POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served, appeals the reduction of his disability rating for PTSD from 70 percent to 50 percent and the denial of TDIU. The Board found the reduction improper, restoring the 70 percent rating for PTSD. The AOJ reduced the rating based on a February 2025 VA examination, but failed to demonstrate actual improvement in the Veteran's ability to function under ordinary conditions. The Board noted the Veteran's ongoing PTSD symptoms, including flashbacks, nightmares, anxiety, and difficulty with social and work relationships, as documented in VA treatment records and his own statements. The Board also found the Veteran entitled to TDIU, concluding that the combined physical and mental effects of his service-connected disabilities, including PTSD, back conditions, foot disabilities, and headaches, preclude him from substantially gainful employment. The Board cited the Veteran's reported difficulties with physical tasks, fatigue, pain, and mental health symptoms impacting his ability to work and maintain relationships. The Board resolved reasonable doubt in the Veteran's favor for both the PTSD rating restoration and the TDIU claim. The Board remanded the claim for an increased rating for PTSD to allow VA to obtain private treatment records from a social worker, K.A.D., which were identified by the Veteran.

Rationale

Reduction improper as AOJ failed to demonstrate actual improvement in ability to function; Competent and credible evidence weighed against finding material improvement; Restoration of prior rating warranted due to VA's failure to meet burden of proof

Full Decision Text

Citation Nr: A26040467
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260407-645596
DATE: April 30, 2026

ORDER

A 70 percent disability rating for posttraumatic stress disorder (PTSD) is restored effective February 20, 2025.

Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted.

REMANDED

Entitlement to a disability rating in excess of 70 percent for PTSD is remanded.

FINDINGS OF FACT

1. At the time of the April 2025 rating decision, sustained improvement in the Veteran's PTSD under the ordinary conditions of life and work had not been demonstrated.

2. Resolving reasonable doubt in the Veteran's favor, it is at least as likely as not the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities.

CONCLUSIONS OF LAW

1. The reduction of the disability rating for service-connected PTSD from 70 percent to 50 percent, effective February 20, 2025, was improper, and restoration of the 70 percent disability rating is warranted.  38 U.S.C. §§ 1155, 5107, 5112; 38 C.F.R. §§ 3.105, 4.10, 4.126, 4.130, Diagnostic Code 9411.

2. The criteria for entitlement to a TDIU due to service-connected disabilities have been met.  38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.400, 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

In October 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the evaluation of PTSD most recently addressed in a May 2024 rating decision.  In April 2025, the agency of original jurisdiction (AOJ) issued the rating decision on appeal reducing the disability rating for PTSD to 50 percent, effective February 20, 2025, based on the evidence of record at the time of that decision.  

In the April 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 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. 

However, because the Board is remanding the claim of entitlement to a disability rating in excess of 70 percent for PTSD, any evidence the Board could not consider will be considered by the AOJ in the readjudication of that claim.  38 C.F.R. § 3.103(c)(2)(ii). 

A claim stemming from a rating reduction action is a claim for restoration of the prior rating and, typically, does not contemplate a claim for an increased rating.  See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991); Dofflemyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992).  However, in this case, the April 2025 rating decision was issued as part of the Veteran's continuous pursuit of a November 2023 claim for entitlement to an increased disability rating for PTSD.  Therefore, the Veteran's appeal from the rating action has brought before the Board the issues of the propriety of the rating reduction, as well as the claim for an increased rating.  See also April 2026 representative statement (contentions regarding both the rating reduction and for an increased rating)

The Board finds entitlement to a TDIU has been raised as part and parcel of the claim for an increased disability
lemyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992).  However, in this case, the April 2025 rating decision was issued as part of the Veteran's continuous pursuit of a November 2023 claim for entitlement to an increased disability rating for PTSD.  Therefore, the Veteran's appeal from the rating action has brought before the Board the issues of the propriety of the rating reduction, as well as the claim for an increased rating.  See also April 2026 representative statement (contentions regarding both the rating reduction and for an increased rating)

The Board finds entitlement to a TDIU has been raised as part and parcel of the claim for an increased disability rating for PTSD.  See February 2025 rating decision (TDIU deferred); October 2024 representative statement; Rice v. Shinseki, 22 Vet. App. 447 (2009).

In Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims held the Board should not adjudicate an appeal until the time for the appellant to switch Board dockets has ended.  This period ends either one year from the date the AOJ mailed notice of the decision on appeal, or 60 days from the date the Board received the VA Form 10182, whichever date is later.  38 C.F.R. § 20.202(c)(2).  Here, the Board may proceed with adjudication because on April 7, 2026, the Board received the representative's waiver of the remainder of the period to switch dockets. 

1. Whether the reduction of the disability rating for PTSD from 70 percent to 50 percent, effective February 20, 2025, was proper

The Veteran's representative contends the rating reduction for the Veteran's service-connected PTSD was not warranted because the reduction was based on a single VA examination and not the entire history of the Veteran's condition, and the evidence does not show any improvement in the Veteran's ability to function under the ordinary conditions of life and work.  See April 2026 representative statement.

A veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred.  38 U.S.C. § 1155.  The law provides that where a rating reduction was made without observance of law, although a remand for compliance with that law would normally be an adequate remedy, in a rating reduction case the erroneous reduction must be vacated and the prior rating restored.  Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).  When a veteran's disability rating is reduced without following the applicable regulations, the reduction is void ab initio.  See Greyzck v. West, 12 Vet. App. 288, 292 (1999).

Prior to reducing a veteran's disability rating, VA regulations impose a clear requirement that VA rating reductions be based upon review of the entire history of the veteran's disability.  See 38 C.F.R. §§ 4.1, 4.2, 4.10; Schafrath, 1 Vet. App. at 594.  Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.  Thus, in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work.  See Stern v. McDonough, 34 Vet. App. 51, 56 (2021) (quoting Brown v. Brown, 5 Vet. App. 413, 421 (1993)).  In rating reduction cases, the burden is on VA to establish that a rating reduction was warranted.  Id.

First, in a February 2025 supplemental claim decision, the AOJ granted a 70 precent disability rating for PTSD, effective October 10, 2023.  In the April 2025 rating decision, the AOJ reduced the Veteran's rating for PTSD from 70 percent to 50 percent, effective February 20, 2025.  The April 2025 rating decision did not result in a reduction in overall compensation payments currently being made to the Veteran, as his combined disability rating remained 90 percent.  Accordingly, the Board finds the claim is not subject to the notification requirements of 38 C.F.R. § 3.105(e).  Further, the greater protections set forth in 38 C.F.R. § 3.344 do not apply in this case because the
 granted a 70 precent disability rating for PTSD, effective October 10, 2023.  In the April 2025 rating decision, the AOJ reduced the Veteran's rating for PTSD from 70 percent to 50 percent, effective February 20, 2025.  The April 2025 rating decision did not result in a reduction in overall compensation payments currently being made to the Veteran, as his combined disability rating remained 90 percent.  Accordingly, the Board finds the claim is not subject to the notification requirements of 38 C.F.R. § 3.105(e).  Further, the greater protections set forth in 38 C.F.R. § 3.344 do not apply in this case because the 70 percent disability rating was not in effect for five or more years at the time of the reduction effective February 2025.

After reviewing the evidence of record, the Board finds there is competent and credible evidence that the Veteran's service-connected PTSD had not improved at the time of the April 2025 rating decision.  In reducing the disability rating from 70 to 50 percent, the AOJ considered the results of the Veteran's February 2025 VA examination, which tended to show that the Veteran's PTSD did not meet the criteria for a 70 percent disability rating.  Crucially, however, the AOJ failed to make a specific determination that there was an actual improvement in the Veteran's ability to function under the ordinary conditions of life and work.  

After considering the Veteran's entire medical history, the most probative evidence of record persuasively weighs against finding a material improvement in the service-connected PTSD.

Upon a January 2024 VA PTSD examination, the Veteran reported living alone, that he was retired, and he saw a private therapist biweekly.  The January 2024 VA examiner noted the Veteran's reports of being unable to stand loud noises, having flashbacks, weeping, continuous intrusions, strong sense of survivor's guilt, rare feelings of joy, and suspiciousness of others.  The VA examiner reported the Veteran's symptoms for rating purposes as depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and inability to establish and maintain effective relationships.  Upon examination, the VA examiner reported the Veteran was well kempt in business casual attire, was lucid and oriented in all spheres, the Veteran was able to complete the give-and-take conversation/examination without difficulty, and his eye contact and speech prosody were good.

VA treatment records dated between May 2024 and September 2024 continued to report the Veteran's concerns about his PTSD, including flashbacks, nightmares, stress, guilt, anger, and depression and anxiety symptoms which made it somewhat difficult to work, take care of things at home, or get along with others.  The treatment records also note the Veteran expressed frustration, "feeling unheard and not being listened to as it relates to his PTSD."  See May 2024 mental health case manager note; see also September 2024 mental health contact note; July 2024 addendum to mental health case management note; May 2024 addendum to mental health case manager note; May 2024 mental health care coordination consult; May 2024 primary care mental health initial assessment.

In statements received in October 2024, the Veteran reported a variety of mental health symptoms.  He reported he remained retired, and could only be friends with other veterans.  He reported it was a "task" to keep up hygiene and routine tasks, and "sometimes you don't feel like you care."  He also stated he needed to take his time to make sound judgments, and noted that he lost interest in his hobbies and things he once enjoyed.  The Veteran reported feeling "dead inside."

Upon the February 2025 VA examination, the Veteran reported he was still retired, continued to live alone, was divorced, and reported a good relationship with his adult children but that he believed his ex-wife told them to stay away from him.  The Veteran also reported social support through a select group of friends, and reported difficulty connecting with others.  The Veteran reported no longer participating in therapy, stating, "It's not good for me to go over things.  It's not good for my head."  The VA examiner stated the Veteran demonstrated "help[-] rejecting behaviors and believes there is no therapy for PTSD."  The VA examiner reported the Veteran's symptoms for rating purposes as the exact same symptoms as those noted upon the January 2024 VA examination.  

Notably, although the February 2025 VA examiner did not specifically address whether the Veteran experienced all of the symptoms the Veteran had reported in his October 2024 statements, the February 2025 VA examiner did not opine that there was any
 through a select group of friends, and reported difficulty connecting with others.  The Veteran reported no longer participating in therapy, stating, "It's not good for me to go over things.  It's not good for my head."  The VA examiner stated the Veteran demonstrated "help[-] rejecting behaviors and believes there is no therapy for PTSD."  The VA examiner reported the Veteran's symptoms for rating purposes as the exact same symptoms as those noted upon the January 2024 VA examination.  

Notably, although the February 2025 VA examiner did not specifically address whether the Veteran experienced all of the symptoms the Veteran had reported in his October 2024 statements, the February 2025 VA examiner did not opine that there was any improvement in the Veteran's PTSD, or his ability to function under the ordinary conditions of life or work.

As VA has failed to meet its burden to demonstrate actual improvement of the Veteran's PTSD resulting in sustained improvement in his ability to function under the ordinary conditions of life and work, the Board finds restoration of a 70 percent disability rating for PTSD is warranted.

2. Entitlement to a TDIU due to service-connected disabilities

Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when a Veteran is unable to secure and follow a substantially gainful occupation as a result of service-connected disabilities.  38 C.F.R. § 4.16(a).

The phrase "unable to secure and follow a substantially gainful occupation" contains both economic and noneconomic components.  See Ray v. Wilkie, 31 Vet. App. 58, 73 (2019).  The economic component is met when the Veteran is unemployed or marginally employed.  Marginal employment generally shall be deemed to exist when the Veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person.  38 C.F.R. § 4.16(a).  Marginal employment includes employment in a protected environment, such as a family business or sheltered workshop, which involves a lower-income position that, due to the Veteran's service-connected disabilities, is shielded in some respect from competition in the employment market.  LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024).  Consideration shall be given in all claims to the nature of the employment and the reason for termination.  38 C.F.R. § 4.16(a). 

The non-economic component of the phrase "unable to secure and follow a substantially gainful occupation" includes consideration of the Veteran's history, education, skill, and training; whether the Veteran has the physical ability (both exertional and non-exertional) to perform the type of activities required by the occupation at issue (e.g., lifting, bending, sitting, standing, walking, climbing, as well as auditory and visual limitations); and whether the Veteran has the mental ability to perform the activities required by the occupation at issue (e.g., memory, concentration, ability to adapt to change, handle work place stress, get along with coworkers, and demonstrate reliability and productivity).  Ray, 31 Vet. App. at 73. 

The Board is not permitted to consider advancing age or a nonservice-connected disability when determining entitlement to a TDIU.  38 C.F.R. §§ 3.341(a), 4.16, 4.19.

A TDIU does not require a showing of 100 percent unemployability.  Roberson v. Principi, 251 F.3d 1378, 1385 (Fed. Cir. 2001).  The ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether the Veteran can find employment.  Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993).  In this regard, entitlement to a TDIU is a legal determination, not a medical one.  Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013).  Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a Veteran may "secure and follow a substantially gainful occupation" based on all evidence of record.  See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

During the period on review before the Board, the Veteran had the following service-connected disabilities: PTSD; tension headaches; lumbosacral strain with intervertebral disc syndrome (IVDS) and bilateral sacroiliac joint arthritis; sciatic and femoral radiculopathy of the right lower extremity;
, 733 F.3d 1350, 1354 (Fed. Cir. 2013).  Medical examiners may provide evidence regarding functional and occupational impairment, but the Board must decide whether a Veteran may "secure and follow a substantially gainful occupation" based on all evidence of record.  See Delrio v. Wilkie, 32 Vet. App. 232, 243 (2019).

During the period on review before the Board, the Veteran had the following service-connected disabilities: PTSD; tension headaches; lumbosacral strain with intervertebral disc syndrome (IVDS) and bilateral sacroiliac joint arthritis; sciatic and femoral radiculopathy of the right lower extremity; sciatic and femoral radiculopathy of the left lower extremity; cervical strain; irritable bowel syndrome (IBS) with gastrointestinal (GI) dysmotility syndrome; residuals, multiple fractures, bones left foot, with degenerative arthritis, left foot; partial amputation of left great toe with degenerative arthritis; tender scars left foot; tinnitus; and bilateral hearing loss.  See March 2026 rating decision code sheet (listing effective dates of service-connected disabilities).

For the reasons that follow, the Board finds it is at least as likely as not the Veteran is unable to secure or follow a substantially gainful occupation as a result of his service-connected disabilities.

The Veteran reported that following active duty service he completed a bachelor's degree, while other times he has reported having a master's degree.  The Veteran reported he taught high school for two years, worked as a police officer for a short period, worked as an analyst and then as an investigator for the state, and then as a car sales representative.  The Veteran reported he retired from car sales in 2009.  See February 2025 VA review PTSD examination report; May 2024 addendum to VA mental health case management note; October 2024 Veteran statement; January 2024 VA review PTSD examination report; October 2023 VA initial PTSD examination report; September 2023 VA environmental health registry consult note; August 2023 VA mental health comprehensive assessment consult; October 1990 VA examination report.

The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the physical effects of his service-connected disabilities.  The evidence of record indicates that due to his service-connected back disability, the Veteran has difficulty with heavy lifting, twisting, bending motions, driving, and stairs.  See February 2025 VA back examination report.  The Veteran has reported that due to his service-connected left foot disabilities he experiences pain that can be unbearable if he spends a significant amount of time on his feet, foot swelling and pain causing difficulty spending time in shoes, and trouble walking for prolonged periods related.  The Veteran has also reported it is hard to walk due to the pain in his legs.  See September 2024 Veteran statement; June 2017 VA foot examination report; June 2017 Veteran statement.  The Veteran has reported the aching in his extremities make him very fatigued, and some days he is drained and tired.  See September 2024 Veteran statement.  Even if seated, the Veteran's service-connected neck disability causes difficulty with neck movements including turning his neck to look around.  See February 2025 VA neck examination report.  Further, due to his IBS and GI dysmotility syndrome, the Veteran always needs to be near a bathroom due to constipation and diarrhea, and his heartburn and nausea would interrupt the flow of his work.  See March 2025 VA intestinal examination report; September 2024 Veteran statement.

The Veteran's ability to secure and follow a substantially gainful occupation is impacted by the mental effects of his tension headaches and PTSD.  The Veteran experiences prostrating tension headaches described as constant headaches occurring five to six times a week, lasting less than a day, for which the Veteran needs to lay down in a dark quiet room making it difficult to perform tasks, and resulting in decreased focus and productivity impacting his ability to work.  See February 2025 VA headaches examination report; October 2024 representative statement; September 2024 Veteran statement.  Further, the Veteran's PTSD has been reported to be manifested by chronic sleep impairment, hypervigilance, exaggerated startle response, panic attacks, disturbances of motivation and mood, suspiciousness of others, and difficulty connecting with others, to include an inability to establish and maintain effective relationships.  See, e.g., February 2025 VA review PTSD examination report; October 2024 Veteran statements; January 2024 VA review PTSD examination report.  Medical professionals have described the Veteran in the context of his PTSD as hyperverbal, but responsive to redirection, with the Veteran reporting he had put himself in careers to keep from facing his PTSD, and
 report; October 2024 representative statement; September 2024 Veteran statement.  Further, the Veteran's PTSD has been reported to be manifested by chronic sleep impairment, hypervigilance, exaggerated startle response, panic attacks, disturbances of motivation and mood, suspiciousness of others, and difficulty connecting with others, to include an inability to establish and maintain effective relationships.  See, e.g., February 2025 VA review PTSD examination report; October 2024 Veteran statements; January 2024 VA review PTSD examination report.  Medical professionals have described the Veteran in the context of his PTSD as hyperverbal, but responsive to redirection, with the Veteran reporting he had put himself in careers to keep from facing his PTSD, and "he used to be able to hold it back, but he can't anymore."  See August 2023 VA mental health comprehensive assessment consult; see also February 2025 VA review PTSD examination report; October 2024 Veteran statement; May 2024 VA mental health case manager note (noting Veteran's tangential flow); June 2023 VA primary care mental health initial assessment (Veteran had to be redirected multiple times).

The evidence of record indicates the Veteran does experience physical and mental effects from nonservice-connected disabilities during the review period before the Board.  See, e.g., September 2024 Veteran statement.  However, given the foregoing, the Board resolves reasonable doubt in the Veteran's favor and finds it is at least as likely as not the combined physical and mental effects due to the Veteran's service-connected disabilities preclude the Veteran from the ability to secure and follow a substantially gainful occupation consistent with the Veteran's education, skills, training, and work history.

For the reasons discussed above, the Board resolves reasonable doubt in the Veteran's favor, and finds the Veteran is unable to secure and follow a substantially gainful occupation as a result of his service-connected disabilities.  Accordingly, the criteria for entitlement to a TDIU have been met.

REASONS FOR REMAND

Entitlement to a disability rating in excess of 70 percent for PTSD is remanded.

Prior to the April 2025 rating decision on appeal, the Veteran identified relevant outstanding private treatment records.  On a November 2024 VA Form 21-4142, the Veteran listed K.A.D., whom he indicated is a social worker.  A May 2024 VA mental health case manager note included the Veteran's report that this provider was his community care provider for his PTSD, and indicated he wanted those records associated with his VA record.  A remand is required for VA to undertake reasonable efforts to obtain these records.

The matter is REMANDED for the following action:

Ask the Veteran to complete a VA Form 21-4142 for social worker K.A.D.  Make two requests for the authorized records from K.A.D., unless it is clear after the first request that a second request would be futile.

 

 

David Gratz

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. M. Cooney, 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.