POSTTRAUMATIC STRESS DISORDER (PTSD)

S. KIM · 2026 · Case ID: A26040260

DENIED

Summary

The veteran, who served on active duty from November 1984 to June 1987, appeals the denial of a separate compensable rating for posttraumatic stress disorder (PTSD). The veteran is currently rated 100 percent for major depressive disorder (MDD) with psychotic features, and the Board found that PTSD was a progression of this existing condition, sharing the same etiology. The Board reviewed a September 2022 rating decision that granted service connection for PTSD but combined it with the existing MDD rating, assigning no separate rating. The veteran argued that PTSD should be rated separately, citing different diagnostic codes. However, the Board found that both PTSD (DC 9411) and MDD (DC 9434) are evaluated under the same general rating formula for mental disorders. The Board relied on a May 2022 VA examination which stated that the diagnosed PTSD and MDD are progressive conditions with the same etiology, and that the symptoms and functional impairment attributable to each disorder cannot be differentiated. The Board concluded that assigning a separate rating for PTSD would constitute pyramiding, as the existing 100 percent rating for MDD with psychotic features fully contemplates the veteran's symptoms and functional impairment. The Board found the evidence persuasively weighed against a separate rating for PTSD, and the benefit of the doubt doctrine did not apply. The appeal was denied.

Rationale

Overlapping symptomatology between PTSD and MDD; Pyramiding rule violation; Existing 100% rating for MDD contemplates PTSD symptoms

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

9411

Docket No.

221027-290509

Full Decision Text

Citation Nr: A26040260
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 221027-290509
DATE: April 29, 2026

ORDER

Entitlement to a separate compensable rating for posttraumatic stress disorder (PTSD), as distinct from major depressive disorder (MDD) with psychotic features which is currently rated 100 percent disabling is denied.

FINDING OF FACT

The competing lay and medical evidence persuasively weighs against finding that PTSD causes additional functional impairment which was not contemplated by the assigned 100 percent rating for PTSD and MDD with psychotic features.

CONCLUSION OF LAW

The criteria for entitlement to a rating separate from the currently assigned 100 percent rating for PTSD and MDD with psychotic features have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Codes (DC) 9411 and 9434.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from November 1984 to June 1987.

These matters are before the?Board of Veterans' Appeals?(Board) on appeal of a September 7, 2022 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).

In the October 27, 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the September 2022 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

On October 27, 2022, the Veteran submitted two separate VA Forms 10182. In the first form, the Veteran indicated a desire to appeal issues relating to a reduction for his service-connected back disorder, entitlement to earlier effective dates for the awards of service connection for intervertebral disc syndrome and a thoracic spine disorder, an increased rating for the service-connected low back disorder, service connection for right and left shoulder disorders, entitlement to special monthly compensation based on aid and attendance, service connection for hypertension and stroke residuals and service connection for a left knee disorder. There was no rating decision received within one year prior to the October 27, 2022 VA Form 10182 pertaining to these issues. Accordingly, that document was not a timely appeal as to any of the above issues, and they will not considered by the Board at this time.

In a second VA Form 10182, submitted on the same day, the Veteran stated that he wanted an earlier effective date "for my service-connected PTSD, because it was added to my MDD, that was [diagnosed] in 1995." The Board observes that the September 2022 rating decision which granted service connection for PTSD did not assign a separate rating for PTSD, but rather recharacterized the existing rating for MDD as including PTSD. This decision was based on the August 2022 VA medical opinion that "the diagnosed PTSD and MDD are progressive conditions from the previously service connected MDD with psychotic features" and noted that the two disorders have the same etiology. In other words, PTSD was found not to be a separate condition, but a progression of the already service-connected MDD. As such, no effective date of service connection for PTSD was assigned by the September 2022 rating decision. Rather, that condition was combined with the already service connected MDD. There is no rating decision within one year prior to the October 27, 2022 VA Form 10182 which assigned an effective date of service connection
ized the existing rating for MDD as including PTSD. This decision was based on the August 2022 VA medical opinion that "the diagnosed PTSD and MDD are progressive conditions from the previously service connected MDD with psychotic features" and noted that the two disorders have the same etiology. In other words, PTSD was found not to be a separate condition, but a progression of the already service-connected MDD. As such, no effective date of service connection for PTSD was assigned by the September 2022 rating decision. Rather, that condition was combined with the already service connected MDD. There is no rating decision within one year prior to the October 27, 2022 VA Form 10182 which assigned an effective date of service connection for PTSD and MDD with psychotic features. Accordingly, any appeal as to the effective date of those disabilities is not timely, and is not before the Board.

Additionally, in the second October 27, 2022 VA Form 10182, the Veteran indicated a desire to appeal from the rating assigned for PTSD, arguing that his PTSD should be rated separately from MDD. The Board concludes that this is the only issue which is properly before the Board in this appeal. Therefore, the Board will proceed to consider the question of whether a separate compensable rating can be assigned for PTSD, distinct from MDD with psychotic features.

Service connection for a psychiatric disorder was first granted in a July 1994 rating decision, effective April 9, 1993. In December 2014 the Veteran submitted a claim for service connection for PTSD, which was denied in a May 2020 Board decision. In February 2022 the Veteran submitted a VA Form 20-0995 Supplemental Claim Application for service connection for PTSD. Service connection for PTSD was granted in a September 2022 rating decision as a progression of the already-service connected MDD and was combined with the existing 100 percent rating for MDD with psychotic features.

A disability rating is determined by applying VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 38 C.F.R. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board may consider whether separate ratings may be assigned for separate periods of time - a practice known as "staged ratings," - whether or not the claim concerns an initial rating. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Generally, pyramiding, which is the evaluation of the same manifestation under different diagnoses, is to be avoided. 38 C.F.R. § 4.14. However, if a veteran has separate and distinct manifestations relating to the same injury, he should be compensated under different diagnostic codes. Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225 (1993). Separate ratings may be assignable under different diagnostic codes where a disability involves distinct conditions. Cullen v. Shinseki, 24 Vet. App. 74, 80-81, 84 (2010).

The critical element for separate evaluations is that none of the symptoms for any one of the residuals was duplicative of or overlapping with the symptoms of the other conditions, but the pyramiding inquiry does not end with whether two disabilities share a common manifestation. It must also be determined whether that common manifestation would be improperly compensated more than once. Lyles v. Shulkin, 29 Vet. App. 107, 118 (2017).

Under the General Formula for Mental Disorders (General Formula), a 100 percent schedular evaluation contemplates 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; memory loss for names of close relatives, own occupation, or own name.

In Amberman v. Shinseki, the Federal Circuit recognized that separately diagnosed psychiatric conditions could be service connected, but could not be separately rated unless they resulted in different manifestations. 570 F.3d 1377, 1381 (Fed. Cir. 2009) ("Section 4.14 clearly contemplates that several separately diagnosed disorders may have a single manifestation, and it clearly prohibits the VA from rating that manifestation for each disorder."). The Federal Circuit found that it was possible evidence could be received that reflected that two conditions resulted in different manifestations, thus allowing the two conditions to be separately rated. Id.

Here, the probative evidence of record weighs persuasively against the Veteran's contention that separate ratings are warranted for PTSD, distinct from MDD with psychotic features. As discussed above, the August 2022 VA examiner opined that PTSD was a progression of the already service-connected MDD with psychotic features. In a May 2022 VA examination, psychiatric symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty in understanding complex commands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting inability to establish and maintain effective relationships and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The Veteran was noted to have multiple mental health disorders diagnosed, but it was not possible to differentiate what symptoms were attributable to each diagnosis, nor was it possible to differentiate which impairment was caused by each mental disorder.

The existing 100 percent rating assigned for MDD with psychotic features contemplates the Veteran's depressed mood, anxiety, suspiciousness, chronic sleep impairment, difficulty in understanding complex commands, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting inability to establish and maintain effective relationships and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Therefore, these symptoms are fully contemplated by the Veteran's assigned 100 percent rating, and assignment of a separate rating for PTSD would constitute pyramiding.

The Board has considered the Veteran's argument that PTSD and MDD are evaluated under different diagnostic codes (DCs 9411 and 9434 respectively) and therefore should receive separate ratings. However, 38 C.F.R. § 4.130 provides that both DC 9411 and 9434 are evaluated under the same rating criteria, that being the general rating formula for mental disorders. As discussed above, the evidence of record demonstrates that both PTSD and MDD are manifested by overlapping symptomatology, and the symptoms and functional impairment attributable to each disorder cannot be differentiated. Accordingly, assignment of separate ratings for PTSD and MDD would violate the rule against pyramiding.

Based on the foregoing, the Board finds that the competent and credible evidence is neither evenly nor approximately balanced as to whether entitlement to a separate rating for PTSD is warranted. Rather, the evidence persuasively weighs against finding that PTSD caused additional symptoms or functional impairment which are not contemplated by the assigned 100 percent rating. The benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b), Lynch, 21 F.4th 776. The claim is denied.

S. Kim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Bametzreider, Paul J.

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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