SUBSTANCE USE DISORDER

THOMAS H. O'SHAY · 2026 · Case ID: A26039884

GRANTED

Summary

The Veteran, a Veteran who served from December 2005 to December 2009, appeals the denial of service connection for a substance abuse disorder, claimed as secondary to his service-connected PTSD. The Board reviewed evidence including VA examinations from January and February 2020, and a February 2021 VA medical opinion. The Veteran also submitted lay testimony regarding his substance abuse as a coping mechanism for PTSD. The Board found that while the Veteran had pre-service substance abuse issues and family history, the medical opinions on the nexus between his PTSD and substance abuse disorder were mixed and not fully developed. Specifically, opinions against secondary service connection cited pre-service abuse and family history, while one opinion for it noted a strong clinical association between substance abuse and PTSD. The Board determined the opinions were somewhat probative but conclusory, leading to an approximate balance of evidence. Applying the benefit of the doubt, the Board granted service connection for the substance abuse disorder as secondary to PTSD on a causation basis. The Board did not need to address aggravation as causation was a greater benefit.

Rationale

Service-connected PTSD established.; Mixed medical opinions on nexus between PTSD and substance abuse disorder.; Opinions were somewhat probative but conclusory.; Weight of opinions against secondary causation in approximate balance with opinion for secondary causation.; Benefit of the doubt afforded to Veteran.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210604-164105

Full Decision Text

Citation Nr: A26039884
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210604-164105
DATE: April 29, 2026

ORDER

Service connection for substance use disorder, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is granted.

FINDING OF FACT

Affording the Veteran the benefit of the doubt, his substance abuse disorder was caused by his service-connected PTSD.

CONCLUSION OF LAW

The criteria for secondary service connection for substance use disorder on a causation basis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.104, 3.303, 3.310, 20.801.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from December 2005 to December 2009. This matter originated with a February 2021 rating decision which reconsidered his previously denied claim of service connection for stimulant use disorder but then confirmed and continued that denial. In appealing to the Board of Veterans' Appeals (Board), the Veteran's representative requested the hearing docket. A hearing before a Board Veterans Law Judge accordingly was held in February 2025. At the hearing, the representative confirmed it is the aforementioned rating decision on appeal (and that the notice of disagreement indicating it was the earlier, February 2020 rating decision was a mistake). This matter is recharacterized as one concerning a substance abuse disorder at this time, to be more encompassing of the Veteran's diagnoses.

As such, the Board may consider herein the evidence of record at the time of the February 2021 rating decision, submitted at the hearing, and submitted within 90 days following the hearing. 38 U.S.C. § 7113(b); 38 C.F.R. § 20.302(a). Any evidence submitted either between the rating decision and the hearing or more than 90 days following the hearing cannot be considered. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. If the Veteran would like such evidence to be considered, he may file a supplemental claim (following the instructions included herein) and resubmit or identify it. 38 C.F.R. § 3.2501. Another rating decision will be issued provided there is new and relevant evidence, and it will be considered along with the previously considered evidence. Id.

Service Connection

Direct service connection is established when there is a nexus between a current disability and an injury or disease incurred or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). It also is established for a disease diagnosed after separation if incurred during service. 38 C.F.R. § 3.303(d).

Secondary service connection is established when a current disability is due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). It also is established when aggravation of a current disability is due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). Aggravation is an incremental increase in disability, regardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233, 241-242 (2019).

The claimant is afforded the benefit of the doubt when there is an approximate balance of positive and negative evidence on any given point. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Although all the evidence must be reviewed, only the most relevant evidence must be discussed. Gonzales v. West, 218 F.3d 1378, 1380-1381 (Fed. Cir. 2000).

Substance Abuse Disorder

The Veteran contends he had a substance abuse disorder as a result of his service-connected PTSD. Specifically, he contends he abused substances to self-medicate or cope with his PTSD symptoms. He notes being in remission now.

Substance Abuse Disorder

In the February 2021 rating decision, the agency of original jurisdiction (AOJ) found that the Veteran has been diagnosed with a substance abuse disorder. The Board is bound by this favorable finding unless it is rebutted by clear and unmistakable evidence. 38 C.F.R. §§ 3.104(c), 20.801(a). No such evidence exists here. Indeed, VA and private treatment records reflect various diagnoses such as opioid use disorder, stimulant use disorder, and alcohol use disorder. Opioid use disorder and stimulant use disorder additionally were diagnosed at a January 2020 VA medical examination, while a February 2020 VA medical examination diagnosed opioid use disorder, alcohol use disorder, and cannabis use disorder. A disability, in sum, clearly is established. It is current, even though these sources reveal the Veteran has been in remission since 2019, because it existed just prior to him filing his initial claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).

The second and third criteria for direct service connection are the in-service incurrence or aggravation of an injury or disease and a nexus between such and the current disability. Neither criterion has been established here. Service treatment records indeed are silent for complaints, treatment, or diagnosis related to any substance abuse disorder. The Veteran additionally does not belief his substance abuse disorder is linked to his service, and no medical opinion has been rendered concluding such. Direct service connection thus cannot be granted. All that remains for consideration accordingly is secondary service connection. The second criterion for secondary service connection is having a service-connected disability, and it undisputedly is established. Since December 2009, the Veteran has been service-connected for PTSD.

The last criterion for secondary service connection is a nexus, whether causation or aggravation, between the service-connected disability and the current disability. There is no indication the Veteran has a medical background. He thus is not competent to render an opinion on a medical question. Jandreau v. Nicholson, 492 F.3d 1372, 1376-1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Here, a nexus is a medical question because consideration must be given to the various motivations and factors contributing to substance abuse. This requires knowledge that only those with specialized training possess. Multiple medical opinions have been provided, however. The opinion rendered at the February 2020 VA medical examination is for secondary service connection on a causation basis. It was explained that the Veteran medicates via substance abuse when he experiences a breakthrough episode of his PTSD. The clinical association between his substance abuse disorder and PTSD was classified as strong.

In contrast, the VA medical opinion rendered at the January 2020 VA medical examination is against secondary service connection on a causation basis. So is a January 2021 VA medical opinion. The explanation for both emphasized the Veteran's abuse of multiple substances prior to service, finding ample evidence of such despite some conflicting reports from him in this regard. Both also focused on his family history and genetic predisposition for substance abuse, given the same in his maternal grandfather, mother, and brother. However, both opinions finally concluded that his substance abuse disorder was mildly aggravated beyond its natural course by his PTSD. No explanation in this regard was provided. A February 2021 VA medical opinion lastly is against secondary service connection on a causation basis. Once again, that the Veteran started abusing substances prior to service was highlighted. It was explained that this ultimately became a coping skill, unrelated to his time in service.

The Board finds that all of the opinions concerning secondary service connection on a causation basis are somewhat, though not highly, probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Indeed, all were supported by some explanation but none of these explanations were thorough and well-reasoned. They rather were a bit conclusory in nature. The opinion for secondary service connection, for example, only briefly discussed the Veteran's PTSD. It did not discuss his substance abuse prior to service at all. In contrast, the opinions against secondary service connection discussed his substance abuse prior to service as well as family and genetic factors, but they did not discuss his PTSD. Although there are more opinions against secondary service connection on a causation basis, they are essentially reiterations of one another. Their weight therefore is not substantially different than the weight of the opinion for secondary service connection on that basis.

In conclusion, the weight of the opinions against secondary service connection on a causation basis is in approximate balance with the opinion for secondary service connection on that basis. The benefit of the doubt accordingly is afforded to the Veteran. Service connection for his substance abuse disorder as secondary to his service-connected PTSD on a causation basis, therefore is granted. Regarding secondary service connection on an aggravation basis, it is sufficient to note only that there are two favorable opinions in this regard but that neither is supported with a thorough and well-reasoned explanation. Yet no further discussion is necessary, since secondary service connection on a causation basis is a greater benefit than secondary service connection on an aggravation basis. 38 C.F.R. § 3.310.

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Becker

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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