POSTTRAUMATIC STRESS DISORDER (PTSD)

A. S. CARACCIOLO · 2026 · Case ID: A26039470

MIXED

Summary

The veteran, who served honorably in the U.S. Navy from April 1983 to March 1987, appeals the denial of an increased initial disability rating for PTSD and MDD, and the remand of several other claims. The Board granted an increased initial rating of 70 percent for PTSD and MDD, finding that the veteran's symptoms, including suicidal ideation, anxiety, depression, sleep disturbance, memory loss, and occupational and social impairment, more closely approximated the criteria for this rating. While the Board acknowledged conflicting evidence, such as the veteran's inconsistent reports on violent outbursts versus his testimony denying them, it found the 70 percent rating appropriate based on the totality of the evidence, including VA C&P exams and private treatment records. The Board denied a 100 percent rating, concluding that the veteran did not demonstrate total occupational and social impairment, citing his ability to maintain relationships and employment, despite some difficulties. The Board remanded claims for herpes simplex virus II, left ankle disability (and secondary claims for right ankle, bilateral knees, bilateral feet, and chronic pain syndrome), thoracolumbar spine disability with DDD, generalized psychogenic fatigue/CFS secondary to PTSD/MDD, URIs, and a gastrointestinal disorder claimed as IBS. These remands were primarily due to inadequate VA examinations that failed to address the veteran's contentions or provide sufficient detail for rating purposes.

Rationale

Symptoms approximated 70% criteria; Suicidal ideation present; Occupational/social impairment noted

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210408-151481

Full Decision Text

Citation Nr: A26039470
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 210408-151481
DATE: April 28, 2026

ORDER

Entitlement to an increased initial disability rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is granted.

REMANDED

Entitlement to an initial compensable rating for herpes simplex virus II with recurrent genital ulcers is remanded.

Entitlement to service connection for a left ankle disability (claimed as residuals of a left ankle injury) is remanded.

Entitlement to service connection for a right ankle disability, to include as secondary to a left ankle disability, is remanded.

Entitlement to service connection for a left knee disability, to include as secondary to a left ankle disability, is remanded.

Entitlement to service connection for a right knee disability, to include as secondary to a left ankle disability, is remanded.

Entitlement to service connection for a left foot disability, to include as secondary to a left ankle disability, is remanded.

Entitlement to service connection for a right foot disability, to include as secondary to a left ankle disability, is remanded.

Entitlement to service connection for chronic pain syndrome, to include as secondary to multiple musculoskeletal disabilities, is remanded.

Entitlement to service connection for a thoracolumbar spine disability, to include degenerative disc disease (DDD), is remanded.

Entitlement to service connection for generalized psychogenic fatigue and/or chronic fatigue syndrome (CFS), to include as secondary to service-connected PTSD and MDD, is remanded.

Entitlement to service connection for upper respiratory infections (URIs) is remanded.

Entitlement to service connection for a gastrointestinal disorder, claimed as irritable bowel syndrome (IBS), is remanded.

FINDING OF FACT

Throughout the appeal period, the Veteran's PTSD and MDD symptoms were shown to more nearly approximate occupational and social impairment with deficiencies in most areas; total occupational and social impairment was not demonstrated.

CONCLUSION OF LAW

The criteria for an increased initial rating of 70 percent, but no higher, for PTSD and MDD were met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411 (2022).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably in the United States Navy from April 1983 to March 1987. He was awarded the Navy Expeditionary Medal and the Good Conduct Medal, among other decorations and medals.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2020 Higher-Level Review (HLR) decision and a November 2020 rating decision issued by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). In April 2021, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), electing the Hearing docket. In October 2024, he testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record.

The Board may only consider the evidence of record at the time of the underlying January 2020 and November 2020 rating decisions as well as evidence submitted at the hearing and within 90 days of the hearing, including hearing testimony. See 38 C.F.R. § 20.302(a).

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

Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 (2022).

In this case, with respect to the increased rating claim adjudicated herein, there is no indication of any error on VA's part in notifying or assisting the Veteran that reasonably affects the fairness of the adjud
to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In this case, with respect to the increased rating claim adjudicated herein, there is no indication of any error on VA's part in notifying or assisting the Veteran that reasonably affects the fairness of the adjudication. See 38 C.F.R. § 3.159. The Veteran has not raised any issues with VA's duties to notify or assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).

The Board notes that the Veteran asserted (in his HLR request and his VA Form 10182) that there was clear and unmistakable error (CUE) in prior AOJ decisions. On review, however, he has continuously pursued his appeals as to the issues listed above, and as such a motion alleging CUE is not needed to vitiate the finality of those decisions. Rather, the AOJ decisions of record merely review the initial or supplemental claims that were appealed. As such, the Board will not assess the arguments on appeal in terms of whether CUE was committed.

1. Entitlement to an increased initial rating for PTSD and MDD

The Veteran seeks an initial rating in excess of 50 percent for PTSD and MDD. His symptoms are rated under 38 C.F.R. § 4.130, DC 9411. However, all psychiatric symptoms are rated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130.

Under the General Rating Formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms 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. Id.

A 70 percent rating is assigned for 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 situations (including work or a worklike setting); and inability to establish and maintain effective relationships. Id.

Finally, a total schedular rating of 100 percent is warranted when the disorder results in 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 mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

The symptoms listed in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the General Rating Formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the Federal Circuit stated that "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,
in the rating schedule are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002). Nevertheless, all ratings in the General Rating Formula are associated with objectively observable symptomatology, and in Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013), the Federal Circuit stated that "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."

The Federal Circuit further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." Id. Thus, "[a]lthough the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Id. at 118. As such, the Board will consider both the Veteran's specific symptomatology as well as the occupational and social impairment described in the General Rating Formula to determine whether an increased evaluation is warranted.

In this case, after careful review, the Board disagrees with the AOJ's assignment of an initial 50 percent rating. Rather, an initial 70 percent rating is more appropriate, as the relevant lay and medical evidence shows that the Veteran experienced sleep disturbance, depression, anxiety, loss of concentration, memory loss, disturbances of motivation and mood, and, perhaps most notably, suicidal ideation during the appeal period.

The Veteran received a VA Compensation and Pension (C&P) examination for his PTSD and MDD in November 2020. Additionally, he submitted a copy of a November 2022 examination during the 90-day post-hearing evidentiary window. The reports from these examinations reveal that the Veteran struggled with symptoms such as recurring and intrusive memories, intense or prolonged psychological distress at exposure to cues that symbolize aspects of traumatic events, and avoidance behaviors (among other PTSD-specific symptomatology), as well as more generalized psychiatric symptoms such as depressed mood, anxiety, suspiciousness, chronic sleep impairment, impairment of short- and long-term memory, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The C&P reports also show that the Veteran had positive relationships with his wife, children, and grandchildren. The Veteran stated that he worked full-time at the Post Office; however, he reported that he sometimes had to leave work in the middle of the day due to stress. The examiners estimated that the Veteran's psychiatric symptoms were productive of occupational and social impairment with reduced reliability and productivity.

The Board has reviewed the Veteran's VA and private treatment records from the appeal period, which include psychotherapy progress notes. These records show that he reported many of the same symptoms that are listed in the C&P reports. For example, an April 2020 private counseling note reflects that the Veteran was feeling anxious and stressed and was having difficulty sleeping, among other symptoms consistent with those reported during the VA examinations discussed above.

At his Board hearing, the Veteran testified that he struggled with sleep, anxiety, depression, nervousness, confusion, memory loss, occasional hallucinations, and thoughts of hurting himself (which he identified as suicidal ideation). In addition, the Veteran submitted a list of symptoms in January 2025, including anger, confusion, danger of hurting self or others, difficulty coping with stress, difficulty thinking straight, feeling hopeless or like life is too hard, hallucinations, "hoping you won't wake up when you go to sleep," illogical thinking, inability to make or keep friends, inappropriate behavior, neglect of family, paranoia, poor judgment, suicidal thoughts or feelings, violent outbursts, and many other symptoms.

Based on the above evidence, the Board finds that the Veteran's psychiatric symptoms more nearly approximated the criteria for a 70 percent rating under the General Rating Formula. 38 C.F.R. § 4.130. As to specific psychiatric symptomatology, the Veteran regularly presented with mood disturbances, to include depression and anxiety, which at times appear to have more nearly approximated "near-continuous panic or depression." He also reported having difficulty with attention and concentration, and, perhaps most importantly, suicidal ideation. All of these symptoms are implicated in the criteria for a 70 percent rating under the General Rating Formula. Id.

The Board acknowledges that there is some conflicting evidence regarding the nature and severity of the Veteran's psychiatric symptoms. For instance, in the list of symptoms he submitted in January 2025, he listed "violent
70 percent rating under the General Rating Formula. 38 C.F.R. § 4.130. As to specific psychiatric symptomatology, the Veteran regularly presented with mood disturbances, to include depression and anxiety, which at times appear to have more nearly approximated "near-continuous panic or depression." He also reported having difficulty with attention and concentration, and, perhaps most importantly, suicidal ideation. All of these symptoms are implicated in the criteria for a 70 percent rating under the General Rating Formula. Id.

The Board acknowledges that there is some conflicting evidence regarding the nature and severity of the Veteran's psychiatric symptoms. For instance, in the list of symptoms he submitted in January 2025, he listed "violent outbursts" despite testifying at his Board hearing that he never resorted to physical violence. Notwithstanding, the lay and medical evidence outlined above establishes a disability picture that more nearly approximates occupational and social impairment with deficiencies in most areas since service connection was granted.

The Board further finds that the criteria for an increased 100 percent rating were not met in this case. The Veteran's symptoms can fairly be said to have resulted in deficiencies in his ability to function with respect to work, family relations, judgment, thinking, and mood. On the whole, however, the Board finds that the Veteran's symptoms were not shown to have resulted in total occupational and social impairment. The evidence of record does not indicate that the Veteran posed a persistent danger to himself or others (notwithstanding the January 2025 list referenced above); at his Board hearing, he denied any history of violent confrontations or attempts to harm himself. Furthermore, the Veteran's symptoms were not shown to more nearly approximate gross impairment of thought processes or communication, memory loss for names of close relatives, or other symptoms of similar type and degree.

Rather, the C&P reports, treatment records, and lay statements show that the Veteran was consistently oriented to time and place and generally behaved appropriately and cooperatively on examination. He did not demonstrate a history of psychosis or persistent hallucinations or delusions (though he did report occasional hallucinations at his Board hearing). Additionally, despite the Veteran's reports of social difficulties, he showed an ability to maintain functional relationships, including with his wife and children and in the context of full-time employment. Thus, despite significant impairment, the Board finds that the relevant evidence does not establish "total" social and occupational impairment. See 38 C.F.R. § 4.130.

Accordingly, the Board finds that the Veteran's PTSD and MDD was severe enough to warrant a 70 percent rating from the date service connection went into effect. To that extent, the claim is granted. However, total occupational and social impairment was not established; an initial rating in excess of 70 percent is denied. Neither the Veteran nor his attorney have raised any other pertinent issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the record).

REASONS FOR REMAND

2. Entitlement to an initial compensable rating for herpes simplex virus II with recurrent genital ulcers

The Veteran received VA C&P skin diseases examinations in September 2019 and November 2019. The November 2019 examination report notes that he experienced herpes flare-ups once every two or three months; however, the report does not indicate the percentage of body area affected during flare-ups. Accordingly, the November 2019 examination was inadequate (as the Veteran's attorney argued at the Board hearing). Additionally, the Veteran made the more general argument that the examination reports of record did not accurately capture the severity of his symptoms. The Board agrees that an updated VA examination is needed to correct this pre-decisional duty to assist error. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA provides a claimant with a medical examination or opinion, it must ensure that the examination or opinion is adequate).

3. Entitlement to service connection for a left ankle disability (claimed as residuals of a left ankle injury)

The Veteran contends that his current left ankle disability is related to an in-service injury. His service treatment records reflect that in May 1986, he was treated for an inversion injury, initially diagnosed as a suspected avulsion fracture and later diagnosed as a sprain. The AOJ did not afford the Veteran a VA examination to evaluate his contentions. Given his reports of current left ankle symptoms and the documented in-service evidence of a left ankle injury, the Board finds that an examination was warranted. See 38 C.F.R. § 3.
or opinion, it must ensure that the examination or opinion is adequate).

3. Entitlement to service connection for a left ankle disability (claimed as residuals of a left ankle injury)

The Veteran contends that his current left ankle disability is related to an in-service injury. His service treatment records reflect that in May 1986, he was treated for an inversion injury, initially diagnosed as a suspected avulsion fracture and later diagnosed as a sprain. The AOJ did not afford the Veteran a VA examination to evaluate his contentions. Given his reports of current left ankle symptoms and the documented in-service evidence of a left ankle injury, the Board finds that an examination was warranted. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The matter must be remanded to correct this pre-decisional duty to assist error.

4. Entitlement to service connection for a right ankle disability, to include as secondary to a left ankle disability

5. Entitlement to service connection for a left knee disability, to include as secondary to a left ankle disability

6. Entitlement to service connection for a right knee disability, to include as secondary to a left ankle disability

7. Entitlement to service connection for a left foot disability, to include as secondary to a left ankle disability

8. Entitlement to service connection for a right foot disability, to include as secondary to a left ankle disability

9. Entitlement to service connection for chronic pain syndrome, to include as secondary to multiple musculoskeletal disabilities

The Veteran contends that he developed right ankle, bilateral knee, and bilateral foot disabilities secondary to his left ankle disability. He also contends that he has a chronic pain syndrome secondary to multiple musculoskeletal disabilities. The AOJ's failure to provide an adequate examination as to the etiology of the primary left ankle disability constitutes a pre-decisional duty to assist error which extends to the secondary claims. As such, these inextricably intertwined claims must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

10. Entitlement to service connection for a thoracolumbar spine disability, to include DDD

The Veteran contends that his current thoracolumbar spine disability is related to an in-service injury. His service treatment records reflect that in August 1985, he was treated for low back pain, diagnosed as a muscle strain. The AOJ afforded the Veteran a VA examination in September 2019. The examiner provided a negative nexus opinion. On review, however, the examiner failed to address the Veteran's competent lay reports of back pain since the in-service injury. Accordingly, the Board finds that the VA examination is inadequate. The matter must be remanded for an updated examination in order to correct this pre-decisional error. Barr, supra.

11. Entitlement to service connection for generalized psychogenic fatigue and/or CFS, to include as secondary to service-connected PTSD and MDD

The Veteran contends that he has a current generalized psychogenic fatigue disorder, also claimed as CFS, that is related to his service-connected PTSD and MDD. The AOJ did not afford the Veteran a VA examination to evaluate his contentions. The Board finds that an examination was warranted. See 38 C.F.R. § 3.159(c)(4); McLendon, supra. The matter must be remanded to correct this pre-decisional duty to assist error.

12. Entitlement to service connection for URIs

The Veteran contends that he has recurrent URIs that are related to his period of active service. His service treatment records reflect that he was seen on multiple occasions for URIs, including in December 1984, September 1985, December 1985, March 1986, and March 1987. The AOJ did not afford the Veteran a VA examination to evaluate his contentions. Given his reports of current symptoms and the documented in-service evidence of recurrent URIs, the Board finds that an examination was warranted. See 38 C.F.R. § 3.159(c)(4); McLendon, supra. The matter must be remanded to correct this pre-decisional duty to assist error.

13. Entitlement to service connection for a gastrointestinal disorder, claimed as IBS

The Veteran contends that he has a current gastrointestinal disorder, claimed as IBS, secondary to medications prescribed for his service-connected disabilities. The record also shows that he was treated for gastrointestinal symptoms while on active duty. A January 1986 service treatment record shows that he was seen for abdominal pain of unknown etiology, and a September 1983 treatment record reflects that he
-service evidence of recurrent URIs, the Board finds that an examination was warranted. See 38 C.F.R. § 3.159(c)(4); McLendon, supra. The matter must be remanded to correct this pre-decisional duty to assist error.

13. Entitlement to service connection for a gastrointestinal disorder, claimed as IBS

In a January 2025 brief, the Veteran's attorney submitted links to websites in support of the proposition that gastrointestinal symptoms were possible side effects of many of the medications that the Veteran was taking for his service-connected disabilities.

The AOJ did not afford the Veteran a VA examination to evaluate his contentions. Although the Board acknowledges that the attorney's January 2025 brief was received after the rating decision on appeal, the Board finds that the Veteran's initial lay contentions coupled with the documented in-service treatment for gastrointestinal problems means that an examination was warranted. See 38 C.F.R. § 3.159(c)(4); McLendon, supra. The matter must be remanded to correct this pre-decisional duty to assist error.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination by an appropriate clinician to determine the nature and severity of the Veteran's herpes simplex virus with recurrent genital ulcers. The clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

The clinician should specifically address:

(a) Whether the Veteran uses medications, and if so whether such medications affect the level of severity of his symptoms.

(b) Identify the likely level of severity of the Veteran's herpes simplex virus manifestations in the absence of medication.

The clinician is advised that the Veteran is competent to report symptoms, treatment, events, and injuries, and that her assertions must be taken into account, along with the other evidence of record, in formulating the requested medical opinions.