PTSD DUE TO COMBAT

THOMAS H. O'SHAY · 2026 · Case ID: A26039985

MIXED

Summary

The veteran, who served from November 2011 to July 2015, appeals the denial of a higher rating for his service-connected PTSD with alcohol use disorder, currently rated at 70 percent. The veteran also sought Total Disability based on Individual Unemployability (TDIU). The Board reviewed the evidence, including statements from the veteran and his spouse, VA treatment records, an October 2024 VA medical examination, and a March 2026 private vocational evaluation. The Board found that while the veteran experienced significant occupational and social impairment, his symptoms did not meet the criteria for a 100 percent rating. Symptoms like depressed mood, anxiety, panic attacks, chronic sleep impairment, flattened affect, disturbances of motivation, impaired judgment, and difficulty with social relationships were noted, aligning with ratings of 30, 50, and 70 percent. However, the Board found no evidence of gross impairment in thought processes, communication, persistent hallucinations/delusions, or inability to perform basic ADLs, which are required for the highest rating. The Board concluded that the veteran's current 70 percent rating accurately reflects his level of impairment. Regarding TDIU, the Board found the veteran's 70 percent rating for PTSD with alcohol use disorder and his 30 percent rating for bilateral pes planus met the schedular requirements for TDIU (combined 80 percent). The Board found the private vocational evaluation highly probative, concluding that the veteran's PTSD and pes planus symptoms rendered him unable to secure or follow substantially gainful employment. Therefore, TDIU was granted.

Rationale

Symptoms align with 30%, 50%, and 70% ratings.; No symptoms listed or similar to 100% rating criteria.; No gross impairment in thought processes, communication, or ADLs.; Social relationships persist, indicating not total social impairment.

Special Benefit

TDIU

Diagnostic Code

9411

Docket No.

260108-621042

Full Decision Text

Citation Nr: A26039985
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260108-621042
DATE: April 29, 2026

ORDER

A higher rating for service-connected posttraumatic stress disorder (PTSD) with alcohol use disorder, currently 70 percent, is denied.

A total disability based on individual unemployability (TDIU) is granted.

FINDINGS OF FACT

1. The Veteran's PTSD with alcohol use disorder has not manifested total occupational and social impairment.

2. The Veteran's service-connected disabilities have rendered him unable to secure or follow a substantially gainful occupation.

CONCLUSIONS OF LAW

1. The criteria for a higher rating for service-connected PTSD with alcohol use disorder have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.102, 3.400, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.21, 4.124a Diagnostic Code 8045, 4.126, 4.130 Diagnostic Code 9411.

2. The criteria for a TDIU have been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 4.19, 4.25.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 2011 to July 2015. This matter stems from a January 2025 rating decision which continued the previously established 70 percent rating for his service-connected PTSD with alcohol use disorder. In timely appealing that determination by submitting a notice of disagreement (NOD) to the Board of Veterans' Appeals (Board), the Veteran's representative requested the evidence docket. A TDIU has been added as an issue, as it was expressly raised as part and parcel to this higher rating matter in the NOD. Rice v. Shinseki, 22 Vet. App. 447, 455 (2009); Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001).

Given this procedural history, the Board may consider the evidence of record at the time of the rating decision as well as evidence submitted with the NOD or within 90 days following its receipt. 38 U.S.C. § 7113(c); 38 C.F.R. § 20.303. Any evidence added to the record after the rating decision was issued but before the NOD was received as well as more than 90 days after the NOD was received accordingly has not been considered herein. If the Veteran would like such evidence to be considered by VA, he may file a supplemental claim (following the included instructions) and resubmit or identify it. 38 C.F.R. § 3.2501. There must be new and relevant evidence, which will be considered along with the previous evidence in issuing another rating decision. Id.

Higher Rating

Ratings represent as far as practicably can be determined the average impairment in earning capacity due to a disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. A rating is assigned under the Rating Schedule by comparing the extent to which a disability impairs the ability to function under the ordinary conditions of daily life, as demonstrated by symptoms, with the criteria for that disability. Id.; 38 C.F.R. § 4.10; Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). The disability's history and all other relevant evidence is to be considered. 38 C.F.R. §§ 4.1, 4.6. Examinations are to be interpreted and, if necessary, reconciled. 38 C.F.R. § 4.2.

When two ratings may be applicable, the higher is assigned only if the criteria for it are more nearly approximated. 38 C.F.R. § 4.7. Any reasonable doubt on this or any other point is resolved in the claimant's favor. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776, 781-782 (2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Different ratings may be assigned for different periods, a process known as staging. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007); Francisco v. Brown, 7 Vet. App. 55, 58 (1994). When a disability worsened thus must be determined. The review period begins one year prior to a higher rating claim. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2).

PTSD with Alcohol Use Disorder

38 C.F.R. § 4.130 addresses mental disorders. The Veteran's service-connected PTSD with alcohol use disorder is evaluated pursuant to Diagnostic Code 9411, which is for PTSD, thereunder. It, like all other mental disorders except eating disorders, calls for use of the General Rating Formula for Mental Disorders (General Rating Formula). This formula assigns a 10 percent rating for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or for when symptoms are controlled by continuous medication.

A 30 percent rating is assigned for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). Symptoms of such impairment include depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, or recent events).

For a 50 percent rating, for occupational and social impairment with reduced reliability and productivity is required. Symptoms of such include flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty understanding complex commands, short- and long-term memory impairment (retention of only highly learned material, forgetting to complete tasks), impaired judgment and abstract thinking, disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas such as work, school, family relationships, judgment, thinking, or mood. Symptoms include suicidal ideation, obsessional rituals which interfere with routine activities, intermittently illogical, obscure, or irrelevant speech, 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 adapting to stressful circumstances (for example work or a worklike setting), and an inability to establish and maintain effective relationships.

Finally, the maximum 100 percent rating is assigned for total occupational and social impairment. Symptoms include gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent ability to perform activities of daily living (ADLs) (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name.

The frequency, duration, and severity of all symptoms attributable to the service-connected psychiatric disability must be considered. 38 C.F.R. §§ 4.126(a); Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Those listed in the rating formula are simply examples that justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-443 (2002). It thus is not required that all, most, or even some of these listed symptoms be present. Id.; 38 C.F.R. § 4.21; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115-118 (Fed. Cir. 2013).

Currently, the Veteran's PTSD with alcohol use disorder has a 70 percent rating. The Board
ulkin, 29 Vet. App. 10, 22 (2017). Those listed in the rating formula are simply examples that justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-443 (2002). It thus is not required that all, most, or even some of these listed symptoms be present. Id.; 38 C.F.R. § 4.21; Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115-118 (Fed. Cir. 2013).

Currently, the Veteran's PTSD with alcohol use disorder has a 70 percent rating. The Board finds that the next highest rating, which also is the maximum possible rating of 100 percent, is not warranted. The Veteran's symptoms, as reported by him and his spouse C.P. in statements as well as noted in VA treatment records, an October 2024 VA medical examination, and a March 2026 private vocational evaluation (for which he was interviewed in January 2026), include depressed mood, anxiety, suspiciousness, panic attacks weekly or less often, and chronic sleep impairment. All are listed for a 30 percent rating. The Veteran also had flattened affect, disturbances of motivation and mood, impaired judgment, and difficulty in establishing and maintaining effective work and social relationships, which are listed for a 50 percent rating. Further, he had impaired impulse control and difficulty in adapting to stressful circumstances. Both are listed for a 70 percent rating.

The Veteran's aforementioned listed symptoms were accompanied by unlisted symptoms. He has some repeat nightmares, for example, which is similar to chronic sleep impairment. His worry even over minor things, sometimes to the point he gets physically ill, is similar to anxiety. His feeling panicky further is akin to panic attacks, while his belief that his bosses did not like him is akin to suspiciousness. That chronic sleep impairment, anxiety, panic attacks weekly or less often, and suspiciousness are listed symptoms for a 30 percent rating is reiterated from above. While the Veteran did not have impaired abstract thinking, a symptom listed for a 50 percent rating, his difficulty with attention and focus is comparable to it. So is his dwelling on daily challenges, as it implies interrupted concentration as well. His isolating, discomfort in crowds, and difficulty going out socially next are similar to difficulty in establishing and maintaining effective work and social relationships or an inability to establish and maintain effective relationships, listed symptoms for a 50 percent and a 70 percent rating respectively.

Although he does not manifest the listed symptom for a 70 percent rating of suicidal ideation, the Veteran's feeling overwhelmed or that he is not in control, guilt, internalization of remarks from others, self-destructive or self-sabotaging tendencies, and belief that he does not deserve life going well are somewhat similar to it. He finally has several unlisted symptoms akin to the listed symptom for a 50 percent rating of disturbances of motivation and mood or to the listed symptom for a 70 percent rating of impaired impulse control. His irritability, impatience, and anger specifically all are like disturbances of mood. Indeed, to be irritable means to be "easily exasperated or excited" or "responsive to stimuli." Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary (last visited April 21, 2026). This correlates with him being triggered even by something small. There is no indication he ever has been violent, much less has periods of violence, but impaired impulse control is apparent in his difficulty maintaining appropriate behavior.

With respect to a 100 percent rating, the VA medical examination specifically found that the Veteran had none of the listed symptoms. There also is no indication of these symptoms or anything like them otherwise. Neither VA treatment records nor the private vocational evaluation discuss the Veteran's behavior. This signifies that it was not grossly inappropriate or even problematic to a lesser degree. Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the absence of an entry in a record may be evidence against the existence of a symptom if it would ordinarily be entered). Next, findings were made that the Veteran did not have a thought disorder. His thoughts were described positively as being within logical and goal-directed. At no point was he noted to have difficulty conveying a message to others or understanding a message being conveyed to him. All of this is inconsistent with gross impairment in thought processes or communication or similar.

The Veteran never struggled to discuss himself, his spouse and children, his other family members, or the jobs he has had in the past. It
ynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (the absence of an entry in a record may be evidence against the existence of a symptom if it would ordinarily be entered). Next, findings were made that the Veteran did not have a thought disorder. His thoughts were described positively as being within logical and goal-directed. At no point was he noted to have difficulty conveying a message to others or understanding a message being conveyed to him. All of this is inconsistent with gross impairment in thought processes or communication or similar.

The Veteran never struggled to discuss himself, his spouse and children, his other family members, or the jobs he has had in the past. It follows that he did not have memory loss for his own name, his own occupation, the names of his close relatives, or the like. He additionally never had disorientation to time or place. On the contrary, he was oriented to person, place, and time. He sometimes has consumed alcohol until he blacks out, which is similar to disorientation. Yet it is unclear whether this was only in the past or still happens. In any case, the situation is temporary and the sole consequence apart from increased family relationship difficulties is sleeping until it passes. The Veteran never had any hallucinations or delusions, let alone persistent ones. No other distortions or alterations from reality were detected in him either. In addition to never having suicidal ideation, he also never had homicidal ideation. He thus never posed a danger, much less a persistent danger, of hurting himself or others. That there is no indication his anger ever turned violent once again is reiterated in this regard.

Finally, the Veteran did not have an intermittent inability to perform ADLs. ADLs are not defined in the applicable rating formula, but they are defined when rating cognitive impairment and subjective symptoms of a traumatic brain injury. 38 C.F.R. § 4.124a Diagnostic Code 8045, Note (3). This definition is informative for mental disorders, as there is no basis to conclude different definitions apply when the impairments rated are very similar. Specifically, ADLs refer "to basic self-care" and include "bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet." There is no indication whatsoever that the Veteran is unable to perform these activities. While an April 2021 VA medical examination found an intermittent inability to perform them, including maintenance of minimal personal hygiene, this finding was not repeated thereafter. At the October 2024 VA medical examination, the Veteran indeed was casually dressed in appropriate attire and had good hygiene.

The Veteran, in sum, has a host of symptoms listed for ratings of 70 percent or lower along with several unlisted symptoms similar thereto. He has no symptoms listed for a 100 percent rating or unlisted symptoms similar thereto. The severity, frequency, and duration of his listed and unlisted symptoms combined clearly caused significant occupational and social impairment. However, this level of impairment was determined to be occupational and social impairment with deficiencies in most areas at the aforementioned VA medical examination. It was not determined to be total occupational and social impairment. This is equivalent to a rating of 70 percent instead of 100 percent. The other evidence also is against total occupational and social impairment. The Veteran has not worked in a number of years as a result of his PTSD with alcohol use disorder symptoms. This may or may not signify total occupational impairment. No determination is necessary, however, as he clearly does not have total social impairment.

In that regard, the Veteran has maintained his marriage with C.P for years and describes their relationship as good. They have three minor children under the age of 10, and he stays at home to care for them. His relationship with each was not characterized, but there is no indication they are problematic. The Veteran also stays in contact with his father on a weekly basis and with his brothers on a monthly basis. He is estranged from his mother and has no close friends, a change from the April 2021 VA medical examination when he had frequent contact with one close friend. It follows that he has several relationships, though fewer than before. While these relationships may be challenging, that they persist signifies that his symptoms are not so severe that he is completely unable to engage socially. This correlates with the depiction of him as cooperative and friendly at the October 2024 VA medical examination. All of the aforementioned is inconsistent with total social impairment; rather, it is encompassed by the current 70 percent rating.

The Board's holistic analysis, in conclusion, reveals that the occupational and social impairment caused by the Veteran's listed and unlisted
He is estranged from his mother and has no close friends, a change from the April 2021 VA medical examination when he had frequent contact with one close friend. It follows that he has several relationships, though fewer than before. While these relationships may be challenging, that they persist signifies that his symptoms are not so severe that he is completely unable to engage socially. This correlates with the depiction of him as cooperative and friendly at the October 2024 VA medical examination. All of the aforementioned is inconsistent with total social impairment; rather, it is encompassed by the current 70 percent rating.

The Board's holistic analysis, in conclusion, reveals that the occupational and social impairment caused by the Veteran's listed and unlisted symptoms combined is significant but falls short of being total. The evidence indeed is persuasive that his disability picture does not more nearly approximate the criteria for a 100 percent rating. A rating higher than 70 percent for service-connected PTSD with alcohol use disorder accordingly is denied.

TDIU

A TDIU is warranted if a veteran is unable to secure or follow a substantially gainful occupation due to service-connected disability or disabilities rated less than 100 percent. 38 C.F.R. § 4.16(a). It may be granted on a schedular basis when there is one such disability rated at 60 percent or more or when there are two or more such disabilities with a combined rating of 70 percent or more and one is rated individually at 40 percent or more. Id. If neither percentage threshold is met, it may be granted on an extraschedular basis. 38 C.FR. § 4.16(b). This may be by the Board in the first instance. Witkowski v. Collins, No. 24-0640, 2025 U.S. App. Vet. Claims LEXIS 1423 (Oct. 21, 2025) (the requirement in the regulation to refer to the Director, Compensation Service, does not apply to the Board).

The economic component of "unable to secure or follow a substantially gainful occupation," means an occupation earning more than marginal income (outside of a protected environment) as determined by the US Department of Commerce, Bureau of the Census, as the poverty threshold for one person. 38 C.F.R. § 4.16(a); Ray v. Wilkie, 31 Vet. App. 58, 72-73 (2019). The non-economic component involves consideration of the veteran's history, education, skill, and training as well as whether he/she has the physical and mental ability to perform the type of activities required for that occupation. Id.; Pederson v. McDonald, 27 Vet. App. 276, 286-287 (2015).

For physical ability, relevant considerations include, but are not limited to, limitations with respect to lifting, bending, sitting, standing, walking, climbing, grasping, typing, reaching, being able to hear, and being able to see. Id. Relevant considerations for mental ability include, but are not limited to, limitations with respect to memory, concentration, the ability to adapt to change, the ability to handle workplace stress, getting along with coworkers, and demonstrating reliability and productivity. Id. In other words, there must be an impairment of body and/or mind which renders it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1).

The veteran's age is not for consideration in determining whether a TDIU is warranted, however. 38 C.F.R. §§ 3.341(a), 4.19. Neither is the impairment attributable to nonservice-connected disabilities. Whether a TDIU should be awarded is a legal determination to be made by VA; it is not a medical determination. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013). Finally, 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; Lynch, 21 F.4th at 781-782; Gilbert, 1 Vet. App. at 53.

As determined above, the 70 percent rating for the Veteran's service-connected PTSD with alcohol use disorder is continued. It follows that this disability meets the individual rating requirement for a schedular TDIU of at least 40 percent. The only service-connected disability the Veteran has is bilateral pes planus. It has a 30 percent rating. Combined, his two service-connected disabilities have an 80 percent rating. 38 C.F.R. § 4.25. The 70 percent combined rating requirement for a schedular TDIU when there are multiple service-connected disabilities accordingly is met. The Board thus finds that both ratings requirements for a schedular TDIU are met. The Board next finds that a schedular TDIU is warranted. Indeed, the Veteran has been unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. In making this determination, that he is not qualified by education or work experience for a number of occupations is acknowledged.

The Veteran specifically has a GED. While he took a few community college courses, he did not receive any degree. After his separation from service, he worked full-time as a tire technician, an electric apprentice technician, an ironworker, and an electric technician. According to the March 2026 private vocational evaluation, which in turn references the United State Department of Labor's Dictionary of Occupational Titles (DOT), these positions are of medium to heavy physical demand and range from semi-skilled to skilled. No basis is found to dispute these classifications. In sum, the Veteran has a limited education and prior experience in jobs that are at least moderately physically demanding and require some to substantial skills. This background precludes him from all employment where a college degree is a prerequisite and qualifies him most for employment that uses the skills he has already acquired or will provide on-the-job training.

Notably, the Veteran has not worked since September 2019. He and his spouse attribute this primarily to his PTSD with alcohol use disorder. They indicate that this disability affected his employment ever since he separated from service. Although doing well initially in the aforementioned positions, he resigned from all but one after less than a year. He resigned from the exception after just over a year. The Veteran recounts that his mind would race on the job, and he sometimes would vomit given his level of anxiety. He also recounts using alcohol three days out of a five-day work week to overcome his social anxiety, so he could comfortably interact with managers, coworkers, and customers. In addition, he had frequent angry outbursts. He sometimes threw tools, for which he was sent home early at least three times. When working collaboratively, the Veteran's anger, irritability, and internalization of remarks from others were problematic. When working independently, he tended to dwell on daily challenges. Overall, he felt like he was trapped in a self-destructive cycle and was emotionally overwhelmed by it.

The March 2026 private vocational evaluation found that the Veteran's PTSD with alcohol use disorder symptoms, as discussed above, reduce his reliability and productivity. Specifically, they result in frequent episodes of decompensation, limit his attention, interfere with his ability to follow instructions and maintain appropriate behavior, may create unsafe behavior, impair his judgment and ability to engage with coworkers (and customers; they was not expressly stated, but it is clearly implied), preclude his tolerance of supervision, and increase his absenteeism. Regarding the Veteran's bilateral pes planus, his reported symptoms include constant pain, frequent swelling, and occasional numbness. The vocational evaluation found that they preclude him from standing more than one hour, walking more than short distances, and climbing stairs. Therefore, they restrict him from performing physical or mixed-exertional occupations. They also increase his irritability and reduce his stress tolerance.

Putting these findings together, the vocational evaluation concluded the Veteran is unable to obtain and maintain substantially gainful employment as a result of his service-connected disabilities. This includes all jobs, including those he is most likely to succeed in given his education and work history. That he is not capable even of unskilled sedentary employment, with sedentary particularly defined here as sitting most of the time, was discussed. Rouse v. McDonough, 34 Vet. App. 43, 50 (2021); Withers v. Wilkie, 30 Vet. App. 139, 147-148 (2018). In general, employers were noted to require that employees follow instructions, recall work tasks without reminders, attend to these tasks without supervision or a decline in performance or behavior when interrupted, maintain attention and focus for at least two hours, produce a minimum amount of work, not take unscheduled breaks, and work a regular schedule. How the Veteran does not meet these requirements was discussed.

The Veteran's PTSD with alcohol use disorder indeed was cited as the primary cause of his unemployability. His bilateral pes planus also was found to contribute, however. The March 2026 private vocational opinion, in conclusion, is highly probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Indeed, it was based upon consideration of the relevant evidence and presents a clear conclusion supported by a well-reasoned rationale. No other opinion concerning the Veteran's employability exists. The evidence thus is persuasive that a TDIU is warranted. A TDIU is granted; assigning an effective date for this grant falls to the agency of original jurisdiction.

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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