PTSD DUE TO COMBAT

JENNA BRANT · 2026 · Case ID: A26040448

GRANTED

Summary

The Veteran, who served from February 1984 to April 1989 and again from January 2003 to April 2004, appeals the denial of an increased rating for PTSD and TDIU. The case involves a claim for an increased rating for PTSD, with the Board reviewing evidence from the period beginning December 11, 2017, based on a TDIU application filed in December 2018, which the RO treated as a supplemental claim for an increased rating. The Board found that the Veteran's PTSD and bipolar disorder symptoms worsened to total occupational and social impairment by August 8, 2018. Key evidence included a private mental health professional's opinion detailing significant impairments in concentration, trust, relationships, and judgment, along with periods of homelessness and suicidal ideation. VA treatment records and examinations also noted symptoms such as depressed mood, anxiety, flattened affect, impaired impulse control, and difficulty adapting to stress. The Board found the Veteran's symptoms, including suicidal ideation, compulsive buying during manic phases, difficulty leaving the home, and estrangement from family, best matched the criteria for a 100 percent disability rating. The Board concluded that the Veteran experienced total occupational and social impairment due to her PTSD and bipolar disorder, granting a 100 percent rating effective August 8, 2018.

Rationale

Symptoms best match criteria for 100 percent evaluation.; Total occupational and social impairment demonstrated.; Factually ascertainable worsening by August 8, 2018.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210517-159889

Full Decision Text

Citation Nr: A26040448
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 210517-159889
DATE: April 29, 2026

ORDER

Entitlement to a 100 percent rating for posttraumatic stress disorder (PTSD) with depressed mood and bipolar disorder is granted effective August 8, 2018.

FINDING OF FACT

The severity, frequency, and duration of the Veteran's symptoms most closely approximate total occupational and social impairment.

CONCLUSION OF LAW

The criteria for a 100 percent disability rating for PTSD with bipolar disorder have been met from August 8, 2018. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9432-9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 1984 to April 1989, and January 2003 to April 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In December 2018, the Veteran filed a VA Form 21-8940, Application for a Total Disability Evaluation Based on Individual Unemployability (TDIU), contending that her service-connected disabilities, including PTSD, rendered her unable to work. In a March 2019 rating decision, the RO denied the claim for TDIU and denied an increased rating for PTSD.

In September 2019, the Veteran filed a supplemental claim for an increased rating. The Veteran also attached the new and relevant evidence necessary to readjudicate the claim. See 38 U.S.C. § 5108; 38 C.F.R. § 3.2501. In a November 2019 rating decision, the RO readjudicated the claim on the merits and granted an increased rating of 70 percent, effective December 11, 2018. The RO also denied the TDIU claim again.

In April 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the November 2019 decision. In August 2020, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior November 2019 decision.

In the May 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in October 2024.

Therefore, the Board may only consider the evidence of record at the time of the November 2019 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review 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.

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.

The Board notes that a separate claim for TDIU is pending in a different appeal stream. However, because the current grant of a 100 percent rating is an equal or greater benefit that TDIU, the Board will not imply a claim for TDIU in this appeal under Rice v. Shinseki, 22 Vet. App. 447 (2009).

Entitlement to a 100 percent rating for PTSD with depressed mood and bipolar disorder is granted effective August 8, 2018.

The Veteran contends she is entitled to a 100 percent rating for her PTSD. The Board agrees.

Disability ratings are determined by applying
. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to a 100 percent rating for PTSD with depressed mood and bipolar disorder is granted effective August 8, 2018.

The Veteran contends she is entitled to a 100 percent rating for her PTSD. The Board agrees.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 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. 38 C.F.R. § 4.7.

In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27.

Additionally, the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. See 38 C.F.R. § 4.14. Separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Under 38 C.F.R. § 4.130, a 70 percent disability rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood due to symptoms such as: suicidal ideation; obsessive rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; 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 work-like setting); and an inability to establish and maintain effective relationships.

A 100 percent disability rating is warranted 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); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

When determining the appropriate disability evaluation to assign
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 work-like setting); and an inability to establish and maintain effective relationships.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is a Veteran's symptoms, but it must also make findings as to how those symptoms impact a Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (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. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a Veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118.

By way of background, in an August 2013 rating decision, the Veteran was initially granted service connection for PTSD and assigned a 50 percent rating, effective August 19, 2009.

As previously noted, the Veteran filed a claim for unemployability in December 2018. In March 2019, the RO implied and denied a claim for an increased rating for PTSD. Although no VA Form 20-0995 supplemental claim was filed until September 2019, the RO treated the December 2018 filing as a supplemental claim. This approach is consistent with a later decision by the Court of Appeals for Veterans Claims, Chisholm v. Collins, 38 Vet. App. 140 (2025). (Holding that a TDIU application may serve as a supplemental claim in VA's modernized appeal system, even if the application is not submitted with a supplemental claim form, if the application continues the same benefit request for the same disabilities). Although Chisholm was decided after the RO decisions, it still dictates the outcome here and is binding on the Board.

In September 2019, the Veteran filed a supplemental claim for an increased rating for PTSD. In a November 2019 decision, the RO granted a 70 percent rating effective December 11, 2018, the date of the VA Form 21-8940 application for TDIU.

The relevant rating period begins on December 11, 2018, which is based on the date of submission of the TDIU claim, which the RO impliedly found included a claim for an increased rating for PTSD. Accordingly, the Board has reviewed all relevant evidence, to include evidence dated within the one year look back period commencing December 11, 2017. 38 U.S.C. § 5110(b)(3).

The Board finds that it is factually ascertainable that the Veteran's PTSD and bipolar symptoms worsened to total social and occupational impairment within the one-year lookback period from December 11, 2017, to December 11, 2018. Specifically, the Board finds a factually ascertainable worsening on August 8, 2018.

As a final initial matter, the Veteran has been service connected for both PTSD and bipolar disorder for the entire period at issue. See Codesheet. Thus, she must be compensated for symptoms of both disabilities, regardless of which symptom is caused by which disability.

The Veteran has a significant history of psychiatric treatment. In August 2018, the Veteran went to a VA emergency room for suicidal ideation. She stated she was thinking of jumping off a bridge. The provider wrote

She stated that she went to Walmart and got caught shoplifting
11, 2017, to December 11, 2018. Specifically, the Board finds a factually ascertainable worsening on August 8, 2018.

She stated that she went to Walmart and got caught shoplifting. She was let go with the understanding that she would be coming to the VA for treatment. She says that her dog died in February and this has made her more depressed. She started to drink heavily after the loss of her dog. She said that this devastated her. She has been experiencing decreased memory; she is slow to respond at times.

On August 8, 2018, the Veteran was admitted to a VA hospital for inpatient psychiatric treatment. She was discharged a week later, once her mood was stabilized with lithium. She was living with her sister at the time.

In July 2019, the Veteran provided a disability benefits questionnaire (DBQ) and opinion letter from a private mental health professional. The author provided a detailed history from the Veteran. As to the Veteran's occupational functioning, the author found the Veteran had significantly impaired concentration and limited ability to focus on tasks. She prefers isolation and has difficulty trusting or getting along with others.

The Veteran tends to isolate from her own family. The examiner wrote that the Veteran reported she could not trust her family members. The Veteran was adamant that her sister poisoned the Veteran's dog, because the sister did not want the Veteran living with her anymore. The author noted the Veteran had periods of homelessness.

The private examiner noted symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flat affect, impaired judgment, disturbances of motivation and mood, difficulty/inability in establishing relationships, difficulty adapting to stress, suicidal ideation, impaired impulse control, and intermittent inability to perform activities of daily living. The author assessed the Veteran as having total occupational and social impairment.

October 2019 VA mental health treatment records note the Veteran has a

long history of Behavioral Health treatment for PTSD and for Bi-Polar disorder. Pt. was seen following an incident in which the pt. made some superficial cuts on her arm. Pt. denies any suicidal or homicidal ideation, intent, or plan. Pt. is a compulsive buyer when in her manic phase. Pt. currently on medication for her Bipolarity and her PTSD. ... Pt. has relocated to her own home.

A week later in October 2019, VA examined the Veteran for her claim. The examiner also provided a history from the Veteran and wrote down several direct quotes from the Veteran. The examiner quoted the Veteran as saying "I'm divorced; I have two children who are grown and 4 grandkids. No, I don't have any friends to talk to. Sometimes I'll go with my mother to church things, but usually I stay home." The examiner noted the Veteran had periods of homelessness.

The Veteran also explained her difficulties at work. She said

I used to never have trouble getting along and now I do. I worked for the state of Tennessee and I had a group of females come around bullying me. We got into arguments, and I got written up a few times. I don't take people's crap anymore. I don't take kindly to people's attitudes. I'd forget how to do things and have to be told several times even if I wrote down notes. I would get extremely depressed or anxious and I would just call out. I have a record of missing work. I missed a week of work at times.

The Veteran described greatly impaired impulse control. For example, she reported "[w]hen I was in the National Guard I went spur of the moment to get tattoos and I was against them. I would have never done these type of things when I was younger."

The examiner noted symptoms of depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty establishing and maintaining relationships, difficulty adapting to stress, and inability to establish and maintain relationships. The examiner opined that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. This is consistent with the requirements for a 70 percent
impaired impulse control. For example, she reported "[w]hen I was in the National Guard I went spur of the moment to get tattoos and I was against them. I would have never done these type of things when I was younger."

In October 2024, the Veteran testified before the Board. She testified to extreme anxiety when leaving the home for things like walking her dogs or going to the grocery store. She only leaves the home one or two times a week. Sometimes, when she goes shopping, she will buy so many items that she cannot take them all home. She sometimes abandons entire carts of things she already purchased.

The Veteran also testified to being estranged from family and a friend she had known since the 1970s. She reported she was no longer in contact with a brother. She was not always in contact with her mother. The Veteran did not mention her sister.

The Veteran testified she was willing to return to work, and had applied for several jobs, but was not hired.

After reviewing the evidence, the Board finds that throughout the rating period, the Veteran's symptom presentation best matches the criteria for a 100 percent evaluation under 38 C.F.R. § 4.130. This level of impairment is characterized by total occupational and social impairment.

In reaching this conclusion, the Board acknowledges the record evidence that supports the following symptoms: depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty/inability in establishing relationships, difficulty adapting to stress, suicidal ideation, impaired impulse control, and intermittent inability to perform activities of daily living.

In summary, the evidence demonstrates that the Veteran last worked at an Amazon warehouse in 2018, when she was hospitalized for a week for suicidal ideation. She had serious attendance problems at work before that and would call out sick whenever she was overwhelmed. She is totally occupationally impaired from her PTSD and bipolar disorder.

The Veteran is also completely socially impaired by her PTSD and bipolar disorder. She has serious difficulty getting along with others, including her own family. She is barely able to leave the home to shop for groceries or walk her dogs.

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Thus, it is factually ascertainable that the Veteran's symptoms materially worsened during the one-year lookback period before the December 11, 2018, claim. Further, the evidence supports that the Veteran's symptoms most closely approximated total occupational and social impairment by at least August 8, 2018. Accordingly, the Veteran is entitled to a 100 percent rating for her PTSD and bipolar disorder from August 8, 2018.

Jenna Brant

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T.E. Yahner, Associate 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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