT

Resolving reasonable doubt in favor of the Veteran, his diagnosed acquired psychiatric disorder is etiologically related to service.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1984 to January 2004.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued February 2025 by a Department of Veterans Affairs (VA) Regional Office; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In December 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for posttraumatic stress disorder (PTSD) and prostate cancer most recently addressed in a May 2019 rating decision. In February 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision.

In the March 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 February 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of entitlement to service connection for prostate cancer, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to service connection for an acquired psychiatric disorder.

The Veteran contends he has PTSD, with symptoms that started during service, related to the threats of missile attacks while flying missions in hostile environments and hearing victim stories while transporting injured and deceased service members.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also 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).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2022).

Regarding the first
78 F.3d 604 (Fed. Cir. 1996). Service connection may also 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).

Regarding the first element of service connection, in the rating decision on appeal, the AOJ favorably found that the Veteran was diagnosed with a disability, noting a January 2025 VA examination report showing a diagnosis of unspecified anxiety disorder. Under the AMA, absent evidence of clear and unmistakable error, the Board is bound by any favorable findings made by the AOJ. 38 C.F.R. § 3.104(c). Notably, a private psychological evaluation report dated August 2024 also reflects a separate diagnosis of PTSD. Therefore, the Veteran has a current disability of a diagnosed acquired psychiatric disorder and the remaining inquiry is whether such is etiologically related to service.

The Veteran provided lay statements in December 2024 reporting that he started experiencing episodes of depression, panic attacks, or anxiety in August 1990 that have continued to the present. He described his overseas experience as an aircrew member flying missions in hostile environments with a constant threat of missile attacks and hearing victim stories while transporting service members injured and killed in action that he reported have stayed in his mind ever since. Notably, the Veteran's DD Form 214, Certificate of Release or Discharge from Active Duty, reflects foreign service and several medals supporting his description of overseas service as an aircrew member.

In the August 2024 psychological evaluation report, a private clinician described the Veteran's relevant history, current symptoms, and objective test results, and opined that the Veteran's symptoms are indicative of PTSD which appear to be related to his military involvement.

The January 2025 VA examination report reflects the finding that the Veteran did not meet the diagnostic criteria for PTSD and was diagnosed with unspecified anxiety disorder. The examiner opined that the Veteran's unspecified anxiety disorder was less likely than not incurred in or caused by service with the rationale that there is no evidence that the Veteran's ongoing mental health disorder is related to the Veteran's military service, no record of mental health problems or treatment during service, or record of consistent report of ongoing mental health problems or treatment since military service.

Upon review of the record, the Board finds that the evidence is at least in approximate balance as to whether the Veteran has an acquired psychiatric disorder that is etiologically related to service. In this regard, the Board notes that the January 2025 VA etiology opinion is conclusory, without adequate rationale, and is largely based on the lack of record of treatment, failing to consider the Veteran's reports of symptoms during and since service. The Board finds the August 2024 private opinion to be most probative, therefore, as it considers the totality of the Veteran's specific circumstances, to include the Veteran's reports of symptoms during and since service and provides a reasoned explanation for the conclusions offered. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for an acquired psychiatric disorder is warranted, and the Veteran's claim is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102

REASONS FOR REMAND

Entitlement to service connection for prostate cancer.

The Veteran contends he developed prostate cancer due to environmental exposures, to include burn pits, during Persian Gulf service.

Upon review of the record, the Board finds that remand is required to correct a pre-decisional duty to assist error. 38 C.F.R § 20.802. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The medical opinion must support its conclusions with sufficient data and reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-304 (2008). Failure to ensure a VA
. 38 C.F.R § 20.802. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The medical opinion must support its conclusions with sufficient data and reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-304 (2008). Failure to ensure a VA medical examination is adequate is a duty to assist error, warranting remand. See 38 C.F.R. § 20.802.

Furthermore, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) requires that, when a veteran whose active service subjected the veteran to participation in a toxic exposure risk activity (TERA) files a claim for service connection and there is evidence of such disability, VA must provide the veteran with a VA examination and obtain a medical opinion addressing the possibility of a nexus between the claimed disability and the TERA. See 38 U.S.C. § 1168(a)(1).

As reflected in VA memorandums dated December 2022, January 2023, December 2024, and January 2025, the Veteran was found to have presumptive toxic exposure as a Persian Gulf Veteran with service in the Southwest Asia theater of operations and to have participated in a TERA. Therefore, the Board finds that the January 2025 VA medical examination is inadequate, as the examiner did not consider the combined, synergistic effects of all TERAs the Veteran participated in. Notably, the examiner included the nexus opinion rationale that there is no evidence indicating exposure to known service-related risk factors (e.g., Agent Orange or other carcinogens) during active duty and that current medical literature does not establish a direct causal relationship, absent specific exposures. As such, it is unclear if the examiner provided the opinion on the factually inaccurate premise that the Veteran had no environmental exposures or if the examiner was suggesting that the Veteran's prostate cancer was not etiologically related to his specific exposures. In either case, the January 2025 VA examination is inadequate to adjudicate the claim and the failure of the AOJ to obtain an adequate examination and etiology opinion addressing the nature and etiology of the Veteran's prostate cancer, to include all TERAs, constituted a pre-decisional duty to assist error. Therefore, remand is required to correct the error and provide the Veteran with an adequate examination and etiology opinion.

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination with an appropriate clinician to address the nature and etiology of his diagnosed prostate cancer.

Following examination and a full review of the claims file, the examiner is asked to opine as to whether it is approximately at least as likely as not that the Veteran's prostate cancer had its onset in or is otherwise etiologically related to service, including exposure to burn pits or the Veteran's toxic exposure risk activities (TERA), after considering the total potential exposure through all applicable military deployments of the Veteran, and the synergistic, combined effect of all TERA.

A complete rationale for all opinions and conclusions expressed must be provided.

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Lane, J.

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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