POSTTRAUMATIC STRESS DISORDER (PTSD)

B. MULLINS · 2026 · Case ID: A26040085

GRANTED

Summary

The Veteran, who served honorably in the United States Marine Corps from January 1982 to January 1985, appeals the denial of an increased disability rating for his service-connected psychiatric disorder, including anxiety, depression, and PTSD, and for his service-connected headaches. The Board reviewed the Veteran's service records, lay statements, and a VA PTSD examination from November 2021. The Veteran testified that his psychiatric symptoms, including irritability, anger, poor impulse control, and hypervigilance, have worsened since 2013, impacting his relationships and ability to manage daily tasks. Lay statements from his wife, son, and a friend corroborated these worsening symptoms. The Board found the Veteran's psychiatric symptoms, particularly poor impulse control and significant social/occupational impairment, met the criteria for a 70 percent disability rating, granting the increase. For headaches, the Veteran reported frequent, severe episodes since an in-service assault, causing incapacitation, syncope, and dizziness, which his wife corroborated. The Board found these symptoms approximated characteristic prostrating attacks occurring at least once a month, warranting a 30 percent rating for headaches, granting this benefit as well. The Board found the evidence weighed against a 100 percent rating for the psychiatric disorder due to the Veteran's continued employment and farm activities.

Rationale

Symptoms align with 70% rating criteria; Lay statements corroborate worsening symptoms; Benefit of doubt resolved in Veteran's favor

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

9411

Docket No.

200630-94744

Full Decision Text

Citation Nr: A26040085
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 200630-94744
DATE: April 29, 2026

ORDER

Entitlement to an evaluation in excess of 50 percent disabling for a service-connected psychiatric disorder, to include anxiety, depression and posttraumatic stress disorder (PTSD) from February 4, 2013, and in excess of 30 percent from November 2, 2018, is granted.

Entitlement to a compensable evaluation for service-connected headaches is granted.

FINDINGS OF FACT

1. Throughout the appeal period, the Veteran's psychiatric disorder, to include anxiety, depression and PTSD, has been manifested by symptomology consistent with occupational and social impairment with deficiencies in most areas.

2. At minimum, as of April 9, 2019 (the date of the favorable Board Decision which granted service connection), the Veteran's headaches have more nearly approximated characteristic prostrating attacks occurring on an average once per month over the last several months.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to an evaluation of 70 percent disabling, but no higher, for a service-connected psychiatric disorder, to include anxiety, depression, and PTSD, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.29, 4.130, Diagnostic Code 9411.

2. The criteria for establishing entitlement to a compensable evaluation for service-connected headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had honorable active-duty service with the United States Marine Corps from January 1982 to January 1985.

Pursuant to a December 2019 Rating Decision, the Veteran was granted service connection for psychiatric disorder, to include anxiety, depression and PTSD and assigned evaluation of 50 percent disabling, effective February 4, 2013. An evaluation of 30 percent disabling was assigned from November 2, 2018. That decision also granted service connection for headaches and assigned a non-compensable evaluation, effective February 4, 2013.

The Veteran timely appealed the above referenced rating decision to the Board, via VA Form 10182 Notice of Disagreement, dated June 2020 and requested a Board Hearing with 90 days to submit additional evidence, thereafter.

In May 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record.

Within the applicable evidentiary window, additional evidence was submitted to include multiple lay statements and a copy of a VA Post Traumatic Stress Disorder (PTSD) Disability Benefits Questionnaire, dated November 2021.

In rendering a decision in this matter, the Board has reviewed the file in accordance with the applicable evidentiary restrictions. 38 C.F.R. §§ 20.300, 20.301, 20.801. In the event that evidence was submitted outside the applicable evidentiary window, the Veteran may file a Supplemental Claim (VA For 20-0995) and submit or identify this evidence, along with a request for VA to consider any evidence that was submitted that the Board could not consider. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Preliminarily, the Board observes that prior to issuance of a decision in this matter, the AOJ issued a December 2021 Rating decision which increased the assigned evaluation for the Veteran's service-connected psychiatric disorder, to include anxiety, depression and PTSD from 30 percent disabling to 50 percent disabling, effective November 19, 2021.

Increased Ratings, Generally

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2020). The Board determines the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.10 (2020). Where entitlement to compensation has already been established and an increase in the assigned evaluation is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Although the recorded history of a particular disability should be reviewed in order to make an accurate assessment under the applicable criteria, the regulations do not give past medical reports precedence over current findings. Id.

The Court has held that staged ratings are appropriate for initial rating and increased rating claims when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When all the evidence is assembled, the Board is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence weighs pervasively against the claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to an evaluation in excess of 50 percent disabling for a service-connected psychiatric disorder, to include anxiety, depression and PTSD from February 4, 2013, and in excess of 30 percent from November 2, 2018.

The Veteran contends that his service-connected psychiatric disorder, to include anxiety, depression and PTSD warrants a higher evaluation throughout the appeal period. As discussed more fully below, the evidence supports his claim.

Review of the record indicates that the Veteran's psychiatric disorders have been evaluated as 50 percent disabling from February 4, 2013, 30 percent disabling from November 2, 2018, and 50 percent disabling from November 19, 2021, pursuant to Diagnostic Code 9411. 38 C.F.R. § 4.130.

Under the General Formula for Mental Disorders (General Formula), Diagnostic Code 9411 (PTSD), a 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as 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 in adapting to stressful circumstances (including work or a worklike setting); or cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for 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; or memory loss for names of close relatives, own occupation or own name.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is the claimant's symptoms, but it must also make findings as to how those symptoms impact the claimant's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need
minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is the claimant's symptoms, but it must also make findings as to how those symptoms impact the claimant's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442; see also Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004).

Nevertheless, all ratings in the General Rating Formula are associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the claimant's impairment must be "due to" those symptoms; therefore, a claimant may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118; Mauerhan, 16 Vet. App. at 442.

Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record to include consideration of occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126 (a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2.

Having carefully considered the evidence of record in this case, the Board concludes that the Veteran's symptoms more nearly approximate the diagnostic criteria for an evaluation of 70 percent disabling, but no higher.

According to the Veteran, he has continued to experience worsening symptoms associated with his service-connected psychiatric disorder.

Private treatment records indicate that the Veteran underwent a psychiatric evaluation in March 2014. At that time, his documented symptoms included anxiety, suspiciousness, chronic sleep impairment, impaired judgment, and inability to establish and maintain personal relationship. The Veteran was diagnosed with a psychiatric disorder that was deemed causally related to the personal assault he sustained in service. A subsequent private physician's opinion, dated November 2018, indicated that the Veteran's current symptomology is consistent with a diagnosis of PTSD.

On examination in November 2021, current diagnoses were listed as PTSD with syncope, hearing loss and traumatic brain injury (TBI). The examiner suggested that the diagnosis of TBI had resolved, as no active symptoms were documented in connection with a TBI VA examination conducted the same month.

During the clinical interview, the Veteran reported having a good relationship with his wife and children, and a few close friends. Regarding his children, the Veteran acknowledged prior involvement in verbal altercations with the spouses of his children. Presently, he reported feeling stressed and noted that his mother, who has Alzheimer's disease, resides with him and his wife. Problems with panic attacks, claustrophobia, poor sleep and impaired memory were also endorsed. The Veteran endorsed a preference for controlling his surroundings and states that he routinely sits with his back to the door. He denied participation in therapy or use of psychiatric medications. Alternatively, the Veteran endorsed self-medication with alcohol and periodic use of marijuana. After separation, the Veteran worked for United States Postal Service (USPS) for 34 years. He is now retired and keeps busy working on his farm and serves as the president of a livestock association.

The examiner listed current symptoms of anxiety, suspiciousness, panic attacks more than once per week, chronic sleep impairment, mild memory loss, impaired impulse control and unprovoked irritability. Behavioral observations indicate that the Veteran was alert and appropriately dressed, with a neutral mood and broad affect. His thought processes were described as logical and goal oriented. No evidence of delusions, hallucinations, suicidal or homicidal ideations were found. The Veteran's insight and judgement were deemed adequate. He is competent to manage his own finances. Evidence of symptom progression was observed,
Veteran worked for United States Postal Service (USPS) for 34 years. He is now retired and keeps busy working on his farm and serves as the president of a livestock association.

The examiner listed current symptoms of anxiety, suspiciousness, panic attacks more than once per week, chronic sleep impairment, mild memory loss, impaired impulse control and unprovoked irritability. Behavioral observations indicate that the Veteran was alert and appropriately dressed, with a neutral mood and broad affect. His thought processes were described as logical and goal oriented. No evidence of delusions, hallucinations, suicidal or homicidal ideations were found. The Veteran's insight and judgement were deemed adequate. He is competent to manage his own finances. Evidence of symptom progression was observed, with no basis for rendering any additional diagnoses. The above referenced symptoms were associated with 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.

In May 2024, the Veteran testified at a Board hearing. Therein, The Veteran contends that the reduction in rating from 50 percent disabling to 30 percent disabling was improper as he had not experienced or reported any favorable change in symptom severity. Throughout the appeal period, the Veteran has struggled with irritability, anger, and poor impulse control.

On examination in 2021, the examiner documented symptoms which included poor impulse control; however, an evaluation of 50 percent disabling was denied. Poor impulse control has been associated with a higher evaluation of 70 percent disabling. The Veteran denied any symptom improvement dating back to 2013. In fact, he reports worsening symptoms include an inability to sleep, anxiousness and hypervigilance that includes double checking door looks, windows, vehicle looks and installing security cameras. The Veteran endorsed an angry outburst with a friend while playing baseball. In a separate incident, a drunken outburst in anger against his younger sister resulted in police intervention and he was threatened with arrest. The Veteran states that he was not charged. He also reported involvement in a verbal alternation at work and he was dismissed. He symptomology impairs his ability to maintain relationships, to include with friends.

According to his wife, he also struggles with motivation to leave the house, social isolation, or contribute to household chores including work on the farm. Some severe episodes include an inability to get out of bed, manage self-care/personal hygiene, loss of interest in consuming food, becomes easily distracted, and experiences difficulty with task completion. The identified symptoms have persistent for at least the last five years. To manage his symptoms, the Veteran acknowledged self-medication with alcohol consumption. The Veteran denied participation in any mental health treatment or therapy. Counsel noted that there has not been any significant symptom improvement to include in 2018.

In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible.

To date, multiple lay statements have been associated with the record. Each corroborates the Veteran's contentions that his service-connected psychiatric condition is worse than currently evaluated. The Veteran's wife confirmed personal knowledge of his struggles with psychiatric symptoms to include impaired sleep, hypervigilance, defensiveness, and sitting with his back to the door. According to his son and family friend, the Veteran experienced a decline in basic functioning to include a loss of interest, increased anger and aggression, hypervigilance, irritability, and paranoia. Over the years, these symptoms have resulted in outbursts in anger at work, required him to miss work, and impaired his relationships functioning. Other evidence suggests substance abuse as a coping mechanism.

Given the above, the Board finds that evidence of record is at least in approximate balance as to whether the Veteran's psychiatric symptoms result in a level of impairment required to meet a 70 percent disability rating. In so finding, the Board notes that the lay statements of record have consistently reported symptomology identified in the rating criteria for the above referend evaluation.

Therefore, resolving reasonable doubt in his favor, the Board finds entitlement to an initial 70 percent disability rating is warranted. To that extent, the appeal is granted.

The Board finds no higher disability rating warranted, however, as the evidence persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating. In reaching the stated conclusion, the Board notes that despite his significant struggles, the Veteran continued to maintain his occupation with the USPS for 34 years prior to his retirement. Under the circumstances, total occupational impairment has not been established.

2. Entitlement to a compensable evaluation for headaches

The Veteran contends that he
above referend evaluation.

Therefore, resolving reasonable doubt in his favor, the Board finds entitlement to an initial 70 percent disability rating is warranted. To that extent, the appeal is granted.

2. Entitlement to a compensable evaluation for headaches

The Veteran contends that he is entitled to a compensable evaluation for his service-connected headaches. As discussed in further detail below, the evidence supports his claim.

Review of the record indicates that a noncompensable evaluation has been assigned for the Veteran's service-connected headaches pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100.

Under Diagnostic Code 8100, the rating criteria for headaches provides a noncompensable evaluation for migraine headaches with less frequent attacks. Migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months are rated as 10 percent disabling. Characteristic prostrating attacks occurring on an average once a month over the last several months are rated as 30 percent disabling. Migraine headaches manifested by very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability warrants a 50 percent disability rating. 38 C.F.R. § 4.124a, Diagnostic Code 8100.

The rating criteria do not define "prostrating," nor has the Court. By way of reference, the Board notes that DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1531 (32nd Ed. 2012), defines "prostration" as "extreme exhaustion or powerlessness."

However, in a recent precedential decision, Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018), the Court the Court also found that the phrase "characteristic prostrating attacks" plainly describes migraine attacks that typically produce powerlessness or a lack of vitality. Thus, the rating criteria under Diagnostic Code 8100 are successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Id.

Additionally, "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria" when assigning a disability rating. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). As the rating criteria under 38 C.F.R. § 4.124a, Diagnostic Code 8100, do not explicitly contemplate the ameliorative effects of medication, the assigned rating for migraine headaches should contemplate the frequency of characteristic prostrating attacks that would occur without medication.

Turning to the evidence of record, indicates that the Veteran has consistently reported frequent bouts with headaches dating back to an in-service physical assault.

His most recent VA examination was conducted in February 2014; it does not reflect his lengthy history of struggles with worsening symptoms. During a traumatic brain injury (TBI) consultation in March 2020, the Veteran reported suffering a deployment-related TBI in a bar fight while stationed in Japan in 1984. Reportedly, he was attacked and struck in the head and left jaw area. Thereafter, he experienced a headache, tinnitus, and brain fog or confusion that persisted for more than a day. Subsequent medical treatment included having his jaw wired shut for approximately 4 and 1/2 months. Post-service, he continues to experience residual symptoms including headaches and left sided tinnitus. The Veteran also endorsed a history of self-medication with alcohol (1-6 beers per night); a 1-pack per day habit of excessive smoking, and use of marijuana for relaxation.

To date, multiple lay statements have been associated with the record. Therein, members of the Veteran's family and close friends have attested to personal knowledge of his prolonged battle with moderate to severe headache pain and worsening symptoms that failed to improve with use of over-the-counter medications, including Tylenol and Advil. During bouts will severe symptoms, he experienced episodes of syncope, dizziness and disorientation that required him lie down and rendered him unable to function for hours after initial onset.

In May 2024, the Veteran testified at a Board hearing. Therein, attention was called to progressive symptoms since the initial VA examination that was conducted more than six years earlier. To date, a contemporaneous examination has not occurred. According to the Veteran, his current symptoms include constant headache pain, that begins when he rises from bed in the morning. The pain is so severe that use of Aspirin or Tylenol is required. At times, his pain is incapacitating and he is required to lay down or lounge in a recliner all day.

The Veteran endorsed an initial symptom onset while stationed in Okinawa. He contends that he was attacked by three mean and struck in the head and about the face. Since that time, the Veteran has endured a "low level of headache pain" that persists at all times.

During flare-ups, the Veteran experienced headaches that impaired his ability to work as a mail carrier with the United States Postal Service (USPS). At least once per month, he suffered severe/debilitating headache pain that required him to miss work and impaired his ability to function at home. As a result, he was unable to perform household chores or assist his wife with tending the animals (livestock) on their farm. More recently, the Veteran experienced two episodes of syncope due to severe headache pain. Following those episodes, he was treated at the Cleveland clinic.

The Veteran's wife provided additional hearing testimony about witnessing his struggles with severe debilitating-type headaches that impaired his equilibrium and caused syncope episodes. On multiple occasions, she revived him from a syncope episode through cooling methods. Reportedly, he was unresponsive for 5-10 minutes or more. Other symptoms include dizzy spells or vertigo. After onset, he often needed to sit down and place his head between his legs. During those periods, she closely watched him, tried to help him consume water, and managed fear surrounding his condition. According to the Veteran's wife, he probably experienced 1 or more severe headaches per month over the previous ten-year period. Episodes of dizziness, disorientation and vertigo often occurred in connection with severe headaches.

After reviewing the foregoing evidence, the Board finds that the Veteran's headache disability more nearly approximates characteristic prostrating attacks occurring on an average once a month over the last several months. In so finding, it concedes that the Veteran is competent to report the frequency of his headaches and accompanying symptoms such as dizziness, syncope, and vertigo. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Board also finds the lay assertions of record to be credible as there is nothing in the record that impugns the contentions as to the nature, severity, and frequency of headache episodes. Further, those statements both suggest and corroborate the Veteran's report of significant headache symptoms throughout the appeal period.

Additionally, the Board finds that the Veteran's complaints of severe headaches are consistent with "prostrating attacks," because he reports an inability to function, with dizziness, vertigo, syncope episodes and a need to lie down. The identified symptoms render him unable to perform other activities after symptom onset, to include work-related tasks, or household obligations. In other words, they incapacitate him and prevent him from performing activities of daily living or work.

The Board also finds that the identified symptomology and its reported frequency is most consistent with the diagnostic criteria for an evaluation of 30 percent disabling under Diagnostic Code 8100. As noted above, a 30 percent rating is assigned when a Veteran has characteristic prostrating attacks an average of once a month over several months. In this case, the Veteran's wife reported providing care for him during his struggles with severe or debilitating headaches at least once per month over the last several years. Given her description of the physical manifestations including vertigo, syncope, and dizziness, the Board deems the noted symptoms as suggestive of "prostrating attacks" within the meaning of the diagnostic criteria.

Conversely, the Board finds that the Veteran's headaches are not capable of producing severe economic inadaptability. While reports of severe headache pain that required the Veteran to miss work and impaired his ability to meet household obligations are acknowledged; the evidence of record does not credibly establish that the identified symptoms recur up to
average of once a month over several months. In this case, the Veteran's wife reported providing care for him during his struggles with severe or debilitating headaches at least once per month over the last several years. Given her description of the physical manifestations including vertigo, syncope, and dizziness, the Board deems the noted symptoms as suggestive of "prostrating attacks" within the meaning of the diagnostic criteria.

In this case, even with disregard for the ameliorative effects of the Veteran's use of over-the-counter medications, the Board concludes that frequency of his experience of severe headaches does not recur up to five times per month.

Therefore, resolving all reasonable doubt in the Veteran's favor, the Board finds that the Veteran's disability picture more closely approximated a 30 percent disability, and no higher. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Whitaker, Nakiya E.

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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