POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, who served in the Air Force from May 1970 to September 1971, appeals the denial of service connection for several conditions. The Board granted service connection for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis, finding that the Veteran's detailed accounts of in-service racial discrimination and personal assault were sufficiently corroborated by service records and private medical opinions. The Board also granted service connection for obstructive sleep apnea, finding that a private sleep medicine specialist's opinion, linking the condition to the Veteran's psychiatric disabilities and military experiences, was probative. Furthermore, service connection for lumbar and cervical spine arthritis, degenerative disc disease, and multilevel spinal stenosis was granted, based on the Veteran's contentions of in-service duties and physical assaults, supported by probative opinions from treating physicians. The Board applied the benefit of the doubt in favor of the Veteran for the sleep apnea and spine conditions. The Veteran's discharge was characterized as general due to unsuitability stemming from a personality disorder, with in-service difficulties noted, but no discharge upgrade was sought.

Rationale

Detailed accounts of in-service racial discrimination and personal assault.; Corroborated by service records and private medical opinions.; Private opinions found probative due to personal treatment and familiarity with history.

Full Decision Text

Citation Nr: A26040255
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 200916-110040
DATE: April 29, 2026

ORDER

Entitlement to service connection for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis is granted.

Entitlement to service connection for obstructive sleep apnea is granted.

Entitlement to service connection for arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis is granted.

Entitlement to service connection for arthritis of the cervical spine and degenerative disc disease is granted.

FINDINGS OF FACT

1. The Veteran's PTSD, major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis have been etiologically linked to in-service abuse.

2. Resolving reasonable doubt in favor of the Veteran, his obstructive sleep apnea is secondary to his acquired psychiatric disabilities.

3. Resolving reasonable doubt in favor of the Veteran, his arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis are etiologically related to in-service duties and physical assaults.

4. Resolving reasonable doubt in favor of the Veteran, his arthritis of the cervical spine and degenerative disc disease are etiologically related to in-service duties and physical assaults.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for PTSD, major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304(f), 4.125(a).

2. The criteria for entitlement to service connection for obstructive sleep apnea have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for entitlement to service connection for arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

4. The criteria for entitlement to service connection for arthritis of the cervical spine and degenerative disc disease have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1970 to September 1971.  This matter comes before the Board on appeal from a May 2018 Regional Office (RO) rating decision.

The May 2018 rating decision denied each of the above service connection claims.  The Veteran filed a notice of disagreement with this decision in December 2018.  He was issued a statement of the case in May 2019.  He filed a VA Form 9, substantive appeal, to perfect his appeal in July 2019.

In September 2019, the Board remanded these claims for additional development.  Following completion of this development, the RO issued a supplemental statement of the case in August 2020.  In September 2020, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), in which he opted into consideration of the issues on appeal under the Appeals Modernization Act (AMA).  At that time, he selected the Hearing Docket.  The Veteran testified at a hearing before the undersigned Veterans Law Judge on July 25, 2024.

The Board notes that the Veteran only listed the issues of entitlement to service connection for an acquired psychiatric disability and obstructive sleep apnea on his VA Form 10182.  However, at that time, he also submitted a portion of the August 2020 supplemental statement of the case.  The Veteran was unrepresented at the time of his submission of the VA Form 10182.  The Veteran clarified at his Board hearing that he believed he had appealed the back and neck disability claims as well.  Given that he did submit a portion of the August 2020 supplemental statement of the case at the time that he submitted his VA Form 10182, the Board accepts the Veteran's explanation that it was his intention to appeal each of the issues that were listed in the supplemental statement of the case.  The Board therefore finds that it has jurisdiction to consider the back and neck disability claims at this time.  

In cases such as the one at hand, when the Veteran has opted into the AMA from a legacy rating decision, the supplemental statement
 Veteran was unrepresented at the time of his submission of the VA Form 10182.  The Veteran clarified at his Board hearing that he believed he had appealed the back and neck disability claims as well.  Given that he did submit a portion of the August 2020 supplemental statement of the case at the time that he submitted his VA Form 10182, the Board accepts the Veteran's explanation that it was his intention to appeal each of the issues that were listed in the supplemental statement of the case.  The Board therefore finds that it has jurisdiction to consider the back and neck disability claims at this time.  

In cases such as the one at hand, when the Veteran has opted into the AMA from a legacy rating decision, the supplemental statement of the case from which the Veteran opted into the AMA system is considered to be the AOJ decision on appeal.  Under the hearing docket, the Board may only consider the evidence of record at the time of the supplemental statement of the case, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  

In this case, the supplemental statement of the case was issued on August 20, 2020.  Therefore, the earlier evidentiary window closes on August 20, 2020.  

The second evidentiary window spans from the July 25, 2024, hearing date to October 23, 2024.

If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801.

Service Connection

Service connection is warranted where the evidence of record establishes that an injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service.  38 C.F.R. § 3.303(d).

Pain resulting in functional impairment may constitute a disability, even without an identifiable underlying pathology.  Saunders v. Wilkie, 997 F.3d 1356, 1368 (Fed. Cir. 2018).  To establish the presence of a disability pursuant to Saunders, there must be competent evidence specific to the claimant tending to show that a veteran's impairment rose to a level to affect earning capacity.  Wait v. Wilkie, 33 Vet. App. 8 (2020).

To establish a right to compensation for a present disability, a veteran must show (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the present disability and the disease or injury incurred or aggravated during service.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for listed chronic diseases, such as arthritis and psychosis, if such were shown as chronic in service; manifested to a compensable degree within a presumptive period (usually one year) after separation from service; or were noted in service with continuity of symptomatology since service.  38 U.S.C. §§ 1112, 1113; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).  

A disability that is proximately due to, or results from, a service-connected disease or injury shall be considered a part of the original condition.  38 C.F.R. § 3.310(a).  Secondary service connection on the basis of aggravation is permitted.  38 C.F.R. § 3.310(b).  Compensation is payable for that degree of aggravation of a non-service-connected disability caused by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439 (1995).

1. Entitlement to service connection for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis is granted.

Claims for service connection for PTSD require (1) medical diagnosis conforming to the requirements of section 
 service-connected disease or injury shall be considered a part of the original condition.  38 C.F.R. § 3.310(a).  Secondary service connection on the basis of aggravation is permitted.  38 C.F.R. § 3.310(b).  Compensation is payable for that degree of aggravation of a non-service-connected disability caused by a service-connected disability.  Allen v. Brown, 7 Vet. App. 439 (1995).

1. Entitlement to service connection for posttraumatic stress disorder (PTSD), major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis is granted.

Claims for service connection for PTSD require (1) medical diagnosis conforming to the requirements of section 4.125(a) (which requires that a diagnosis conform to the DSM-5 criteria), (2) an in-service stressor accompanied by supporting evidence that the stressor claimed to be the cause of the disorder occurred in service, and (3) established medical evidence connecting the current disability to the stressor.  38 C.F.R. § 3.304(f); 38 C.F.R. § 4.125(a); Cohen v. Brown, 10 Vet. App. 128, 138 (1997).

If a PTSD claim is based on an in-service personal assault, medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated.  Menegassi v. Shinseki, 638 F.3d 1379, 1382 (Fed. Cir. 2011).  Specifically, 38 C.F.R. § 3.304(f)(5), allows Veterans claiming PTSD from an in-service military assault to submit evidence other than in-service medical records to corroborate the occurrence of a stressor, and this includes medical opinion evidence.  See Menegassi, 638 F.3d at 1382; see also 67 Fed. Reg. 10,330, 10,330-31 (Mar. 7, 2002).  VA can submit any evidence, including alternate source evidence, to a medical or mental health professional for interpretation.  Bradford v. Nicholson, 20 Vet. App. 200 (2006). For claims involving an in-service personal assault, after-the-fact medical evidence can be used to establish a stressor.  Id.

In the case at hand, the Veteran has provided detailed accounts of racial discrimination and personal assault committed by fellow servicemembers during service.  (See Board hearing transcript, pages 6-8.)  A November 1970 service treatment record notes that the Veteran suffered trauma to the left eye when "patient was going out a door and somebody opened it and it hit pt in eye."  The Veteran testified at his Board hearing that he had actually "got hit in the left eye by a right hook by the sergeant."  (See Board hearing transcript, page 7.)  

His service treatment records reflect that he was diagnosed with impotence and referred to the mental health clinic in August 1971.  An August 1971 urology clinic treatment record notes an impression of psychologic impotence.  

The Veteran's service personnel records reveal that he received a general discharge due to unsuitability due to a personality disorder.  A March 1982 Memorandum denying a request for a Change of Reenlistment Code notes that "The applicant's military records show that he was discharged on September 22, 1971 for a diagnosed personality disorder.  The applicant's record is replete with misconduct, including a seven-day AWOL and numerous failures to repair.  The record borders upon shirking.  His duty performance was rated as substandard."  His in-service difficulties are described in more detail in his service personnel records.  An Air Force Discharge Review Board describes the following evidence:

MFR of Comdr, 21 May 71.  Amn [Airman] registered a complaint with me on this date that: the Sq 1st/Sgt had been abusive toward him and that he felt the Sq 1st/Sgt was practicing discrimination against him.  His supvrs in the Student Dispensary, Sgt --- and Sgt ---, he believes are practicing discrimination against him.  He stated that he and Amn --- a fellow worker in the Dispensary are being unduly harassed.  Cause of this harassment against him he stated, was directed only to build evidence to support an administrative disch from the svc.  I asked Amn to submit stmts to me regarding these charges and that I would investigate the matter and take necessary action.

The Veteran had provided the following statement as the basis for review of his discharge status: "Prejudice by 2 of my commanding officers and by not being given a chance to redeem myself and become a better
gt was practicing discrimination against him.  His supvrs in the Student Dispensary, Sgt --- and Sgt ---, he believes are practicing discrimination against him.  He stated that he and Amn --- a fellow worker in the Dispensary are being unduly harassed.  Cause of this harassment against him he stated, was directed only to build evidence to support an administrative disch from the svc.  I asked Amn to submit stmts to me regarding these charges and that I would investigate the matter and take necessary action.

The Veteran had provided the following statement as the basis for review of his discharge status: "Prejudice by 2 of my commanding officers and by not being given a chance to redeem myself and become a better airman."  

Various evaluation and treatment records contain the following diagnoses: PTSD, major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis.  (See May 2015 VA examination report; July 2024 record from Dr. R.S.; June 2020 record from S.S., LCSW; July 2021, April 2022, and July 2024 records from Dr. S.N.; and July 2020 and May 2020 records from C.K., PMNHP.)  The cited private medical evidence comes from the Veteran's treatment providers, and much of it was submitted by the Veteran and his accredited representative within the 90-day period following the Board hearing.

The Board notes that the private medical opinions link the Veteran's diagnosed psychiatric disabilities to the alleged in-service events.  The Board finds these opinions to be probative as they are based on personal treatment of the Veteran and familiarity with the Veteran's pertinent history.  They cite in-service stressor events that are sufficiently documented in service records.  Suozzi v. Brown, 10 Vet. App. 307 (1997).

In short, the Board finds that entitlement to service connection for PTSD, major depressive disorder, generalized anxiety disorder, insomnia, and unspecified psychosis is warranted.  The benefit sought on appeal is granted.

2. Entitlement to service connection for obstructive sleep apnea is granted.

The Veteran contends that his obstructive sleep apnea is secondary to his acquired psychiatric disabilities.  (See Board hearing transcript, page 14.)  

An April 2018 VA sleep apnea examination report found that no diagnosis of sleep apnea was warranted.  However, the Veteran has submitted a January 2023 letter from a sleep medicine specialist noting that the Veteran "is under my sleep medicine care for his obstructive sleep apnea and my opinion based on medical management it is at least as likely, as not as likely to be service connected."  He specified that "it is my professional opinion that [the Veteran's] chronic sleep condition is from his negative traumatic military experiences contribute to his chronic sleep apnea and are at least as likely as not, related to his time in military service."  

The Board finds that this evidence of a current obstructive sleep apnea diagnosis and a link to a service related disability is probative, as it was authored by a sleep medicine specialist who possesses the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159(a)(1).  See Cox v. Nicholson, 20 Vet. App. 563 (2007).  It is based on personal treatment of the Veteran.  The Board resolves reasonable doubt in favor of the Veteran and finds that the above evidence establishes that the criteria for entitlement to service connection for obstructive sleep apnea as secondary to acquired psychiatric disabilities have been met.  

Therefore, entitlement to service connection for obstructive sleep apnea is warranted.  The benefit sought on appeal is granted.

3. Entitlement to service connection for arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis is granted.

4. Entitlement to service connection for arthritis of the cervical spine and degenerative disc disease is granted.

The Veteran contends that his current back and neck disabilities arose as a result of his in-service duties and physical assaults.  (See Board hearing transcript, pages 15-16, 19.)

The medical evidence of record diagnoses arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis.  (See April 2018 VA back conditions examination report; January 2022 record from Dr. C.K.; December 2023 record from Dr. K.H., and May 2024 record from Dr. A.D.)  This evidence also diagnoses arthritis of the cervical spine and degenerative disc disease.  (See April 2018 VA neck conditions examination report; January 2022 and April 2022 records from Dr. C.K.; and May 2024 record from Dr. A.D.)

The Veteran's treatment providers have also linked the Veteran's current back and neck disabilities to
19.)

The medical evidence of record diagnoses arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis.  (See April 2018 VA back conditions examination report; January 2022 record from Dr. C.K.; December 2023 record from Dr. K.H., and May 2024 record from Dr. A.D.)  This evidence also diagnoses arthritis of the cervical spine and degenerative disc disease.  (See April 2018 VA neck conditions examination report; January 2022 and April 2022 records from Dr. C.K.; and May 2024 record from Dr. A.D.)

The Veteran's treatment providers have also linked the Veteran's current back and neck disabilities to his military service, to include his in-service duties and physical assaults.  (See, e.g., January 2022 and April 2022 opinions from Dr. C.K.; December 2023 opinion from Dr. K.H.)  The Board finds that these opinions are probative as they were authored by physicians who possess the necessary education, training, or experience to provide competent medical evidence under 38 C.F.R. § 3.159(a)(1).  See Cox v. Nicholson, 20 Vet. App. 563 (2007).  They have been written by physicians who are familiar with the Veteran's medical history, and they provide a rationale that reflects their familiarity with the Veteran's pertinent in-service history.  Resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for entitlement to service connection for arthritis of the lumbar spine, degenerative disc disease, and multilevel spinal stenosis and for arthritis of the cervical spine and degenerative disc disease have been met.  The benefits sought on appeal are granted.

 

 

TANYA SMITH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Elizabeth Jalley, Counsel

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.