ANXIETY DISORDER

Summary

The Veteran served in the Army from March 1976 to September 1979. The Veteran appeals the denial of service connection for anxiety disorder, right ear hearing loss, migraine headaches, and bilateral foot conditions. The Board found no current disability for anxiety disorder or right ear hearing loss. For anxiety, the Board determined the Veteran's reported anxiety symptoms were fully contemplated by her existing service-connected PTSD and unspecified depressive disorder, and did not manifest as a separate disability. For right ear hearing loss, the Board found the VA audiology examination results did not meet the regulatory criteria for a hearing loss disability, and that service treatment records were negative for such a condition. For migraine headaches and bilateral foot conditions, the Board found current disabilities existed but the probative evidence weighed against service connection. The Veteran's August 1979 separation examination and Report of Medical History were negative for headaches and foot trouble, and these were found more persuasive than the Veteran's later contentions and lay statements. The Board noted the lack of in-service complaints or events for these conditions and the significant time delay in seeking treatment. The Board acknowledges the Veteran's representative's argument that headaches may be secondary to PTSD, but found no pre-decisional duty to assist error as this theory was not raised prior to the appeal. Service connection for anxiety disorder, right ear hearing loss, migraine headaches, and bilateral foot conditions were denied. The claim for tinnitus was remanded for an adequate examination.

Rationale

No separate and distinct anxiety disorder diagnosis; Anxiety symptoms considered part of existing PTSD/depressive disorder; Lay evidence of symptoms requires medical expertise for diagnosis

Full Decision Text

Citation Nr: A26040039
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250320-526919
DATE: April 29, 2026

ORDER

Service connection for anxiety disorder is denied.

Service connection for right ear hearing loss is denied.

Service connection for migraine headaches is denied.

Service connection for bilateral foot conditions is denied.

REMANDED

Service connection for tinnitus is remanded.

FINDINGS OF FACT

1. The Veteran is service-connected for PTSD; anxiety is a symptom of this service-connected disability and does not manifest as a separate and distinct disability.

2. Hearing loss meeting the definition of a disability for VA compensation purposes was not shown in the right ear.

3. No headache condition was shown during service or for many years thereafter, and the probative evidence of record is against finding that the Veteran's current migraine headaches are related to her service. 

4. No foot condition was shown during service or for many years thereafter, and the probative evidence of record is against finding that the Veteran's current left plantar fasciitis and bilateral metatarsalgia are related to her service. 

CONCLUSIONS OF LAW

1. The criteria for service connection for an anxiety disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. The criteria for service connection for right ear hearing loss have not been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.385.

3. The criteria for service connection for migraine headaches have not been met. 38 U.S.C. §§ 1112, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

4. The criteria for service connection for any left or right foot conditions have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1976 to September 1979, in the United States Army. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that, in part, denied service connection for anxiety disorder, right ear hearing loss, migraine headaches, bilateral plantar fasciitis, and tinnitus. In March 2025, the Veteran filed a timely VA Form 10182, Decision Review Request: Board Appeal, citing disagreement with these denials and electing the Direct Review docket. 

Given the Veteran's selection of the Direct Review docket, the Board may only consider the evidence of record at the time of the January 2025 rating decision. See 38?C.F.R. § 20.301. If any evidence was submitted after this rating decision, it was not considered. If the Veteran would like any such evidence to be considered, the Veteran may file a supplemental claim. 38 C.F.R. § 3.2501.

Service connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995).

The existence of a current disability is
den v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995).

The existence of a current disability is the cornerstone of a claim for VA disability compensation and in the absence of proof of a present disability, there can be no valid claim. See Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Brammer v. Derwinski, 3 Vet. App. 223 (1992). "Current" means near the time a claim is filed or at any time during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); McClain v. Nicholson, 21 Vet. App. 319 (2007). "Disability" refers to the functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1359, 1363 (Fed Cir. 2018) (holding that pain resulting in functional impairment can constitute a disability even without an identified underlying diagnosis). Functional impairment in earning capacity can be demonstrated by "showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person." Wait v. Wilkie, 33 Vet. App. 8, 17 (2020).

Lastly, the Board notes that when a veteran served continuously for 90 days or more certain chronic diseases, including hearing loss and migraines, are presumed to have been incurred in service if such manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309.

1. Service connection for anxiety disorder

2. Service connection for right ear hearing loss

The Veteran seeks service connection for an anxiety disorder and right ear hearing loss. (In the rating decision on appeal, service connection was granted for posttraumatic stress disorder (PTSD) with unspecified depressive disorder and for left ear hearing loss.) 

The initial question for the Board regarding these claims is whether the Veteran has a current anxiety disorder or a right ear hearing loss disability for VA purposes. Upon review of the record in this case, the Board concludes that the Veteran does not have a current diagnosis of any such disabilities and has not had a current diagnosis of any such disabilities at any time during the pendency of the claims for service connection or recent to the filing of the claims.

Regarding the Veteran's claim for service connection for an anxiety disorder, as the Veteran is already service-connected for PTSD with unspecified depressive disorder, in order for service connection for an anxiety disorder to be granted, the evidence would need to reflect a diagnosis of an anxiety disorder that is separate and distinct from the Veteran's service-connected PTSD with unspecified depressive disorder. If a separate pathology does not exist, then service connection for an anxiety disorder is not warranted.

In January 2025, the Veteran underwent a VA PTSD examination. The examiner diagnosed PTSD and unspecified depressive disorder. In listing the Veteran's symptoms, the examiner noted that the Veteran suffers from anxiety. The examiner classified the Veteran's anxiety as a symptom of her PTSD. 

Like the VA examination, the Veteran's treatment records are also negative for any diagnosis of an anxiety disorder. 

In a December 2024 statement, the Veteran reported that her psychiatric symptoms include anxiety and she has appealed the issue of entitlement to service connection for anxiety disorder. However, while the Veteran is competent to report her symptoms, the diagnosis of a disability manifested by such symptoms requires medical expertise to determine. Thus, any opinion of the Veteran regarding any current disability is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis or etiology). 

The Board notes that the Veteran has been service-connected for PTSD and unspecified depressive disorder throughout the pendency of her claim here for an anxiety disorder. The Veteran has not contended and the record does not show that the Veteran's claimed anxiety disorder manifests in any symptoms separate and distinct from the symptoms of her
 to report her symptoms, the diagnosis of a disability manifested by such symptoms requires medical expertise to determine. Thus, any opinion of the Veteran regarding any current disability is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis or etiology). 

The Board notes that the Veteran has been service-connected for PTSD and unspecified depressive disorder throughout the pendency of her claim here for an anxiety disorder. The Veteran has not contended and the record does not show that the Veteran's claimed anxiety disorder manifests in any symptoms separate and distinct from the symptoms of her already service-connected mental disorders. See Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009) (holding that where a claimant requests additional service connection for the same symptoms caused by a different psychiatric disorder, 38 C.F.R. § 4.14 prohibits VA from rating the same manifestations under different diagnoses); see also Dollison v. Wilkie, 750 F. App'x 986 (Fed. Cir. 2018) (nonprecedential) (dismissing, for lack of standing, veteran's appeal of a Board decision that denied service connection for PTSD and granted service connection for major depressive disorder (MDD) because veteran did not demonstrate how entitlement to service connection for PTSD rather than, or in addition to, MDD would result in a better rating or otherwise greater benefits).

Accordingly, the Board finds, based on the above, that the Veteran's anxiety symptoms are fully contemplated by her service-connected PTSD. As she does not manifest an anxiety disability that is separate and distinct from her already service-connected condition, service connection for anxiety disorder on a direct or secondary basis is not warranted. 

Regarding the Veteran's claim for service connection for right ear hearing loss, the initial question for the Board is whether the Veteran has a current hearing loss disability for VA purposes. For the purposes of applying the law administered by VA, 38 C.F.R. § 3.385 provides that impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or more; when the auditory thresholds for at least three of the frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent.

The Veteran underwent a VA audiology examination in November 2024. The examiner noted the Veteran's report that she worked around large generators and firing ranges during her service. However, the examination did not show a current right ear hearing loss disability for VA purposes. The examiner indicated right ear pure tone thresholds of 15, 25, 20, 30, 15 decibels at 500, 1000, 2000, 3000, and 4000 Hertz, respectively. The Veteran's speech discrimination score was 96 percent in the right ear. These findings fail to show that the Veteran suffers from a current hearing loss disability for VA purposes pursuant to 38 C.F.R. § 3.385 in the right ear.  

The Board acknowledges the Veteran's report of the functional impact of her hearing loss on her daily life-that she has difficulty understanding conversations and often has to ask people to repeat themselves. In Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit held that even in the absence of a diagnosis, there is a current disability where a veteran experiences functional impairment from symptoms of a disorder. 886 F.3d 1356, 1368 (Fed. Cir. 2018). However, since VA has specifically defined what constitutes a hearing loss disability in 38 C.F.R. § 3.385, the Federal Circuit's holding in Saunders is not applicable to a claim for service connection for hearing loss. See McKinney v. McDonald, 28 Vet. App. 15, 25 (2016) (concluding that § 3.385 "reasonably interpreted what constitutes a hearing disability").

As the November 2024 hearing loss examination was conducted in accordance with 38 C.F.R. § 4.85(a), the Board finds the results to be probative. See 38 C.F.R. § 4.85(a) ("An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test.").

The Veteran's service treatment records (STRs) and post-service treatment records are also negative for evidence of a right ear hearing loss disability for VA
. 15, 25 (2016) (concluding that § 3.385 "reasonably interpreted what constitutes a hearing disability").

As the November 2024 hearing loss examination was conducted in accordance with 38 C.F.R. § 4.85(a), the Board finds the results to be probative. See 38 C.F.R. § 4.85(a) ("An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test.").

The Veteran's service treatment records (STRs) and post-service treatment records are also negative for evidence of a right ear hearing loss disability for VA purposes.

Thus, the competent and probative evidence of record indicates that the Veteran does not have hearing loss in the right ear that meets the criteria for disability under 38 C.F.R. § 3.385. Without competent and probative evidence of a current hearing loss disability for VA purposes, service connection for hearing loss cannot be established.

Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. See Brammer, 3 Vet. App. at 225. As the probative evidence of record does not show that the Veteran has a current distinct anxiety disorder or right ear hearing loss for VA purposes, there is no basis upon which service connection for such conditions can be awarded. See Degmetich, 104 F.3d at 1333. 

As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and the claims for service connection for anxiety disorder and right ear hearing loss are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

3. Service connection for migraine headaches

4. Service connection for bilateral foot conditions

The Veteran seeks service connection for migraine headaches and bilateral plantar fasciitis.  

While current disabilities of migraine headaches, bilateral metatarsalgia and left plantar fasciitis are shown by the record, the weight of the evidence is against finding that these conditions were incurred in or caused by the Veteran's service. 

The Veteran's STRs are negative for complaints, diagnosis, or treatment of headache or foot conditions. In August 1979, shortly before her separation from service, the Veteran completed a Report of Medical History. The form asked "have you ever had or have you now" regarding several conditions. The Veteran reported "no" to "frequent or severe headache" and reported "no" to "foot trouble." The Veteran's August 1979 separation examination reported that the Veteran's feet were normal and did not note any headache condition. There is also no post-service evidence of any headache or foot condition for several years after service.

The first medical evidence of a headache condition is from a January 2001 VA treatment record, which notes a diagnosis of migraine and describes the headache symptoms and frequency. The record does not contain any information regarding the history of the condition. 

In an August 2024 statement, the Veteran reported that during service she "began to experience symptoms of nausea, sensitivity to light, pain in my face/neck area and dizziness." The Board notes that the Veteran's August 1979 explicit denial of frequent or severe headaches is in direct conflict with her current contention that a chronic headache condition onset during her active duty service. Given that the August 1979 denial is consistent with the lack of any record of headache complaints during service and was made at the time in question, the Board finds it to be more persuasive than the Veteran's current contentions. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006) (the lack of contemporaneous medical records, the significant time delay between the affiants' observations and the date on which the statements were written, and conflicting statements of the veteran are factors that the Board can consider and weigh against a veteran's lay evidence).

The Veteran has also contended that her chronic headache condition was caused by an in-service "event" (see December 2024 claim for service connection), but has not provided any further explanation or details of the event. The Board notes that the Veteran's STRs do not contain any indication of an in-service head injury.

Regarding the Veteran's claim for service connection for bilateral plantar fasciitis, the Veteran has also contended that the condition onset during her active service, reporting that while on active duty she began to "feel pain on the bottom of my feet and a stabbing pain in the bottom of my foot near the heel." She has also submitted a buddy statement from fellow servicemember D.H., who reports that the Veteran  has plantar fasciitis that results in difficulty walking as well as standing for even
-service "event" (see December 2024 claim for service connection), but has not provided any further explanation or details of the event. The Board notes that the Veteran's STRs do not contain any indication of an in-service head injury.

Regarding the Veteran's claim for service connection for bilateral plantar fasciitis, the Veteran has also contended that the condition onset during her active service, reporting that while on active duty she began to "feel pain on the bottom of my feet and a stabbing pain in the bottom of my foot near the heel." She has also submitted a buddy statement from fellow servicemember D.H., who reports that the Veteran  has plantar fasciitis that results in difficulty walking as well as standing for even short periods of time.  Further, she stated the Veteran was always "the first one to take a seat and put her feet up after walking and standing and always trying to find remedies."

The Veteran has also contended that her bilateral foot conditions were caused by an in-service "event" (see December 2024 claim for service connection), but has not provided any further explanation or details of the event. The Board notes that the Veteran's STRs do not contain any indication of an in-service foot injury.

The first medical evidence in the record of any foot condition is from an August 2016 private treatment record. The record notes gradual onset of foot pain following no specific incident. The record discusses the condition as existing over the past three years, i.e. from approximately 2013. The Veteran was diagnosed with bilateral metatarsalgia. Later records also contain a diagnosis of left plantar fasciitis. 

The Board notes that the Veteran's August 1979 explicit denial of foot problems is in conflict with her current contention that bilateral foot conditions onset during her active duty service. Given that the August 1979 denial is supported by the August 1979 separation examination, is consistent with the lack of any record of foot complaints during service, and was made at the time in question, the Board finds it to be more persuasive than the Veteran's current contentions. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006).

The Board acknowledges the Veteran's belief that her current headache and foot conditions were incurred in and/or caused by her service. However, while the Veteran is competent to report her symptoms, she has not shown that she has specialized training sufficient to render an opinion as to the etiology of such disabilities. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The etiology of migraine and foot disabilities are medically complex issues that require medical expertise to determine.

The Board notes that VA has not obtained medical opinions with respect to the Veteran's claims for service connection for migraine headaches and bilateral foot conditions. However, the Board finds no probative evidence suggesting that these conditions were incurred in service or are otherwise related to service. Therefore, VA medical opinions are not required. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (holding that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010) (clarifying that medically competent evidence is not always necessary to indicate a disability may be associated with service for the purpose of warranting an examination, while noting that lay evidence may "fall[] short").

Lastly, the Board notes that in a July 2025 informal hearing presentation, the Veteran's representative argues that the Veteran's headaches are secondary to her service-connected PTSD. While this statement raises a new theory of service connection, under the AMA VA's duty to assist ends when VA issues notice of a decision on a claim (here, the January 2025 rating decision on appeal).  See 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c). As at the time of the rating decision on appeal there was no indication of entitlement to secondary service connection, there can be no pre-decisional duty to assist error here on such basis. In the absence of a pre-decisional duty to assist error by the RO, the Board is unable to remand for development of the Veteran's new theory of secondary service connection. The Board notes that if the Veteran would like this new theory to be considered by the RO, she may file a supplemental claim. 

In the absence of prob
 a claim (here, the January 2025 rating decision on appeal).  See 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c). As at the time of the rating decision on appeal there was no indication of entitlement to secondary service connection, there can be no pre-decisional duty to assist error here on such basis. In the absence of a pre-decisional duty to assist error by the RO, the Board is unable to remand for development of the Veteran's new theory of secondary service connection. The Board notes that if the Veteran would like this new theory to be considered by the RO, she may file a supplemental claim. 

In the absence of probative evidence that the Veteran's migraine headaches and foot conditions were incurred during or are otherwise related to service or a service-connected disability, service connection is not warranted. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and the claims are denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

Upon review of the record on appeal, the Board finds that a pre-decisional duty to assist error occurred regarding the below claim. As this claim cannot be granted under any raised theory of entitlement based on the current evidence of record, remand to correct the pre-decisional duty to assist error is necessary. See 38 C.F.R. § 20.802(a).

Service connection for tinnitus 

The Veteran seeks service connection for tinnitus.

Prior to the rating decision on appeal, a VA (hearing loss and) tinnitus examination was obtained in November 2024. Regarding the Veteran's current symptoms, the examiner noted that the Veteran reported hearing voices intermittently. The examiner concluded that no diagnosis of tinnitus was warranted, explaining that "What the veteran is report[ing] as tinnitus is really auditory hallucinations. Tinnitus is often described as ringing, buzzing, roaring, whistle. Auditory hallucinations are often described as voices or music."

However, in an August 2024 statement, the Veteran had reported experiencing "ringing noises in both of my ears." 

As the examiner noted that tinnitus is often described as ringing but did not explain why the Veteran's report of ringing is not tinnitus, the Board finds the examiner's opinion regarding whether the Veteran has tinnitus to be inadequate. 

Based on the above, the Board finds that a pre-decisional duty to assist error has occurred and remand is warranted in order to obtain a tinnitus examination that is adequate for adjudication. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate).

In remanding this claim, the Board makes no credibility determination, express or implied, at this juncture. See Miller v. Wilkie, 32 Vet. App. 249, 259-62 (noting that a medical opinion may inform the Board's understanding of the medical feasibility and credibility of lay statements).

The matter is REMANDED for the following action:

1. Obtain a tinnitus examination.

2. Then, readjudicate the claim.

 

 

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Jesteadt

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.