POSTTRAUMATIC STRESS DISORDER (PTSD)

DAVID GRATZ · 2026 · Case ID: A26039936

MIXED

Summary

The veteran, who served from July 1988 to November 1991, appeals the denial of an increased disability rating for his psychiatric disorders, specifically PTSD with major depressive disorder (MDD) and anxiety, and alcohol use disorder. The veteran contends he is entitled to a 100 percent disability rating. The Board reviewed VA treatment records showing the veteran reported suicidal thoughts and sought emergency care in August 2016, and experienced flashbacks and nightmares. A January 2017 VA initial PTSD examination noted occupational and social impairment with reduced reliability and productivity, attributing symptoms like sleep impairment, motivation disturbances, and difficulty with relationships to PTSD. A June 2024 VA review examination found significant overlap in symptoms between PTSD and alcohol use disorder, noting depressed mood, anxiety, suspiciousness, and difficulty adapting to stress. A November 2024 private psychological assessment found occupational and social impairment with deficiencies in most areas, consistent with a 70 percent rating, noting severe depression, social isolation, suicidal ideation, and anger issues. The Board found the veteran's symptoms, including severe depression, social isolation, and suicidal ideation, warranted a 70 percent rating, resolving reasonable doubt in his favor. However, the Board found the evidence did not support total occupational and social impairment for a 100 percent rating. The claim for TDIU was remanded for additional development regarding the veteran's unclear employment history and to adjudicate the TDIU claim.

Rationale

Board found symptoms more closely approximated 70% criteria; Resolved reasonable doubt in favor of the Veteran; Suicidal ideation present, but not persistent danger of self-harm

Special Benefit

TDIU

Diagnostic Code

9411

Docket No.

260315-637303

Full Decision Text

Citation Nr: A26039936
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260315-637303
DATE: April 29, 2026

ORDER

Entitlement to a 70 percent disability rating, but no higher, for psychiatric disorder, posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) and anxiety (psychiatric disorder) and alcohol use disorder is granted.

REMANDED

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

FINDING OF FACT

Resolving reasonable doubt in favor of the Veteran, his PTSD is manifested by symptomatology resulting in occupational and social impairment with deficiencies in most areas, and without total occupational and social impairment.

CONCLUSION OF LAW

The criteria for entitlement to a 70 percent disability rating, but no higher, for psychiatric disorder, PTSD with major depressive disorder and anxiety (psychiatric disorder) and alcohol use disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from July 1988 to November 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In March 2026, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal Notice of Disagreement (NOD), the Veteran elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal.

In Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims held the Board should not adjudicate an appeal until the time for the appellant to switch Board dockets has ended. This period ends either one year from the date the AOJ mailed notice of the decision on appeal, or 60 days from the date the Board received the VA Form 10182, whichever date is later. 38 C.F.R. § 20.202(c)(2). Here, the Board may proceed with adjudication because in the Veteran waived his right to change appeal lanes. See March 2025 VA Form 10182.

In addition to the foregoing, the Board finds that the issue of entitlement to TDIU has been raised in conjunction with the claim for an increase rating. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a request for TDIU, whether expressly raised by the veteran or reasonably raised by the record, is not a separate claim for benefits, but involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or, as part of a claim for increased compensation if entitlement to the disability upon which TDIU is based has already been found to be service connected). Accordingly, this matter has been added to the claims on appeal.

1. Entitlement to a 70 percent disability rating, but no higher, for psychiatric disorder, PTSD with MDD and anxiety and alcohol use disorder

Applicable Law

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life and employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will
life and employment. 38 C.F.R. § 4.10.

Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009).

Discussion

The Veteran contends that a rating in excess of 50 percent is warranted for his psychiatric disorders. See March 2026 VA Form 10182. Specifically, he contends that he is entitled to a 100 percent disability rating. Id.

The Veteran's psychiatric disorder is currently rated at 50 percent from August 29, 2016. His psychiatric disorder is rated under diagnostic code 9411.

Under the General Rating Formula for Mental Disorders, the rating criteria are as follows:

A 50 percent rating is warranted when the evidence shows 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.

A 70 percent evaluation is warranted where there is objective evidence demonstrating occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to 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, or 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; and the inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411.

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

Turning to the evidence, the Board considered VA treatment records that reflect the Veteran was treated for his psychiatric disorder. Notably, throughout his VA treatment records the Veteran reported suicidal thoughts. An August 2016 VA psychiatry note documents the Veteran reported he felt suicidal and went to the emergency department. He described that
evaluation is for application when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id.

Turning to the evidence, the Board considered VA treatment records that reflect the Veteran was treated for his psychiatric disorder. Notably, throughout his VA treatment records the Veteran reported suicidal thoughts. An August 2016 VA psychiatry note documents the Veteran reported he felt suicidal and went to the emergency department. He described that he tried going without his medication and felt depressed. He denied any current suicidal ideation, homicidal ideation, audio hallucinations, visual hallucinations, or paranoia. A July 2016 VA psychiatry note documents the Veteran reported feeling suicidal all the time, but he did not do anything. He described that he was having nightmares about disfigured bodies. Further, a February 2017 VA psychiatry note documents the Veteran reported having flashbacks about the trauma. During the visit he denied current suicidal or homicidal ideation. He also denied audio visual and visual paranoia.

The Veteran underwent a VA initial PTSD examination in January 2017. The examiner noted the Veteran has more than one mental disorder diagnosed (PTSD and alcohol use disorder in remission) and opined it is possible to differentiate what symptoms are attributable to each diagnosis, remarking that his depressed mood, anxiety, insomnia are symptoms of his PTSD and the no symptoms were attributed to the alcohol use disorder, in remission. The examiner found occupational and social impairment with reduced reliability and productivity.

The examiner enumerated symptoms applied to the Veteran's diagnoses as the following: chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting. The examiner observed that the Veteran was alert and cooperative during the interview.

Socially, the Veteran reported he is currently living in a home with his girlfriend of eight months. He described the quality of his relationship as fair, and that his girlfriend's primary complaint is moodiness and sleep issues. Further, he reported having a good relationship with his siblings and friends. Regarding occupational impairment the Veteran reported he was last employed in May 2015 as a nurse anesthetist for seven years. He had difficulty at work due to his PTSD and has problems maintaining employment.

He reported experiencing current symptoms of PTSD and that he is currently receiving mental health treatment with the VA consisting of psychotropic medication and counseling for the past six months. He denied suicide attempts.

The Veteran received a VA PTSD review examination in June 2024. The examiner diagnosed PTSD and alcohol use disorder and opined it was not possible to differentiate what symptoms are attributable to each diagnosis, remarking the symptoms overlap significantly. The examiner found occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. During the interview the Veteran reported he has not taken medication to treat his psychiatric disorder since 2017. He reported, "I got off all of them because they weren't doing anything, the side-effects were too much."

The examiner enumerated symptoms applied to the Veteran's diagnoses as the following: depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting. Moreover, the examiner found that his PTSD symptoms include night terrors/possible nightmares and the Veteran described periods of memory lapses/dissociation associated with high stress. He endorsed difficulty with concentration, forgetfulness, some hypervigilance, panic symptoms described as difficulty breathing, feelings of doom, and feeling overwhelmed. The examiner noted that symptoms also include isolation, irritability, problems with concentration, tearfulness, sleeping more than usual, low motivation, low appetite, sleep disturbance, and some low hygiene when severely depressed. He denied current suicidal thoughts/attempts but did mention some passive thoughts.

Socially, the Veteran reported that since his last examination in 2017 he has a few close friends and is in a romantic relationship. Regarding occupational impairment, the Veteran reported that since his last examination he worked in a restaurant, video production, and retail music store. However, he reported that he currently works around 18 to 25 hours a week. It was noted that he has held his job for several years though he was furloughed for 18 months due to the pandemic. Also, he reported he lost his jobs due to his temper.

The examiner observed the Veteran was dressed appropriately and showed
sleep disturbance, and some low hygiene when severely depressed. He denied current suicidal thoughts/attempts but did mention some passive thoughts.

The examiner observed the Veteran was dressed appropriately and showed adequate hygiene and grooming. He was open and cooperative with appropriate eye contact. The examiner noted the Veteran's thoughts were logical, linear, and goal directed.

VA received a private psychological assessment in November 2024. The physician found occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood consistent with a 70 percent disability rating. The physician noted the Veteran described his mental health symptoms include depression which is present most days of the week with extreme loss of motivation, drive, and sense of purpose. He reported suicidal ideation with thoughts or methods and a non-zero level of intent. He had instances of interrupted and/or aborted suicide attempts. The Veteran reported having periods of difficulty with self-care or personal hygiene and panic attack like symptoms. Moreover, he reported symptoms of anger with some physical aggression but most often it is expressed via hostile or demeaning language.

Socially the Veteran described reported that at the time of the examination he was not married and did not have any children. See November 2024 private psychological assessment. He continues to maintain a relationship with his family, including parents and cousins. Id. He reported living in a stable environment with a roommate he sees every day. Id. It was noted he can attend to his basic self-care independently and has at least some level of consistent responsibility for the basic requirements of retaining his living situation. Id. During the examination he reported that he isolates and is avoidant. Id. Specifically, when he isolates he describes near total isolation. Also, he stated he believes he is unable to sustain a meaningful intimate or other relationship. Id.

Regarding occupational impairment, it was noted he is currently working part-time and does various independent side jobs. See November 2024 private psychological assessment. He reported being fired around five times due to poor work attendance and difficulties interacting with co-workers, customers, and supervisors. Id. "He has a pattern of routinely quitting multiple jobs with minimal to no notice. Id. He has had to alter the quantity or nature of his work due to mental illness. He has consistently gravitated toward employment which is more autonomous and/or where he has a sense of control and limited social contact." Id.

Based on the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that the frequency, severity, and duration of the Veteran's psychiatric symptoms more nearly approximate occupational and social impairment with deficiencies in most areas--such as work, school, family relations, judgment, thinking, or mood. The Veteran's most characteristic symptoms are severe depression, social isolation, and suicidal ideation. Based on a description of these symptoms he has lost interest in socializing and his psychiatric disorders often results in a lack of energy, feelings of worthlessness, and loss of interest in socializing. Moreover, the evidence record demonstrates the Veteran expressed suicidal ideation which is contemplated by the 70 percent criteria and is similar to persistent danger of self-harm. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017).

Additionally, the Board finds that the evidence is against a finding that the Veteran's psychiatric disability shows total occupational and social impairment sufficient to warrant a rating of 100 percent. The evidence does not demonstrate symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, disorientation to time or place, memory loss for names of close relatives, own occupation, or own name, or any symptomatology otherwise consistent with total occupational and social impairment. While the Veteran did experience symptoms contemplated by a 100 percent rating-intermittent inability to perform activities of daily living - overall the evidence does not demonstrate the level of impairment associated with a 100 percent rating. Moreover, while the VA medical examinations and private psychological evaluation document the Veteran reported suicidal ideation, he denied a current intent or plan. Consequently, the Board finds that the Veteran's suicidal ideation symptoms, while sufficient to warrant a 70 percent rating, do not rise to the level of rendering him a persistent danger of hurting himself, and therefore a 100 percent rating is not warranted.

RE
, memory loss for names of close relatives, own occupation, or own name, or any symptomatology otherwise consistent with total occupational and social impairment. While the Veteran did experience symptoms contemplated by a 100 percent rating-intermittent inability to perform activities of daily living - overall the evidence does not demonstrate the level of impairment associated with a 100 percent rating. Moreover, while the VA medical examinations and private psychological evaluation document the Veteran reported suicidal ideation, he denied a current intent or plan. Consequently, the Board finds that the Veteran's suicidal ideation symptoms, while sufficient to warrant a 70 percent rating, do not rise to the level of rendering him a persistent danger of hurting himself, and therefore a 100 percent rating is not warranted.

REASONS FOR REMAND

1. Entitlement to a TDIU is remanded.

First, as discussed herein, the evidence of record at the time of the rating decision on appeal suggested that the Veteran may be unable to secure or follow a substantially gainful occupation due to his service-connected disabilities.

Second, remand is required for additional development regarding the Veteran's employment history. A review of the evidence reflects that the Veteran's employment status throughout the appeal period is unclear. Here, the June 2024 VA examination documents the Veteran reported that since his last examination he worked at a restaurant, video production, and retail music store. During the examination he also reported working around 18 to 25 hours a week and that he has held his job for several years though he was furloughed for 18 months due to the pandemic. Additionally, at the time of the November 2024 private evaluation the Veteran reported he was currently working part-time and does various independent side jobs.

Accordingly, remand is required to correct this pre-decisional duty to assist error. See 38 U.S.C. § 5103A(d).

The matters are REMANDED for the following action:

1. Adjudicate the claim of entitlement to a TDIU, as required pursuant to Rice, supra. Request that the Veteran complete a VA Form 21-8940, Veterans Application for Increased Compensation Based on Unemployability. Explain what is needed to establish entitlement to TDIU due to his service-connected disabilities. Ask the Veteran to submit any additional evidence in support of his TDIU claim, specifically include information on his work history, salary, and educational history.

David Gratz

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Braxton

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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