POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, an honorable Navy veteran who served from July 2011 to July 2015, appeals the denial of service connection for an acquired psychiatric disorder. The Veteran claimed PTSD, anxiety, and depression stemming from in-service traumatic events, including a reported sexual assault, an altercation with a superior officer, and the deaths of fellow servicemembers. The Veteran testified to experiencing persistent anxiety, depression, sleep disturbance, intrusive thoughts, avoidance behaviors, and significant occupational and social impairment since service, though he did not seek in-service treatment due to fear of adverse consequences. The Board found that the evidence established the existence of a current psychiatric disorder, citing diagnoses of PTSD and unspecified depressive disorder from a VA examiner and PTSD and bipolar disorder from a private independent medical consultant. The Board also found that the evidence corroborated the Veteran's reported in-service stressors, particularly the sexual assault, citing behavioral markers such as a near-contemporaneous suicide attempt, a halt in rank advancement, loss of focus, and social withdrawal, as well as a private medical opinion linking the symptoms to the assault. The Board found the Veteran's testimony credible and consistent, and not contradicted by service records, noting that the lack of contemporaneous psychiatric treatment did not render his reports incredible. With two positive medical opinions supporting a nexus and no competent negative opinion, the Board found the evidence in approximate equipoise, resolving doubt in the Veteran's favor. Consequently, service connection for an acquired psychiatric disorder, including PTSD, unspecified depressive disorder, and bipolar disorder, was granted.

Rationale

Current psychiatric disorder diagnosed by VA examiner and private clinician.; In-service stressors, including MST, corroborated by behavioral markers and private medical opinion.; Veteran's testimony found credible and consistent.; Evidence in approximate equipoise, doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26039504
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 210709-171305
DATE: April 28, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), unspecified depressive disorder, and bipolar disorder, is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, his acquired psychiatric disorder is at least as likely as not attributable to active?duty service.

CONCLUSION OF LAW

The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125(a).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably on active duty in the United States Navy from July 2011 to July 2015.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), serving as the Agency of Original Jurisdiction (AOJ).

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 24, 2025, a transcript of which is of record. See Hearing Transcript, dated February 24, 2025. Therefore, the Board may only consider the evidence of record at the time of the April 2021 AOJ rating decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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

Finally, the Board notes that in his October 2020 supplemental claim, the Veteran sought service connection for an "Acquired Psychiatric Condition to include Anxiety, Depression & PTSD." VA Form 20-0995 Supplemental Claim Application, received October 13, 2020. At the February 2025 Board hearing, the Veteran, through his representative, clarified that he instead seeks service connection for a single broader acquired psychiatric condition encompassing his reported anxiety and depressive symptomatology. Hearing Transcript, pg. 2, dated February 24, 2025. In light of this clarification, the Veteran's described symptoms, and the psychiatric findings of record, the Board broadly recharacterizes the issue on appeal as entitlement to service connection for an acquired psychiatric disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009) (holding that the scope of a mental health disability claim includes any mental disability reasonably encompassed by the claimant's description, reported symptoms, and other record evidence); see also Grimes v. McDonough, 34 Vet. App. 84, 87 (2021) (holding that "a claim for service connection may encompass a related condition that is initially referenced by the claimant but not diagnosed until later in the appeal stream, regardless of whether the claim is initially granted or denied by the RO").

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish direct service connection, the evidence must show: (1) the existence of a current disability; (2) the in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship,
 the claim is initially granted or denied by the RO").

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish direct service connection, the evidence must show: (1) the existence of a current disability; (2) the in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (reiterating the three elements necessary to establish direct service connection). 

Service connection for PTSD is subject to particular requirements that are separate from those governing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires: (1) a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. 38 C.F.R. § 3.304(f). The diagnosis of PTSD must comply with the criteria set forth in the Fifth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 38 C.F.R. §§ 4.125(a), 4.130. A diagnosis of PTSD rendered by a mental health professional is presumed to have been made using the relevant DSM criteria, unless there is evidence to the contrary. See Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (noting that a PTSD diagnosis by a mental health professional must be presumed to conform to the DSM criteria in the absence of evidence to the contrary). 

For PTSD claims premised on in-service personal assault - such as military sexual assault (MST) - evidence from sources other than the veteran's service records may corroborate the claimed stressor, including records from law enforcement authorities, mental health counseling centers, hospitals, or physicians, and statements from family members, roommates, fellow service members, or clergy. 38 C.F.R. § 3.304(f)(5). Evidence of behavior changes following the claimed assault may also constitute credible evidence of the stressor, including, but not limited to, a request for a transfer to another military duty assignment, deterioration in work performance, substance abuse, episodes of depression, panic attacks, or anxiety without an identifiable cause, or unexplained economic or social behavior changes. Id. Moreover, an after-the-fact medical opinion may itself serve as credible supporting evidence of an in-service personal-assault stressor. See Menegassi v. Shinseki, 638 F.3d 1379, 1382-1383 (Fed. Cir. 2011) (interpreting 38 C.F.R. § 3.304(f)(5) to permit medical opinion evidence to corroborate the occurrence of a personal-assault stressor); Bradford v. Nicholson, 20 Vet. App. 200, 207 (2006) (recognizing that behavioral evidence and post-service medical opinions may corroborate in-service personal-assault stressors); Patton v. West, 12 Vet. App. 272, 280 (1999) (rejecting the requirement that something more than medical nexus evidence is required to serve as credible supporting evidence in personal-assault cases). 

Finally, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990) (articulating the "unique standard of proof" applicable to veterans' benefits claims). In Lynch v. McDonough, the Federal Circuit clarified that positive and negative evidence need not be in precise equipoise for the benefit-of-the-doubt doctrine to apply; rather, the benefit of the doubt is withheld only where the evidence "persuasively favors one side or
 of positive and negative evidence regarding any issue material to the determination of a claim, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990) (articulating the "unique standard of proof" applicable to veterans' benefits claims). In Lynch v. McDonough, the Federal Circuit clarified that positive and negative evidence need not be in precise equipoise for the benefit-of-the-doubt doctrine to apply; rather, the benefit of the doubt is withheld only where the evidence "persuasively favors one side or the other." 21 F.4th 776, 781-782 (Fed. Cir. 2021).

Entitlement to service connection for an acquired psychiatric condition.

The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder stemming from several in-service traumatic events, including a sexual assault that occurred during active-duty service while he was on a trip to Washington, D.C.; an altercation during his first deployment in which a Leading Petty Officer opened a switchblade knife and brandished it at him; and the deaths of fellow servicemembers, including a friend who died during deployment and a fellow ranking servicemember who died by suicide. Hearing Transcript, pgs. 5, 8, 11, dated February 24, 2025. The Veteran testified that he has experienced persistent anxiety, depression, sleep disturbance, intrusive thoughts, avoidance behaviors, and significant occupational and social impairment since service. Id. at 5-7. The Veteran further described difficulty trusting authority figures, nightmares, a prior pattern of sleep paralysis, and severe anxiety limiting his ability to leave his home. Id. at 6-7. The Veteran acknowledged experiencing symptoms of depression and anxiety during active-duty service but explained that he did not seek treatment at the time because he feared a less favorable characterization of his service or an administrative discharge. Id. at. 5, 11. The Veteran also described a suicide attempt shortly after his first deployment, following marital separation, which he characterized as the culmination of overwhelming stress and isolation. Id. at 5.

Applying the aforementioned legal principles, and after a thorough review of the record, the Board finds that the evidence supports granting service connection for an acquired psychiatric disorder.

As to the first element of service connection, the record demonstrates that the Veteran has been diagnosed with multiple acquired psychiatric conditions. In February 2021, VA examiner Dr. A.M. conducted an Initial PTSD examination and diagnosed the Veteran with PTSD and unspecified depressive disorder. C&P Exam, pg. 1, received February 3, 2021. In fact, Dr. A.M. specifically stated, "The veteran meets DSM criteria for a diagnosis of PTSD," and, separately, "The veteran meets DSM criteria for a diagnosis of depression/mood disorder." Id. 

Subsequently, in January 2023, private independent medical consultant A.H., Psy.D., authored a Review PTSD DBQ and diagnosed the Veteran with PTSD  and bipolar disorder following an in-person clinical evaluation. VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, received May 7, 2025. Dr. A.H. specifically worked through each DSM-5 PTSD diagnostic criterion and identified that the Veteran satisfied at least one criterion from Criteria A, B, C, F, G, and H, as well as at least two criteria from Criteria D and E, with specific findings as to applicable symptomatology. Id. at 3-5.

Finally, the record reflects longstanding diagnoses and treatment for bipolar affective disorder and bipolar I disorder in the Veteran's VA mental health treatment records. See, e.g., CAPRI, pgs. 24-26, received April 19, 2021. Because Dr. A.M., Dr. A.H., and the Veteran's psychiatric treatment providers are qualified mental health professionals, their diagnoses are presumed to conform to the applicable DSM-5 criteria. See Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (noting that a PTSD diagnosis by a mental health professional must be presumed to conform to the DSM criteria in the absence of evidence to the contrary). Accordingly, the "current disability" element of service connection is satisfied. See Shedden, 381 F.3d at 1167.

As to the second element of service connection, the Board finds that the evidence adequately establishes the occurrence of the Veteran's reported in-service stressors. Because the Veteran's principal claimed stressor involves in-service personal assault, the particularized evidentiary framework of 38 C.F.R. § 3.304(f)(5) applies. The Veteran
 See Cohen v. Brown, 10 Vet. App. 128, 140 (1997) (noting that a PTSD diagnosis by a mental health professional must be presumed to conform to the DSM criteria in the absence of evidence to the contrary). Accordingly, the "current disability" element of service connection is satisfied. See Shedden, 381 F.3d at 1167.

As to the second element of service connection, the Board finds that the evidence adequately establishes the occurrence of the Veteran's reported in-service stressors. Because the Veteran's principal claimed stressor involves in-service personal assault, the particularized evidentiary framework of 38 C.F.R. § 3.304(f)(5) applies. The Veteran has consistently reported that, while on active duty, he was sexually assaulted during a trip to Washington, D.C. with a fellow servicemember and that servicemember's companion. He described becoming impaired at a concert and regaining awareness in a hotel room during a non-consensual act. Hearing Transcript, pgs. 5, 8, dated February 24, 2025; see also C&P Exam, pg. 4, received February 3, 2021 (noting "Stressor #2" as a reported in-service sexual assault); VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 4, received May 7, 2025; The Veteran explained that he did not report the assault at the time due to shame and fear of adverse consequences to his military career. Hearing Transcript, pg. 5, dated February 24, 2025. 

The Veteran's lay statements recounting his in-service stressor events are corroborated by multiple behavioral markers contemplated by 38 C.F.R. § 3.304(f)(5). First, within months of the reported assault, the Veteran attempted suicide. He testified to this attempt at the February 2025 Board hearing and described it in greater detail to Dr. A.H., explaining that, following his first deployment and the dissolution of his marriage, he attempted to hang himself in a hotel room before stopping himself "halfway through." VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 5, received May 7, 2025; Hearing Transcript, pg. 5, dated February 24, 2025.

Second, the Veteran reported, and Dr. A.H. documented, that he had been steadily advancing in rank prior to the reported in-service assault, but ceased advancing thereafter - a marker indicative of deterioration in work performance. VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 4, received May 7, 2025. 

Third, the Veteran reported a loss of focus, drive, and desire following the incident, consistent with the emergence of a depressive condition without an otherwise identifiable cause. Id.

Fourth, the Veteran's lay statements reflect social withdrawal and avoidance of the individuals involved in the assault, consistent with unexplained social behavior changes. Hearing Transcript, pgs. 8, 11, dated February 24, 2025. These behavioral markers correspond with the examples of relevant evidence delineated in 38 C.F.R. § 3.304(f)(5), including episodes of depression without an identifiable cause, deterioration in work performance, and unexplained social behavior changes.

The Veteran's account is further corroborated by Dr. A.H.'s January 2023 Review PTSD DBQ, in which Dr. A.H. expressly identified the abovementioned markers and, on that basis, connected the Veteran's current psychiatric symptomatology to the reported in-service assault. VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 11, received May 7, 2025. 

As the Federal Circuit has explained, an after-the-fact medical opinion may itself supply the credible supporting evidence contemplated by 38 C.F.R. § 3.304(f)(5). Menegassi, 638 F.3d at 1382-83; see also Bradford, 20 Vet. App. at 207; Patton, 12 Vet. App. at 280. The Board further notes that the Veteran is competent to report the occurrence of events and circumstances of his service that he personally experienced or observed, to include the non-combat stressors identified herein. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (noting that lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372
.F.R. § 3.304(f)(5). Menegassi, 638 F.3d at 1382-83; see also Bradford, 20 Vet. App. at 207; Patton, 12 Vet. App. at 280. The Board further notes that the Veteran is competent to report the occurrence of events and circumstances of his service that he personally experienced or observed, to include the non-combat stressors identified herein. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (noting that lay testimony is competent to establish the presence of observable symptomatology); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting that lay evidence may establish a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional). 

The Board also finds the Veteran's reports credible, as they have been consistent throughout the record - including in contemporaneous accounts rendered to his VA examiners and private clinicians - and are not contradicted by service department records. See Doran v. Brown, 6 Vet. App. 283, 289 (1994) (observing that service department records must support, and not contradict, the claimant's testimony regarding non-combat stressors). The Board further observes that the relative paucity of contemporaneous documentation of psychiatric concerns in the Veteran's service treatment records does not weigh meaningfully against the credibility of his reports, particularly given the well-recognized underreporting of sexual assault and the Veteran's explicit explanation that he declined to seek in-service treatment out of fear of adverse administrative consequences. See Hearing Transcript, pgs. 5, 11, dated February 24, 2025; see also Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (stating that, when assessing a claim, the Board may not consider the absence of evidence as substantive negative evidence); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (holding that the lack of contemporaneous medical records does not, in and of itself, render lay evidence incredible or serve as an absolute bar to service connection).

Ultimately, when resolving reasonable doubt in the Veteran's favor, the Board finds that the claimed in-service stressors, including his reported military sexual trauma (MST), occurred. See 38 C.F.R. § 3.304(f)(5); Arzio, 602 F.3d at 1347. Accordingly, the "in-service incurrence" element of service connection is met. See Shedden, 381 F.3d at 1167.

Thus, the remaining question is whether there is a medical nexus between the Veteran's current acquired psychiatric disorder and his active-duty service. The Board finds that the evidence is, at the very least, in approximate equipoise on this question. 

The record contains two positive medical opinions supporting a nexus between the Veteran's acquired psychiatric disorder and service. In February 2021, Dr. A.M. authored a positive nexus opinion in which he determined that the Veteran's PTSD was related to the in-service stressors that he reported, explaining as follows: 

"The veteran meets DSM criteria for a diagnosis of PTSD. His stressors are documented in the body of this report and clearly meet DSM Stressor Criteria A. They are not directly related to hostile military or terrorist activity, but are related to events that [occurred] in the service. Criteria B (reexperiencing phenomenon) and Criteria C (avoidance behavior) directly revolve around these documented stressors which serves to confirm the connection of these service stressors to the veteran's current diagnosis of PTSD." 

C&P Exam, received February 3, 2021. Dr. A.M. also found that the symptoms of the Veteran's PTSD and unspecified depressive disorder were inextricably intertwined such that it "would be speculative to attempt to delineate symptoms along diagnostic lines." Id. 

More significantly, in January 2023, Dr. A.H., a licensed clinical psychologist, authored a comprehensive Review PTSD DBQ in which she opined that the Veteran's PTSD "was at least as likely as not incurred in or caused by the in-service stressor" of MST. VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 11, received May 7, 2025. Dr. A.H. supported her opinion with specifically enumerated marker evidence, including the Veteran's near-contemporaneous suicide attempt, the halt of his previously steady rank advancement, and his loss of focus and drive, as well as the concurrent breakdown of his
." Id. 

More significantly, in January 2023, Dr. A.H., a licensed clinical psychologist, authored a comprehensive Review PTSD DBQ in which she opined that the Veteran's PTSD "was at least as likely as not incurred in or caused by the in-service stressor" of MST. VA 21-0960P-3 Review Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, pg. 11, received May 7, 2025. Dr. A.H. supported her opinion with specifically enumerated marker evidence, including the Veteran's near-contemporaneous suicide attempt, the halt of his previously steady rank advancement, and his loss of focus and drive, as well as the concurrent breakdown of his marriage. Id. Dr. A.H. further determined that the Veteran's bipolar disorder "is related to the [PTSD]" and that the "symptoms of the two disorders are interrelated and overlap." Id. 

The Board finds Dr. A.H.'s opinion highly probative. Dr. A.H., a licensed clinical psychologist, administered an in-person clinical evaluation, methodically worked through each DSM-5 diagnostic criterion for PTSD, and tied her conclusions to specific factual findings and marker evidence drawn from the Veteran's lay statements and documented history. Id. at 3-5, 11. Dr. A.H.'s opinion is also supported by a well-articulated and reasoned analysis that the Board can weigh. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-04 (2008) (explaining that the probative value of a medical opinion arises from its factually accurate, fully articulated, and sound reasoning); Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (noting that a medical opinion must support its conclusions with analyses the Board can weigh, and that a mere conclusion is insufficient to allow the Board to make an informed decision). Similarly, Dr. A.M.'s February 2021 VA opinion, while less expansive in its discussion of the Veteran's depressive symptomatology, nonetheless provides additional probative support for a service-connected link, as it too is based on an in-person examination, an administered battery of psychometric testing, and a fact-specific discussion of the Veteran's symptomatology and in-service stressors.

Finally, the Board notes that the record does not contain a competent medical opinion affirmatively concluding that the Veteran's acquired psychiatric disorder is unrelated to service. Although the AOJ, in the April 2021 rating decision on appeal, stated that "[t]he evidence does not show a current diagnosis of depression on VA exam dated February 3, 2021," this characterization was inconsistent with the February 2021 C&P Exam of record at that time, in which Dr. A.M. expressly diagnosed both PTSD and unspecified depressive disorder. See Rating Decision - Narrative, dated April 21, 2021; C&P Exam, pg. 1, received February 3, 2021. With two supportive medical opinions in the record and no competent negative opinion against the claim, the Board finds that the evidence is, at a minimum, in approximate equipoise on the question of medical nexus. See 38 U.S.C. § 5107; Lynch, 21 F.4th at 781-82. 

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In conclusion, when resolving reasonable doubt in the Veteran's favor, the Board finds that his acquired psychiatric disorder, to include PTSD, unspecified depressive disorder, and bipolar disorder, is at least as likely as not attributable to his active-duty service, to include as due to the in-service MST and other in-service traumatic events he has described. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. As all three elements of direct service connection have been met, entitlement to service connection for an acquired psychiatric disorder is granted. See Shedden, 381 F.3d at 1167; 38 C.F.R. §§ 3.303, 3.304(f).

 

 

A. S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Cross, 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.