ADJUSTMENT DISORDER

FREDERIC P. GALLUN · 2026 · Case ID: A26040276

GRANTED

Summary

The veteran, who served from April 1966 to February 1976, including service in Vietnam, appeals the RO's denial of an increased rating for adjustment disorder with mixed anxiety and depressed mood and the denial of service connection for irritable bowel syndrome (IBS) and obstructive sleep apnea (OSA). The Board found the RO assigned an incorrect effective date for the psychiatric claim, establishing October 31, 2023, as the correct date. For the adjustment disorder, the Board reviewed lay testimony from the veteran's son and two VA C&P examinations. The son's testimony described significant social and occupational impairment, including anger, irritability, and neglect of hygiene. The VA examinations noted depressed mood, anxiety, sleep impairment, and difficulty with social relationships, but did not fully capture the severity described by the son. The Board found the veteran's symptoms, including occasional neglect of appearance, difficulty adapting to stress, and obsessive rituals, more closely approximated the criteria for a 70 percent rating. For IBS and OSA, the Board reviewed VA examinations that found no service connection or toxic exposure link. However, private medical opinions submitted by the veteran linked IBS to chronic anxiety and pain from service-connected conditions, leading to obesity and IBS. Similarly, the private opinions linked OSA to hernia pain, nightmares, insomnia, and weight gain from service-connected issues, which impaired CPAP mask use and sleep. The Board found these private opinions persuasive, establishing that the veteran's service-connected disabilities contributed to obesity, which in turn caused IBS and OSA. Resolving doubt in the veteran's favor, service connection for IBS and OSA was granted.

Rationale

Holistic analysis of listed and unlisted symptoms; Symptoms approximated 70% rating criteria; No symptoms met 100% rating criteria

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260116-614480

Full Decision Text

Citation Nr: A26040276
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 260116-614480
DATE: April 29, 2026

ORDER

Entitlement to a disability rating in excess of 50 percent for service-connected adjustment disorder with mixed anxiety and depressed mood from October 31, 2023, forward is granted.

Entitlement to service connection for irritable bowel syndrome (IBS) is granted.

Entitlement to service connection for obstructive sleep apnea is granted.

FINDINGS OF FACT

1. The Veteran suffers from occupational and social impairment with deficiencies in most areas from October 31, 2023, forward.

2. The Veteran's IBS and obstructive sleep apnea are due to his service-connected disabilities and obesity resulting from his service-connected disabilities.

CONCLUSIONS OF LAW

1. The criteria for a disability rating of 70 percent for adjustment disorder with mixed anxiety and depressed mood from October 31, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9440.

2. The criteria for service connection for IBS as secondary to his service-connected disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for service connection for obstructive sleep apnea as secondary to his service-connected disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1966 to February 1976, including service in the Republic of Vietnam. The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

This matter comes before the Board of Veterans' Appeals (Board) from a January and June 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the January 2026 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 January and June 2025 agency of original jurisdiction (AOJ) decisions 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to a disability rating in excess of 50 percent for service-connected adjustment disorder with mixed anxiety and depressed mood from October 31, 2023, forward

The Veteran contends that he is entitled to a 70 percent disability rating from October 31, 2023.

Unless specifically provided otherwise, the effective date of an award based on an original claim, a claim reopened after final adjudication, or a claim for increase of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110(a). Generally, the effective date of an evaluation and award of service-connected compensation is the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. However, in a claim for increased compensation, the effective date may date back as much as one year before the date of the application for increase if it is factually "ascertainable that an increase in disability had occurred" within that one year. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2).

The Veteran was originally denied service connection for a psychiatric disability in May 2014. He did not appeal this decision, and it became final. He was again denied service connection for a psychiatric disability in August 2021. He did not appeal this decision, and it became final.

The Veteran next submitted a claim for service connection for a psychiatric disability on October 31, 2023, and identified outstanding treatment records. See VA Form 20-0995 Supplemental Claim Application, October 2023. Despite identifying outstanding treatment records that would qualify as new and relevant evidence, the RO failed to develop his claim, stating new and relevant evidence had not been received. See Other, November 2023. The Veteran's representative asserted in February 2024 that the Veteran was receiving treatment and requested the RO to process his claim. See VA 21-4138 Statement In Support of Claim, February 2024. The Veteran submitted another supplemental claim in September 2024, which the RO then developed and assigned the effective date of September 12, 2024. See VA Form 20-0995 Supplemental Claim Application, September 2024.

The Board initially finds that the RO assigned an incorrect effective date. The Veteran submitted a claim in October 2023 which the RO did not properly develop. The Veteran's representative followed up requesting the claim to be developed in February 2024, and the RO failed to develop the claim. The RO properly developed the claim when the Veteran submitted his September 2024 claim, which was still submitted within one year of his October 2023 claim. The Board finds that the correct effective date for award of service connection is October 31, 2023. There is no evidence of any pending or unadjudicated claim prior to this date.

Turning to the substantive evidence, resolving the benefit of the doubt in favor of the Veteran, the Board finds a 70 percent disability rating is warranted for the entire period on appeal. The Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

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 inability to establish and maintain effective relationships 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.

In September 2024, the Veteran's son submitted a lay statement regarding the Veteran's symptoms. His son stated that the Veteran reacted violently, was socially awkward and defensive, obsessive in routines, severely depressed, confrontational, had few friends, struggled with adapting to stressful situations, lashed out with verbal insults, nervous every day, "scatter brained," could not keep things organized, lived in clutter, was unsanitary, and neglected his clothes and appearance. See VA Form 21-10210 - Lay Witness Statement, September 2024.

The Veteran underwent a VA examination in October 2024 where he was found to suffer from 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. He had a difficult relationship with his son, three friends, went out to eat once a week, belonged to a veteran's organization, attended church, and communicated with a few childhood friends. His symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, nightmares, anger, and irritability. See C&P Exam, October 2024.

Next, the Veteran underwent a VA examination in January 2025 where he was found to suffer occupational and social impairment with reduced reliability and productivity. He had a good relationship with his son, anger issues, did not sleep well, and reported mild panic attacks. His symptoms included depressed mood, anxiety, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships. See C&P exam, January 2025.

Neither of these VA examinations documented neglect of appearance or hygiene.

The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. The Veteran suffered from occasional neglect of personal appearance, difficulty adapting to stressful circumstances, and obsessive rituals.

The Veteran did not experience any symptoms contemplated by a 100 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, the Veteran was not totally socially impaired as he maintained a relationship with his son, friends, and attended church and other organizations.

In short, the evidence of record demonstrates that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating from October 31, 2023.

2. Entitlement to service connection for IBS

3. Entitlement to service connection for obstructive sleep apnea

2. Entitlement to service connection for IBS

3. Entitlement to service connection for obstructive sleep apnea

Service connection will be granted if the evidence demonstrates a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d).

The Veteran contends that his IBS and obstructive sleep apnea are due to his service-connected disabilities.

The Veteran underwent VA examinations for these conditions in December 2023, February 2024, and June 2025. These examinations determined that these conditions were not due to his service nor due to any toxic exposures. However, none of these examinations addressed whether his conditions were caused or aggravated by any service-connected disability or from obesity resulting from any service-connected disability.

In January 2026, the Veteran submitted private opinions for his IBS and obstructive sleep apnea.

Regarding the Veteran's IBS, the examiner concluded it is at least as likely as not that the Veteran's mental health condition contributed to the development of IBS by placing chronic strain on the abdomen during periods of high stress. Due to the Veteran's pain and surgeries from his hernia, he has been unable to exercise and maintain a healthy lifestyle, which has led to the development of obesity. The Veteran's obesity resulted in the development of his IBS. His service-connected disabilities have contributed to the development of his IBS by causing chronic anxiety, obesity, chronic pain, and sleep impairment which affected the frequency and severity of abdominal distress and related gastrointestinal symptoms. See Medical Treatment Record - Non-Government Facility, January 2026.

Regarding his obstructive sleep apnea, the examiner stated his obstructive sleep apnea is due to his mental health symptoms, hernia pain, and voiding due to prostate cancer. His hernia causes constant shifts in position during the night, his nightmares wake him up, and he suffers from insomnia. Due to his constant shifting, frequent voiding, and mental health symptoms, his ability to stay asleep is impaired and his ability to keep his CPAP mask on is impacted. Additionally, he has gained weight due to his pain, low motivation, and energy leading to overeating to cope with pain and his mental health symptoms. His service-connected disabilities have contributed to his weight gain and obesity, which resulted in the development of his obstructive sleep apnea. See VA Examination, January 2026.

While obesity cannot be service-connected on a direct basis, and obesity cannot qualify as an in-service injury or disease for service connection purposes, obesity may serve as an "intermediate step" between a service-connected disability and a current disability that may be service connected on a secondary basis under 38 C.F.R. § 3.310(a). Walsh v. Wilkie, 32 Vet. App. 300 (2020); see also VAOGCPREC 1-2017. In such a case, the evidence would need to reflect that (1) a service-connected disability or disabilities caused the Veteran to become obese or aggravated the Veteran's obesity, (2) the obesity or aggravation of obesity resulting from service-connected disability or disabilities was a substantial factor in causing another disability, and (3) the disability would not have occurred but for the obesity caused by the Veteran's service-connected disability or disabilities or the obesity aggravated by the service-connected disability or disabilities. Walsh, 32 Vet. App. at 306-7.

The Board finds the Veteran's service-connected disabilities caused the development of IBS and obstructive sleep apnea. His pain and anxiety cause increased gastrointestinal symptoms and additionally caused the Veteran to develop obesity which cased his IBS. His voiding and pain caused frequent wakings impacting his ability to wear his CPAP mask. Additionally, his disability lead to his development of obesity,
aggravation of obesity resulting from service-connected disability or disabilities was a substantial factor in causing another disability, and (3) the disability would not have occurred but for the obesity caused by the Veteran's service-connected disability or disabilities or the obesity aggravated by the service-connected disability or disabilities. Walsh, 32 Vet. App. at 306-7.

The Board finds the Veteran's service-connected disabilities caused the development of IBS and obstructive sleep apnea. His pain and anxiety cause increased gastrointestinal symptoms and additionally caused the Veteran to develop obesity which cased his IBS. His voiding and pain caused frequent wakings impacting his ability to wear his CPAP mask. Additionally, his disability lead to his development of obesity, which then caused the development of obstructive sleep apnea. There is no adequate medical opinion contrary to a conclusion that his IBS and obstructive sleep apnea are due to his service-connected disabilities. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for IBS and obstructive sleep apnea is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. See also Buchanan, 451 F.3d at 1335 ("[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself.")

Frederic P. Gallun

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M.H., 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.

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