POSTTRAUMATIC STRESS DISORDER (PTSD)

A. J. SPECTOR · 2026 · Case ID: A26039349

MIXED

Summary

The Veteran, who served from January 1976 to November 1978, appeals the denial of an increased rating for PTSD and the denial of service connection for a skin condition. The Board granted entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected PTSD. The Veteran's PTSD, rated at 70 percent, was found to preclude substantially gainful employment based on symptoms of depressed mood, anxiety, suspiciousness, panic attacks, sleep impairment, memory issues, and difficulty with relationships and adapting to stress. The Board found the Veteran's lay statements credible and probative, aligning with VA examiner findings of occupational and social impairment, and a private vocational counselor's opinion that her symptoms would likely impair her ability to meet employer expectations. The Board resolved reasonable doubt in the Veteran's favor for the TDIU claim. However, the appeal for an increased rating for PTSD was denied, as the Board found the Veteran's symptoms did not rise to the level of total occupational and social impairment required for a 100 percent rating. The claim for service connection for a skin condition was remanded due to an inadequate VA medical opinion. The Board noted that the Veteran's claim for a skin condition, including residuals like hyperpigmentation and scarring, reasonably encompassed any skin disability, and the VA examiner's opinion was insufficient because it did not adequately address the conceded toxic exposure risk activities (TERAs) or provide a medical analysis for the nexus. A new opinion is required to determine the nature and etiology of the skin condition and its relationship to service.

Rationale

Symptoms of depressed mood, anxiety, suspiciousness, panic attacks, sleep impairment, memory loss, and difficulty with relationships and adapting to stress do not meet 100% criteria.; No gross impairment in thought processes, communication, persistent delusions/hallucinations, or grossly inappropriate behavior.; No persistent danger of hurting self or others, or inability to perform daily activities.; Veteran was cooperative, pleasant, with congruent affect and normal speech/thought content.; No current suicidal/homicidal ideation or violent outbursts.

Special Benefit

TDIU

Diagnostic Code

9411

Docket No.

251121-610141

Full Decision Text

Citation Nr: A26039349
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 251121-610141
DATE: April 28, 2026

ORDER

Entitlement to a rating in excess of 70 percent for posttraumatic stress disorder (PTSD) is denied.

Entitlement to a total disability rating based upon individual unemployability due to service-connected disability (TDIU) is granted.

REMANDED

Entitlement to service connection for a skin condition, including residuals of a skin condition, is remanded.

FINDINGS OF FACT

1. For the entire period on appeal, the severity, frequency, and duration of the Veteran's symptoms did not more closely approximate total occupational and social impairment.

2. Resolving reasonable doubt in the Veteran's favor, her service-connected PTSD precluded substantially gainful employment.

CONCLUSIONS OF LAW

1. The criteria for a disability rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411.

2. The criteria for a TDIU have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.16, 4.19.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1976 to November 1978.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of December 2024 and March 2025 supplemental claim rating decisions issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

As further explained below, the Veteran's claim of service connection for melanoma encompasses claims for all skin disabilities that are reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). As such, the Board has recharacterized the claim as reflected above.

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, with respect to the issue of service connection for a skin condition, the Board may only consider the evidence of record at the time of the December 2024 rating decision on appeal, and for the issue of a TDIU and an increased rating for PTSD, the Board may only consider the evidence of record at the time of the March 2025 rating decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ issued the respective rating 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 regarding a TDIU or an increased rating for PTSD 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 service connection for a skin condition, 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.

1. Entitlement to a rating in excess of 70 percent for PTSD is denied.

The March 2025 rating decision continued the Veteran's 70 percent rating for PTSD; she seeks a higher rating. See November 2025 VA Form 10182.

By way of background, the Veteran filed her initial claim for an increased rating for PTSD in a VA Form 21-526EZ received by VA on September 22, 2023. A December 2023 rating decision denied her claim, after which the Veteran submitted her August 2024 supplemental claim for an increased rating for PTSD. After the AOJ issued the March 2025 supplemental claim rating decision on appeal again denying an increased rating for PTSD, she timely appealed in November 2025.

The Board notes that, within one year from the date on which the AOJ issued a notice of a decision on an initial claim, a claim
she seeks a higher rating. See November 2025 VA Form 10182.

The Board notes that, within one year from the date on which the AOJ issued a notice of a decision on an initial claim, a claimant may continuously pursue such claim by properly filing one of the following review options: a supplemental claim, a request for higher-level review, or an appeal to the Board. See 38 U.S.C. §5110; 38 C.F.R. § 3.2500. As the Veteran's August 2024 supplemental claim was filed within one year of the date that the AOJ issued the December 2023 rating decision, and she timely appealed the March 2025 supplemental claim rating decision, the Board finds that her increased rating claim for PTSD has been continuously pursued. Id. Thus, the appeal period before the Board begins on September 22, 2022, which is one year prior to the date VA received the Veteran's increased rating claim. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. See 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2.

All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

For the entirety of the appeal period, the Veteran was assigned a 70 percent rating under DC 9411 for her PTSD, which is evaluated under the General Rating Formula for Mental Disorders (Formula). 38 C.F.R. § 4.130.

Under this Formula, a 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id.

A 100 percent rating under this Formula is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations, grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

The symptoms listed are not exhaustive, but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). A Veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). While symptomatology should be the primary focus when deciding entitlement to a given disability rating, § 4.130
Id.

In addition to frequency, severity and duration of symptoms, the Board must also consider the length of remissions and the Veteran's capacity for adjustment during periods of remission and then assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126.

VA treatment records during the period on appeal consistently show that the Veteran was alert and oriented with grossly intact orientation, and that she was in no acute distress and speaking in full sentences. Her speech, language, and knowledge were normal, and her thought process was linear. Her mood ranged from congruent to anxious, with no hallucinations, delusions, or suicidal or homicidal ideation, and her memory, attention, concentration, insight, and judgment were intact. April 2023 VA treatment records show that she was taking care of her grandchildren during a cruise with her family, and that while she had some issues forgetting conversations, she had no difficulty managing her finances or driving. No other changes in cognitive functioning were noted.

In her October 2023 VA Form 21-8940, the Veteran stated that she had disagreements with her coworkers and "blew up" at those who did not complete their work. She said that people became afraid of her, which made her paranoid that they were trying to get her fired. After getting angry to the point of quitting her job, she had a fight with her husband that resulted in divorce. She said that she tried to be self-employed because she was "okay by herself," noting that she had conflicts with customers while waitressing. She said that she wanted to isolate and that there were "many times where [she] wanted to end [her] life."

The Veteran was first afforded a VA examination to address the current severity of her PTSD in October 2023. The Veteran reported that she was divorced and lived with her daughter, son-in-law, and two grandchildren, and that she has very close relationships with her three living children and 13 grandchildren. She said that while she has not worked since February 2015, she takes care of her grandchildren during the day but isolates herself after dinner. She reported having a close relationship with one brother but not her other siblings and that she does not socialize with friends. She also said that she had problems with people who try to dominate her. She reported symptoms of anxiety, distressing dreams, and depression, but denied suicidal and homicidal ideation.

Upon examination, the Veteran was cooperative and her interactions were appropriate. Her mood was euthymic with congruent affect, and her memory, thought flow and content, speech, perception, and attention were within normal limits. The October 2023 VA examiner endorsed occupational and social impairment with reduced reliability and productivity based on symptoms of depressed mood; anxiety (including exaggerated startle response); suspiciousness (including hypervigilance); panic attacks that occur weekly or less often; chronic sleep impairment (including sleep disturbance); mild memory loss, such as forgetting names, directions or recent events (including problems with concentration); disturbances of motivation and mood (including irritable behavior and angry outbursts with little or no provocation typically expressed as verbal or physical aggression toward people or objects); difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work like setting.

The Veteran was afforded another VA examination for her PTSD in October 2024. She reported that she still lived with her daughter and son-in-law and helps take care of three grandchildren. She said that she had a good relationship with her daughter but they "bump heads" a lot as her daughter has obsessive-compulsive disorder and "never thinks [the Veteran] do[es] things right." She said that she has a good relationship with granddaughters and "enjoys" spending time with them
little or no provocation typically expressed as verbal or physical aggression toward people or objects); difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work like setting.

The Veteran was afforded another VA examination for her PTSD in October 2024. She reported that she still lived with her daughter and son-in-law and helps take care of three grandchildren. She said that she had a good relationship with her daughter but they "bump heads" a lot as her daughter has obsessive-compulsive disorder and "never thinks [the Veteran] do[es] things right." She said that she has a good relationship with granddaughters and "enjoys" spending time with them but that her son-in-law is distant. She said she has a good relationship with her other children but denied having any other significant relationship. She used to enjoy photography but had not "done anything with it in a while."

Regarding work, she said she last worked as a cashier but started having authority issues and felt "everyone else was slacking." After trying to talk to the manager about it several times, nothing was done, so she "blew up and walked off the job." She added that she had difficulty maintaining employment since service due to conflicts with her superiors, and while she would like to work, she always ends up having issues with people in authority.

The Veteran reported symptoms of being withdrawn and very quiet; feeling depressed and tired all the time; brushing her teeth and washing her face daily but showering every couple of days; difficulty motivating herself to get up every day; bouts of crying once or twice a week; anger and irritability, such that she had a problem working all her adult life due to issues with authority; frequent dreams of past trauma and trouble sleeping without medication; and difficulty focusing and staying on task due to her bad short-term memory.

Upon examination, the Veteran was appropriately dressed, with no notable deficits with grooming or hygiene. She was cooperative and pleasant and exhibited no signs of psychomotor agitation or inappropriate behavior. Her speech was clear, with normal rate, rhythm, and volume, and her affect was congruent with access to full range. She reported feeling tired, depressed, and often anxious. While her intelligence appeared to be of average ability, she reported having problems with her memory, sustained attention, or concentration. She was oriented to person, place, time, and situation, and her thought processes were coherent and logical. She credibly denied past and present suicidal or homicidal ideation, intent, or plans. She also denied having hallucinations and there was no evidence of delusions. She was independent with activities of daily living and reported having no major problems with hygiene or self-care. She possessed fair insight, good judgment, and impulse control, and was judged to be a reliable historian.

The October 2024 VA examiner endorsed occupational and social impairment with reduced reliability and productivity based on symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work like setting.

Based on the evidence of record, the Board finds that a rating in excess of 70 percent is not warranted at any point during the appeal period.

As noted above, a 100 percent rating for PTSD is warranted where there is total occupational and social impairment. Here, the Veteran's occupational and social impairment manifests primarily in symptoms of depressed mood; anxiety (including exaggerated startle response); suspiciousness (including hypervigilance); panic attacks that occur weekly or less often; chronic sleep impairment (including sleep disturbance); mild memory loss, such as forgetting names, directions or recent events (including problems with concentration); disturbances of motivation and mood (including irritable behavior and angry outbursts with little or no provocation typically expressed as verbal or physical aggression toward people or objects); difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work like setting. Additional symptoms include impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); neglect of personal appearance and hygiene; and suicidal ideation. However, none of these symptoms are commensurate with a 100-percent rating. See 38 C.F.R. §4.130.

The evidence of record does not show that the Veteran has any symptoms of gross impairment in thought processes or communication; persistent delusions or hallucinations; or grossly inappropriate behavior. Id. The VA examiners of record noted that she was cooperative, pleasant, and appropriate, with congruent affect and
; and difficulty in adapting to stressful circumstances, including work or a work like setting. Additional symptoms include impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); neglect of personal appearance and hygiene; and suicidal ideation. However, none of these symptoms are commensurate with a 100-percent rating. See 38 C.F.R. §4.130.

The evidence of record does not show that the Veteran has any symptoms of gross impairment in thought processes or communication; persistent delusions or hallucinations; or grossly inappropriate behavior. Id. The VA examiners of record noted that she was cooperative, pleasant, and appropriate, with congruent affect and normal speech thought content. February 2023 VA treatment records show that she was pleasant with a normal, polite, and stable mood; made appropriate eye contact; had normal speech; responded appropriately to questions; and had goal-directed thought content. She did not present with any delusions or hallucinations, and her memory, attention, concentration, and judgment were normal.

While the Veteran reported concentration and memory issues that affected her ability to remember conversations, there is no evidence that these issues resulted in a disorientation to time and place or memory loss for names of her close relatives, own occupation, or own name. Id. Although she reported irritability and angry outbursts in 2015 and a history of suicidal ideation, she reported no current suicidal or homicidal ideation or violent outburst indicating that her behavior resulted in a persistent danger of hurting herself or others. See 38 C.F.R. §4.130; Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed April 17, 2026) (defining "persistent" as "existing for a long or longer than usual time or continuously" or "continuing without change in function or structure").

The Board acknowledges the Veteran's report of washing her face and brushing her teeth daily but showering only every couple of days. However, the record shows that the Veteran had no notable deficits with grooming or hygiene at her October 2024 VA examination and she reported being capable of acting independently with respect to activities of daily living, including her finances and driving. Thus, while the Veteran reported a neglect of hygiene and that she sometimes will not shower daily, nothing in the record indicates that she had an inability to perform daily activities, as contemplated by the 100-percent rating. 38 C.F.R. § 4.130.

Moreover, the VA examiners determined that the Veteran's PTSD resulted in, at most, reduced reliability and productivity. While her symptoms of irritability, concentration, and memory issues may have occasionally affected her ability to perform work activities, the examinations note that the Veteran was responsible for the care of her grandchildren and was independent in her daily activities. Further, she maintained a relationship with her children and grandchildren, despite her symptoms of withdrawal or isolation.

Thus, while her symptoms may cause some difficulty at work or with her relationships, the Board finds that this difficulty does not rise to the level of total occupational and social impairment, as contemplated by the 100-percent rating. 38 C.F.R. §§ 4.126, 4.130.

In light of the above, the Board finds that the evidence of record persuasively weighs against a finding that the Veteran has the requisite social and occupational impairment to warrant a rating in excess of 70 percent for her PTSD; as such, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 4.3; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The appeal is denied.

2. Entitlement to a TDIU is granted.

The Veteran asserted that her service-connected PTSD has rendered her unable to secure employment since February 2015. See October 2023 VA Form 21-8940. Specifically, she reported that her anger, conflicts with coworkers, and issues with authority due to her military sexual trauma (MST) prevented her from working. Id.

Initially, the Board notes that the Veteran's only service-connected disability is PTSD and that her disability rating as of September 28, 2015, was 70 percent. A veteran is eligible for schedular TDIU consideration provided that their service-connected disability is ratable at 60 percent or more, or if there are two or more service-connected disabilities, at least one such disability is ratable at 40 percent or more and there is sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4
she reported that her anger, conflicts with coworkers, and issues with authority due to her military sexual trauma (MST) prevented her from working. Id.

Initially, the Board notes that the Veteran's only service-connected disability is PTSD and that her disability rating as of September 28, 2015, was 70 percent. A veteran is eligible for schedular TDIU consideration provided that their service-connected disability is ratable at 60 percent or more, or if there are two or more service-connected disabilities, at least one such disability is ratable at 40 percent or more and there is sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16. The March 2025 rating decision on appeal favorably found that the Veteran meets the schedular criteria for a TDIU; the Board is bound by this favorable finding. 38 U.S.C. § 5104A.

A TDIU may be assigned when a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16. The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components. See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019). The economic component refers to an occupation earning more than marginal income, while the noneconomic component requires a determination as to a veteran's ability to secure and follow such employment. Id. Attention should be given to the veteran's history, education, skills, and training; whether the veteran has the physical ability to perform the types of activities required by the occupation at issue; and whether the veteran has the mental ability to perform the activities required by the occupation at issue. Id.

An award of TDIU is an individualized determination, specific to a veteran's particular circumstances, e.g., their history, education, skills, and training. See Todd v. McDonald, 27 Vet. App. 79, 85 (2014). It does not require a showing of 100 percent unemployability. Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001). Age may not be considered as a factor in evaluating unemployability. 38 C.F.R. §§ 3.341, 4.19. The ultimate question is whether they are capable of performing the physical and mental acts required by employment, not whether they can find employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).

Therefore, the question before the Board is whether the Veteran was unable to secure and maintain substantially gainful employment due solely to her PTSD.

On her October 2023 VA Form 21-8940, the Veteran reported that she joined the military when she was 17, completed two years of college, and had additional training in general nursing, and her DD214 shows that she served as Military Police. Her October 2023 VA Form 21-8940 reflects employment as a waitress, cashier, stocker, and retailer, and a November 2024 VA examiner noted a history of employment as a window cleaner.

The Veteran does not assert, and the record does not show that her service-connected PTSD has resulted in any physical limitations with respect to employment, but the record does show that it has resulted in mental limitations.

Both VA examiners for the Veteran's PTSD endorsed occupational and social impairment with reduced reliability and productivity based on symptoms of depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work like setting.

The October 2023 VA examiner opined that the Veteran's symptoms may result in problems working closely with others due to her anxiety, depression, and relationship issues or problems in jobs where safety is a concern as these jobs may require immediate recall or a high level of alertness which could be impacted by her sleep impairment, anxiety, depression, and forgetfulness.

The October 2024 VA examiner opined that the Veteran's mental health symptoms appeared to have a moderate impact on her social and occupational functioning, noting that she has not worked outside the home since 2015. The examiner said that her noted mental health symptoms interfere with interpersonal relatedness, concentration and memory, and the ability to tolerate stress, which would likely impair her ability to work cooperatively and effectively with coworkers and supervisors, communicate effectively, and maintain persistence on tasks.

The
closely with others due to her anxiety, depression, and relationship issues or problems in jobs where safety is a concern as these jobs may require immediate recall or a high level of alertness which could be impacted by her sleep impairment, anxiety, depression, and forgetfulness.

The Board observes the Veteran's lay statement that the issues with authority stemming from her MST caused conflict with her coworkers and supervisors and a distrust of coworkers due to their fear of her. See October 2023 VA Form 21-8940. This is consistent with her September 2015 statement in support of claim in which she said that, following her MST, she had "constant run-ins with male supervisors" and prefers to be in charge so that "no one can hurt [her]."

The Board notes that the Veteran is competent to report the functional limitations caused by her service-connected disabilities, and as these lay statements are consistent with the other evidence of record, the Board finds these statements credible and probative. Layno v. Brown, 6 Vet. App. 465, 469-71 (1994); Caluza v. Brown, 7 Vet. App. 498, 511 (1995).

Additionally, an August 2024 opinion from a private vocational counselor determined that the symptoms noted in the Veteran's VA examinations would interfere with her ability to produce a certain minimum amount of work each day consistently and reliably, which would preclude her ability to meet employer expectations of adequate pace and productivity. The counselor explained that, due to her depressed mood, low motivation, memory impairments, and difficulty getting started with tasks, she would likely require frequent redirection or reminders to remain on task and to meet productivity goals, which would be considered burdensome to employers, regardless of skill or exertional level.

Further, the counselor opined that her isolation, anxiety, hypervigilance, suspiciousness, difficulty with work relationships, irritability, and feelings of detachment and estrangement would cause her to have difficulty working around or in coordination with others, including incidental contact. As the ability to work with others is a basic requirement of all substantially gainful employment, her inability to do so would eliminate her from competitive employment.

The counselor considered the October 2023 VA opinion suggesting that the Veteran might be able to work remotely or in positions that allow flexibility in terms of schedule or the ability to work independently, as she provides care for her grandchildren on a daily basis. However, the counselor noted that such care is not indicative of her ability to secure and follow substantially gainful employment in any capacity, given that she is not required to report to a supervisor, and there are no established standards for pace, productivity, or interpersonal interaction.

Moreover, the Board notes that nothing in the Veteran's background suggests she has the skills, education, or training to procure remote positions, as her work history is primarily in stockrooms, customer service, and the military. As such, the Board finds that regardless of skills, education, or training, the Veteran's particular circumstances preclude her from employment. See Todd, 27 Vet. App. at 85, Van Hoose, 4 Vet. App. at 363.

In sum, the Board finds that the evidence is at least in approximate balance as to whether the Veteran is entitled to a TDIU due to her service-connected PTSD that precludes her from the ability to secure and follow a substantially gainful occupation consistent with her education, skills, training, and work history, and resolves reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch, 21 F.4th 776, 781-82. The appeal is granted.

REASONS FOR REMAND

Entitlement to service connection for a skin condition, including residuals of a skin condition, is remanded.

The Veteran asserts that her skin condition is due to service. See September 2023 VA Form 21-526EZ.

The December 2024 rating decision on appeal favorably found that the Veteran has a current diagnosis of perioral dermatitis and conceded that she participated in toxic exposure risk activities (TERAs) during service; the Board is bound by these favorable findings. 38 U.S.C. § 5104A.

At her November 2024 VA examination for a skin
21 F.4th 776, 781-82. The appeal is granted.

REASONS FOR REMAND

Entitlement to service connection for a skin condition, including residuals of a skin condition, is remanded.

The Veteran asserts that her skin condition is due to service. See September 2023 VA Form 21-526EZ.

At her November 2024 VA examination for a skin condition, the Veteran reported that she had lesions on her skin that appeared approximately six years prior but was unsure whether the cancer she had was melanoma. She also reported that her current symptoms include hyperpigmentation, skin irritation on her face, and a rash around the mouth and nasal area, and the November 2024 VA examiner noted a scar due to excisional removal of a malignant primary neoplasm currently in remission. The November 2024 VA opinion concluded that the Veteran's skin condition is less likely than not caused by her in-service TERAs, as she served during peacetime, she was unsure of her melanoma diagnosis, and although her post-military records reflected squamous cell carcinoma, there was no pathology report of melanoma and no current evidence of melanoma.

When VA undertakes to provide a VA examination or obtain a VA medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Unfortunately, remand is necessary as the VA opinion of record is inadequate.

Initially, the Board notes that the timeframe that the Veteran served is irrelevant with respect to her TERA, as such exposure has already been conceded by VA. Therefore, the November 2024 VA opinion is inadequate as it concluded that her condition is not related to a TERA without providing any medical analysis for the Board to weigh. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). Furthermore, the opinion is inadequate as it essentially stated that the Veteran's skin condition is not due to service as she did not correctly diagnose her own skin condition.

The Board notes that while a claimant is competent to identify symptoms of their claimed disability, they are generally not competent to diagnose their own condition. Clemons, 23 Vet. App. at 5. Accordingly, a claim for a certain diagnosis must be considered a claim for any disability that may reasonably be encompassed by several factors, including the description of the claim, the symptoms described, and information submitted or obtained in support of the claim. Id.

In this case, the Veteran has described her condition as a type of skin cancer with symptoms of lesions and a subsequent removal, as well as current symptoms of hyperpigmentation, irritation, and rashes. VA treatment records reflect a diagnosis of squamous cell carcinoma of the skin of chest with positive margins as early as October 2018 and an excision in November 2018, and the November 2024 VA examiner noted residual scarring on her chest. Consequently, the Board finds that the Veteran's claim for melanoma reasonably encompasses a claim for any skin condition and any residuals thereof. Id. Remand is therefore necessary to obtain an adequate opinion. Barr, 21 Vet. App. at 312.

The matter is REMANDED for the following action:

Obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's skin condition. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the clinician. If the clinician determines that a new examination of the Veteran is necessary to provide an adequate opinion, one should be scheduled.

The clinician must:

(a.) Identify all current skin disabilities and any residuals of a skin disability, to include hyperpigmentation and scarring.

(b.) For each diagnosis, opine on whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran's skin disability had its onset in or is otherwise related to active service, to include the conceded TERAs and any other verified toxic exposures.

In rendering this opinion, the clinician must address the synergistic, combined effect of all of the Veteran's verified TERAs.

The clinician is reminded that the fact that any diagnosed condition is not on the presumptive list of conditions related to a TERA cannot by itself be the sole basis for a negative nexus opinion. Rather, the clinician should
residuals of a skin disability, to include hyperpigmentation and scarring.

In rendering this opinion, the clinician must address the synergistic, combined effect of all of the Veteran's verified TERAs.

The clinician is reminded that the fact that any diagnosed condition is not on the presumptive list of conditions related to a TERA cannot by itself be the sole basis for a negative nexus opinion. Rather, the clinician should consider the Veteran's specific military history, medical history, risk factors, and any other circumstances deemed relevant by the clinician in rendering an opinion.

The clinician is advised that the Veteran is competent to attest to factual matters of which she has first-hand knowledge, including observable symptomatology. These reports must be acknowledged and considered in formulating any opinion (to include the Veteran's lay statements described in the body of this remand). If the clinician finds any medical reason to reject the lay reports, then an explanation must be provided.

The clinician is reminded that a lack of evidence or medical documentation cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and her military service.

The clinician is further reminded that the absence of a diagnosis in service is not fatal to a service connection claim and is insufficient as a rationale.

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If an opinion cannot be provided without resorting to speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that the limits of current medical knowledge in providing an answer to that particular question have been exhausted.

A. J. Spector

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Garcia, M. A.

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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