POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, an Army Veteran who served from April 1998 to October 2001 and February 2003 to June 2004, including service in Iraq, appeals the denial of an increased rating for PTSD and the effective date for TDIU. The Board granted entitlement to a 70 percent rating for PTSD, effective August 21, 2023, finding that the Veteran's PTSD symptoms, particularly difficulty adapting to stress and neglect of hygiene, met the criteria for this rating. The Board also granted entitlement to TDIU effective August 21, 2023, based on the Veteran's PTSD precluding her from substantially gainful employment, noting her self-employment earnings were marginal and her prior employment terminations were due to PTSD symptoms. The Board also granted entitlement to Special Monthly Compensation (SMC) at the housebound rate, effective from July 9, 2024, as the Veteran has a TDIU for PTSD and other service-connected disabilities (back condition, cancer residuals) independently ratable at 60 percent, exceeding the threshold for this benefit. The Board applied the benefit of the doubt in awarding the 70 percent rating for PTSD, finding the evidence weighed persuasively in the Veteran's favor for this rating.

Rationale

PTSD symptoms consistent with 70% rating; Benefit of the doubt applied in Veteran's favor; VA examinations supported 70% rating

Full Decision Text

Citation Nr: A26039385
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250301-520526
DATE: April 28, 2026

ORDER

From August 21, 2023, entitlement to an initial rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) is granted.

Entitlement to an effective date of August 21, 2023, but not earlier, for the award of a total disability rating due to individual unemployability (TDIU) is granted.

Entitlement to special monthly compensation (SMC) at the housebound rate is granted. 

FINDINGS OF FACT

1. A January 2024 rating decision awarded service connection for PTSD and assigned an initial 50 percent rating effective August 21, 2023.  In July 2024, the Veteran claimed entitlement to a TDIU using VA Form 21-8940, which the Board construes as a supplemental claim.  That claim was adjudicated in October 2024, and the Veteran then continuously pursued the claim.

2. From August 21, 2023, the Veteran's PTSD has manifested with symptoms productive of impairment that more closely approximated occupational and social impairment with deficiencies in most areas; but not total occupational and social impairment.

3. From August 21, 2023, the Veteran's PTSD has precluded her from securing and following a substantially gainful occupation.

4. The Veteran is in receipt of service connection for disabilities independently ratable at least 60 disabling, separate and apart from her total rating for PTSD.  

CONCLUSIONS OF LAW

1. From August 21, 2023, the criteria for an initial rating of 70 percent, but not higher, for PTSD are met.  38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.2500, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.130, Diagnostic Code 9411.

2. The criteria for effective date of August 21, 2023, but not earlier, for the award of a TDIU are met.  38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.400, 3.2500, 4.3, 4.16.  

3. The criteria for entitlement to SMC at the housebound rate are met.  38 U.S.C. § 1114; 38 C.F.R. § 3.350.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from April 1998 to October 2001 and from February 2003 to June 2004, including service in Iraq, with additional National Guard service. 

In October 2024, an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA) adjudicated the Veteran's claim and in relevant part awarded a TDIU effective from June 21, 2024, as well as a 70 percent rating for PTSD effective from July 9, 2024.  The Veteran timely requested Higher-Level Review, and a December 2024 rating decision confirmed these decisions.  In March 2025, the Veteran appointed present counsel as her representative in this matter, filed a timely NOD as to the December 2024 rating decision, and elected Direct Review by the Board of Veterans' Appeals (Board).

As the Veteran elected the Direct Review docket, the Board may only consider the evidence of record when the Veteran was notified of the October 2024 rating decision.  The Board cannot consider evidence submitted after the AOJ issued the October 2024 rating decision.  See 38 C.F.R. § 20.301.

The issue of entitlement to SMC is raised by the record as an aspect of the increased rating claim on appeal.  Although this issue was not identified by the Veteran or her attorney in claim documents or the NOD, VA has a duty to maximize a claimant's benefits.  See Morgan v. Wilkie, 31 Vet. App. 162, 164 (2019) (Board's duty to maximize benefits may require it to explore schedular rating tools, including SMC).  Accordingly, the Board has added this issue for appellate consideration.  

1. From August 21, 2023, entitlement to an initial rating of 70 percent, but not higher, for PTSD
.F.R. § 20.301.

The issue of entitlement to SMC is raised by the record as an aspect of the increased rating claim on appeal.  Although this issue was not identified by the Veteran or her attorney in claim documents or the NOD, VA has a duty to maximize a claimant's benefits.  See Morgan v. Wilkie, 31 Vet. App. 162, 164 (2019) (Board's duty to maximize benefits may require it to explore schedular rating tools, including SMC).  Accordingly, the Board has added this issue for appellate consideration.  

1. From August 21, 2023, entitlement to an initial rating of 70 percent, but not higher, for PTSD is granted.

Through her attorney, the Veteran argues that she is entitled to a rating in excess of 70 percent for PTSD effective from August 23, 2023.  See March 2025 NOD.  

Pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411 (PTSD), the Veteran is currently in receipt of an initial 50 percent rating for PTSD prior to July 9, 2024, and thereafter she is in receipt of a 70 percent rating.  

The period on appeal is from August 21, 2023, the effective date of service connection.  In this regard, the Veteran was awarded service connection for PTSD pursuant to a January 2024 rating decision.  In July 2024, prior to the expiration of the time to appeal that decision, the Veteran claimed entitlement to a TDIU using VA Form 21-8940, the form prescribed by VA.  Although this is not the specific form prescribed by VA for filing Supplemental Claim, the United States Court of Appeals for Veterans Claims (CAVC) has held that other VA forms prescribed to file claims may be used to file a Supplemental Claim.  See Chisholm v. Collins, 38 Vet. App. 140 (2025).  Moreover, after the October 2024 rating decision adjudicated that claim and awarded an increased rating for PTSD and a TDIU, the Veteran continuously pursued her claim by timely seeking Higher-Level Review and then filing a timely NOD.  38 C.F.R. § 3.2500(c). Accordingly, the Board has characterized the issue on appeal as seeking entitlement to an increased initial rating for PTSD.

Although the Veteran's bruxism is rated together with her PTSD, the Veteran's attorney has only sought an increased rating for PTSD and has not submitted any argument addressing bruxism.  See March 2025 NOD.  

PTSD is rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411.  Under Diagnostic Code 9411, a 50 percent rating is warranted where PTSD is manifested by occupational and social impairment with reduced reliability and productivity, due to 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; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is warranted where PTSD is manifested by 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.

A 100 percent rating is warranted where PTSD is manifested by 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. 

The Veteran presented for examinations with VA-contracted examiners in October 2023 and September 2024.  Both examiners diagnosed PTSD and no other mental disorders.  Moreover, both examiners indicated that the Veteran's PTSD was productive of occupational and social impairment with reduced reliability and productivity.  The examiners also noted similar symptoms resulting from the Veteran's PTSD.  Specifically, the October 2023 examiner noted depressed
 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. 

The Veteran presented for examinations with VA-contracted examiners in October 2023 and September 2024.  Both examiners diagnosed PTSD and no other mental disorders.  Moreover, both examiners indicated that the Veteran's PTSD was productive of occupational and social impairment with reduced reliability and productivity.  The examiners also noted similar symptoms resulting from the Veteran's PTSD.  Specifically, the October 2023 examiner noted depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, 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 worklike setting.  The September 2024 endorsed the same symptoms, except that the September 2024 examiner omitted flattened affect and additionally endorsed neglect of hygiene.  The September 2024 examiner also noted that the Veteran regularly experienced passive suicidal ideation in the narrative section of the examination report.  See September 2024 PTSD Disability Benefits Questionnaire (DBQ) at 4.

Here, the disability pictures presented in the October 2023 and September 2024 examination reports are similar.  The examiners assessed the same level of impairment due to PTSD and generally noted mostly the same PTSD symptoms.  The Board attributes the minor differences in the examination reports to different examiners assessing the same disability using different language, rather than a material change in the severity of the Veteran's PTSD.  See 38 C.F.R. § 4.2.  Indeed, the award of an increased 70 percent rating was premised on the findings in the September 2024 examination report, which includes a significantly more detailed narrative than that is found in the initial examination report.  

The AOJ's determination that the September 2024 examination report supports a 70 percent rating is a favorable finding that binds subsequent adjudicators, including the Board, unless clearly erroneous.  See 38 C.F.R. § 3.104.  Here, the AOJ's determination is not clearly erroneous, as the September 2024 examiner noted PTSD symptoms consistent with a 70 percent disability rating.  As the Veteran's initial PTSD examination also reflected a similar level of disability, including symptoms associated with a 70 percent rating in VA's rating schedule, the Board affords the Veteran the benefit of the doubt and finds that she is entitled to an initial 70 percent rating for PTSD effective from August 21, 2023, the effective date of service connection.  

The Board acknowledges evidence that the Veteran's anxiety had intensified between the examinations following an August 2024 incident in group therapy.  See, e.g., September 2024 PTSD DBQ at 4.  However, the Veteran's overall disability picture has been stable, as the evidence shows difficulty in adapting to stressful circumstances including work or a worklike setting has been present throughout the appeal.  See, e.g., July 2024 VA Form 21-4192 (Auto Body) (noting that Veteran had emotional problems under pressure and had to go from full time to part time to lessen the stress); July 2024 VA Form 21-4192 (Construction) (noting that Veteran would miss meetings on purpose to avoid stress).  As noted above, that symptom is associated with a 70 percent rating for PTSD in VA's rating schedule.  

The Veteran is not entitled to an initial rating in excess of 70 percent at any time during the appeal period.  In this regard, the most probative evidence of record shows that the Veteran has retained some residual occupational functioning over portions of the appeal period.  See, e.g., VA Form 21-8940.  Moreover, the most probative evidence of record shows less than total social impairment, as the Veteran has some relationships with a friend and her mother.  See, e.g., October 2023 Statement in Support of Claim.  However, as noted below, the Veteran is entitled to a TDIU premised solely on PTSD.  

In sum, the evidence shows that throughout the appeal period, the Veteran's PTSD has manifested with symptoms that have more closely approximated occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment.  Accordingly, the criteria for an initial rating of 70 percent, but not higher, for PTSD are met throughout the appeal period.  The Board has considered the benefit of the doubt doctrine and applied it in the Veteran's favor in awarding an initial 70 percent rating prior to July 9, 2024, but otherwise the evidence weighs persuasively against an even
3 Statement in Support of Claim.  However, as noted below, the Veteran is entitled to a TDIU premised solely on PTSD.  

In sum, the evidence shows that throughout the appeal period, the Veteran's PTSD has manifested with symptoms that have more closely approximated occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment.  Accordingly, the criteria for an initial rating of 70 percent, but not higher, for PTSD are met throughout the appeal period.  The Board has considered the benefit of the doubt doctrine and applied it in the Veteran's favor in awarding an initial 70 percent rating prior to July 9, 2024, but otherwise the evidence weighs persuasively against an even higher rating.  

2. Entitlement to an effective date of August 21, 2023, but not earlier, for the award of a TDIU is granted.

The Veteran is currently in receipt of a TDIU effective from June 21, 2024, as the AOJ determined that the Veteran last worked the day prior.  See October 2024 Rating Decision at 7.  Through her attorney, the Veteran argues that she is entitled to an effective date for the award of a TDIU of August 23, 2023, as on that date she submitted an intent to a file a claim.  See March 2025 NOD.  

A total disability rating may be assigned, where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as the result of service-connected disabilities.  See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.16.  

The Veteran asserts that she is totally disabled due to her PTSD, her back disability, and cancer, and that she is currently under care for the first two disabilities.  See VA Form 21-8940.  Prior to June 21, 2024, the Veteran is in receipt of service connection for PTSD rated 70 percent disabling; degenerative arthritis of the spine with intervertebral disc syndrome rated 20 percent disabling; vulvar cancer, status post surgery with residuals with a noncompensable (zero percent) rating; tinnitus rated 10 percent disabling; polymorphic light eruption with scars rated 10 percent disabling; allergic rhinitis rated 10 percent disabling; right lower extremity radiculopathy rated 10 percent disabling; and a noncompensable rating for chronic sinusitis.  

The determination as to whether a veteran can secure or follow a substantially gainful occupation includes an economic component and a noneconomic component.  The economic component means that a veteran must not receive income from employment outside of a protected environment that exceeds the poverty threshold for one person.  The noneconomic component requires consideration of a veteran's ability to secure or follow substantially gainful employment, including factors such as the veteran's history of education, skill, and training, as well as his or her ability to perform the physical and mental activities required by the occupation in question.  See Ray v. Wilkie, 31 Vet. App. 58 (2019).  

Substantially gainful employment does not include marginal or protected employment.  Marginal employment shall generally be deemed to exist when a veteran's earned annual income does not exceed the amount published by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person.  See 38 C.F.R. § 4.16(a).  Protected employment means a lower-income position that, due to a veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market.  See LaBruzza v. McDonough, 37 Vet. App. 111 (2024).

With regard to the economic criteria for entitlement to a TDIU, the evidence shows that the Veteran has not been in receipt of substantially gainful income throughout the appeal period.  In this regard, the Veteran reported that since 2021, she has been self-employed earning about $400 per month by reselling items on an e-commerce site.  See VA Form 21-8940.  Although she reported that her highest monthly earnings were $2,000, see id., the evidence shows that her typical earnings are less than that.  Specifically, the Veteran submitted a financial statement from the e-commerce site showing that from the beginning of 2024 through July 23, 2024, her business had grossed $7,758.  However, the statement shows that the e-commerce site deducted over $3,400 from this amount for transaction fees, shipping labels, promotional listings fees, and other charges.  After deducting these expenses, the Veteran's self-employment
 has been self-employed earning about $400 per month by reselling items on an e-commerce site.  See VA Form 21-8940.  Although she reported that her highest monthly earnings were $2,000, see id., the evidence shows that her typical earnings are less than that.  Specifically, the Veteran submitted a financial statement from the e-commerce site showing that from the beginning of 2024 through July 23, 2024, her business had grossed $7,758.  However, the statement shows that the e-commerce site deducted over $3,400 from this amount for transaction fees, shipping labels, promotional listings fees, and other charges.  After deducting these expenses, the Veteran's self-employment earnings do not constitute substantially gainful employment.  

With respect to the noneconomic component of a TDIU, the evidence shows that the Veteran has an Associate degree in Business Administration.  See VA Form 21-8940; October 2023 PTSD DBQ at 4.  Prior to her self-employment the Veteran worked as an administrative office assistant, and she also worked as an Uber driver for a few months in 2020.  See VA Form 21-8940.  The evidence shows that the Veteran was terminated from multiple office administration jobs due to an inability to handle stress and pressure and variable performance.  See July 2024 VA Forms 21-4192.  Moreover, the Veteran reported that she was unable to continue working as an Uber driver due to her back disability and cancer diagnosis.  See July 2024 VA Form 21-8940.  She reported that her e-commerce business allows for a flexible schedule enabling her to attend appointment for her mental health and back issues, and to move around when she needs to do so.  See July 2024 VA Form 21-4192 (Self-Employment).  

Here, the evidence shows that the Veteran's PTSD, alone, has precluded her from securing and maintaining substantially gainful employment.  As noted above, the Veteran was terminated from multiple office administration jobs due to her PTSD symptoms.  Although the evidence also shows impairment due to the Veteran's back disability, her former employers were able to accommodate these impairments.  For example, one of the Veteran's former employers explained that while he was unable to tolerate the Veteran's emotions and unreliability, he would "deal with" her back issues and it was not a problem to let her get up and move around when she needed to do so.  See July 2024 VA Form 21-4192 (Auto Body).  Accordingly, the Veteran is entitled to an effective date of August 21, 2023, the effective date of service connection for PTSD, for the award of a TDIU.

The Veteran is not entitled to an effective date for a TDIU earlier than August 21, 2023.  Prior to that date, the Veteran is in receipt of service connection for vulvar cancer residuals, with a noncompensable rating effective from August 21, 2022.  Although the Veteran reported previously being unable to work due to her cancer diagnosis, the most probative evidence of record does not show that her cancer residuals alone precluded her from securing and maintaining substantially gainful employment from August 2022 to August 2023.  For example, a November 2023 examination report shows that the Veteran's cancer diagnosis and treatment was in January 2019 and at present there was no functional impact from this disability.  See November 2023 Gynecological Conditions DBQ at 2, 8.

In sum, the evidence shows that the Veteran is precluded from securing and maintaining substantially gainful employment due to her PTSD.  Thus, she is entitled to a TDIU from August 21, 2023, the effective date of service connection for PTSD.  The Board has considered the benefit of the doubt doctrine, but the evidence weighs persuasively against entitlement to a TDIU prior to the Veteran's effective date of service connection for PTSD.  

3. Entitlement to SMC at the housebound rate is granted.

Although the issue of entitlement to SMC at the housebound rate was not claimed, that issue is raised by the record and VA has a well-established duty to maximize a claimant's benefits.

One of the instances where SMC at the housebound rate is payable is when a veteran has a single service-connected disability rated as 100 percent disabling and has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems.  For this purpose, a TDIU may satisfy the requirement for a single disability rated at 100 percent.  

As noted above, the Veteran is entitled to a TDIU based solely on
 rate is granted.

Although the issue of entitlement to SMC at the housebound rate was not claimed, that issue is raised by the record and VA has a well-established duty to maximize a claimant's benefits.

One of the instances where SMC at the housebound rate is payable is when a veteran has a single service-connected disability rated as 100 percent disabling and has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems.  For this purpose, a TDIU may satisfy the requirement for a single disability rated at 100 percent.  

As noted above, the Veteran is entitled to a TDIU based solely on her PTSD.  Moreover, effective from July 9, 2024, the Veteran's service-connected disabilities include vulvar cancer residuals rated 40 percent disabling and a back disability rated 40 percent disabling.  The combined disability evaluation for these disabilities exceeds 60 percent, and these disabilities are independent from the Veteran's PTSD.  Accordingly, the criteria for entitlement to SMC at the housebound rate are met.  To avoid prejudice to the Veteran, the Board will allow the AOJ to set the effective date when it implements this award of benefits, and the Veteran may seek review of that decision by filing the appropriate VA form.

 

 

S. BUSH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Badaczewski, Donald 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.