OTHER SPECIFIED SOMATIC SYMPTOM AND RELATED DISORDER

Summary

The Veteran, who served in the U.S. Navy from November 1959 to October 1963, appeals a July 2025 rating decision concerning his insomnia disorder. The Veteran initially claimed service connection for tinnitus, which was granted with a 10 percent rating. Subsequently, he claimed PTSD, anger, depression, and anxiety, which were initially denied but later recharacterized by the VA as insomnia disorder, granted as secondary to tinnitus, and combined with the tinnitus rating at 10 percent under Diagnostic Code (DC) 6260. The Veteran contended that his insomnia disorder is a separate disability warranting its own compensable rating, distinct from the tinnitus. The Board reviewed the evidence, including VA treatment records and a June 2025 VA PTSD examination report, which diagnosed insomnia disorder with other medical comorbidity, recurrent. The Board found that the Veteran's symptoms, such as anger, irritability, tangential and perseverative speech, and fixation on complaints about the VA, aligned with the criteria for a 50 percent rating under the General Rating Formula for Mental Disorders, specifically by analogy to DC 9422 for other specified somatic symptom and related disorders. While the Veteran presented arguments for a 70 percent rating based on reported suicidal ideation and impaired impulse control, the Board found that the overall occupational and social impairment did not meet the higher criteria, particularly given his stable family relationships and limited social withdrawal. Resolving reasonable doubt in the Veteran's favor, the Board granted a separate 50 percent rating for insomnia disorder.

Rationale

Separate diagnosis from tinnitus; Symptoms align with 50% rating criteria; Rated by analogy to DC 9422

Full Decision Text

Citation Nr: A26040516
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 260304-634643
DATE: April 30, 2026

ORDER

Entitlement to a separate 50 percent rating, but not higher, for insomnia disorder with other medical comorbidity, recurrent (insomnia disorder), as a disability separate from and secondary to service-connected tinnitus, is granted.

FINDING OF FACT

The Veteran's insomnia disorder is a separate disability caused by his tinnitus that results in chronic sleep impairment causing reduced reliability and productivity.

CONCLUSION OF LAW

The criteria for a separate 50 percent rating, but not higher, for insomnia disorder, a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) disability separate from tinnitus, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.130, Diagnostic Code (DC) 9422.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from November 1959 to October 1963.

This appeal is being processed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a July 2025 rating decision issued by a Department of Veterans Affairs (VA) regional office (RO), an agency of original jurisdiction (AOJ).

VA received the Veteran's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in March 2026. The Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2025 rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, the Board did not consider it in its decision. 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 claim(s), 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 acknowledges that 38 C.F.R. § 20.202(c)(2) provides that an appellant may modify a VA Form 10182 and change Board dockets by submitting a new VA Form 10182 within one year of notification of the decision on appeal or within 60 days of the date that the Board received the original VA Form 10182, whichever is later. In this case, the Veteran's time to change Board dockets has not yet elapsed. However, the Veteran, through his attorney, waived any remaining time within which to modify the chosen Board docket. See April 2026 Due Process Waiver; see Williams v. McDonough, 37 Vet. App. 305 (2024). Thus, the Board may proceed in adjudicating this appeal without additional delay.

This appeal has been advanced on the Board's docket. 38 C.F.R. § 20.800(c).

Entitlement to a separate disability rating for insomnia disorder

The Veteran seeks a separate rating for his insomnia disorder. See Attachment to March 2026 VA Form 10182.

By way of history, the Veteran's original August 2023 claim for service connection for tinnitus was denied in an October 2023 rating decision. In March 2024, the Veteran filed a VA Form 20-0995 for service connection for tinnitus and, approximately a week later, submitted a claim for post-traumatic stress disorder (PTSD), anger, depression, and anxiety via VA Form 21-526EZ, Application for Disability Compensation and Compensation Related Benefits. See March 2024 VA Form 21-526EZ. Both claims were denied in an April 2024 rating decision, but a May 2024 rating decision awarded service connection for tinnitus and assigned an initial 10 percent rating, effective August 30, 2023.

Next, the Veteran filed a VA Form 20-0995 for service connection for PTSD in June 2024, which
 In March 2024, the Veteran filed a VA Form 20-0995 for service connection for tinnitus and, approximately a week later, submitted a claim for post-traumatic stress disorder (PTSD), anger, depression, and anxiety via VA Form 21-526EZ, Application for Disability Compensation and Compensation Related Benefits. See March 2024 VA Form 21-526EZ. Both claims were denied in an April 2024 rating decision, but a May 2024 rating decision awarded service connection for tinnitus and assigned an initial 10 percent rating, effective August 30, 2023.

Next, the Veteran filed a VA Form 20-0995 for service connection for PTSD in June 2024, which was denied in a November 2024 rating decision. The Veteran then filed a VA Form 20-0995 in March 2025 seeking an increased rating for tinnitus and, on the same day, submitted a VA Form 21-526EZ for claims including service connection for PTSD. An April 2025 rating decision denied a rating in excess of 10 percent for tinnitus.

In the July 2025 rating decision on appeal, service connection was awarded for insomnia disorder (claimed as anger, depression, anxiety), effective March 26, 2024. The rating decision recharacterized the Veteran's claim of anger, depression, and anxiety as insomnia disorder, combined it with the Veteran's tinnitus rating, and denied a rating higher than 10 percent for tinnitus with insomnia disorder under DC 6260. See July 2025 Rating Decision.

The Veteran, through his attorney, contends that he is entitled to a separate compensable rating for his insomnia disorder based on symptoms not contemplated under DC 6260 for tinnitus. See Attachment to March 2026 VA Form 10182. For the following reasons, the Board agrees and finds that a separate 50 percent rating is warranted for insomnia disorder as the insomnia disorder is a separate disability with a separate diagnosis and is distinguishable from the constant "freeway noise" caused by the tinnitus, which in turn causes the insomnia. See April 2025 VA Audiology Examination Report.

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different DCs, is to be avoided when rating a veteran's service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several DCs; however, the critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment).

The July 2025 rating decision awarded service connection for insomnia disorder as secondary to tinnitus. Rather than treating insomnia disorder as a separate disability and assigning a separate rating, as is usual when granting secondary service connection, the RO granted service connection for insomnia disorder but treated insomnia as a symptom of tinnitus and continued the single 10 percent rating under DC 6260. 

The Board notes that DC 6260 provides a 10 percent rating for recurrent tinnitus. See 38 C.F.R. § 4.87, DC 6260.

The selection of a particular DC, and relatedly, whether a disability should be rated under a separate DC, "is a determination that is completely dependent upon the facts of a particular case" and the Board has discretion in determining the appropriate DC. Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc) (applying the more deferential "arbitrary, capricious" standard, rather than de novo review, to the Board's determination of the appropriate DC). 

A June 2025 VA PTSD examination report shows a DSM-5 diagnosis of insomnia disorder with other medical comorbidity, recurrent. For VA purposes, all diagnosed mental disorders eligible for service connection as of August 4, 2014, must conform to the DSM-5 as it is the most current diagnostic criteria for establishing a psychiatric diagnosis. 38 C.F.R. § 4.125; see also Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). This is
 538 (1993) (en banc) (applying the more deferential "arbitrary, capricious" standard, rather than de novo review, to the Board's determination of the appropriate DC). 

A June 2025 VA PTSD examination report shows a DSM-5 diagnosis of insomnia disorder with other medical comorbidity, recurrent. For VA purposes, all diagnosed mental disorders eligible for service connection as of August 4, 2014, must conform to the DSM-5 as it is the most current diagnostic criteria for establishing a psychiatric diagnosis. 38 C.F.R. § 4.125; see also Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). This is the only DSM-5 diagnosis of record. Given that service connection for a psychiatric disorder requires a DSM-5 diagnosis and this criteria for service connection was met, service connection for insomnia disorder should have been granted as a separate disability and not part of the already service-connected tinnitus. Martinez-Bodon v. Wilkie, 32 Vet. App. 393, 404        (2020), aff'd sub nom. Martinez-Bodon v. McDonough, 28 F.4th 1241, 1247 (Fed. Cir. 2022) (a valid DSM-5 diagnosis is required to warrant compensation for a psychiatric disability). 

Moreover, although insomnia disorder is not specifically listed among the disabilities covered by the General Rating Formula for Mental Disorders (General Rating Formula), unlisted disorders may be rated by analogy. See 38 C.F.R. § 4.20. ("When an unlisted condition is encountered, it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings"). 

Here, there is a DC listed for a closely related disorder - DC 9422 for other specified somatic symptom and related disorder. See Lofton v. Wilkie, No. 18-2563, 2019 U.S. App. Vet. Claims LEXIS 844, *2 (May 28, 2019) (mem dec) (Bartley, J.) ("The RO noted that an insomnia disorder is not specifically listed in the rating schedule and rated by analogy to Diagnostic Code (DC) 9422 for 'other specified somatic symptom and related disorder.' R. at 2094, 2098; see 38 C.F.R. § 4.130, DC 9422 (2018)"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

Thus, the Board finds that a separate rating for this separate disability is warranted. As to the appropriate rating, disability evaluations (ratings) are determined by the application of the 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 disorders in civil occupations. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

"Staged" ratings may be assigned when the evidence shows distinct periods during the evaluation period when manifestations of the disability warranted varied ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009).

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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C§ 5107(b); 38 C.F.R.                                                                                                              § 4.3.

Under the General Rating Formula, a 10 percent rating is assigned for mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. 38 C.F.R. § 4.130, DC 9433.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly
 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C§ 5107(b); 38 C.F.R.                                                                                                              § 4.3.

Under the General Rating Formula, a 10 percent rating is assigned for mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment. 38 C.F.R. § 4.130, DC 9433.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation). Id.

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. Id.

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. Id.

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. Id.

When evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remissions should be considered. 38 C.F.R. § 4.126(a). A rating will be assigned based on an evaluation of all the evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of the examination. Id.

Under the 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).

Upon review of all the evidence of record, the Board finds that the Veteran's symptoms warrant the assignment of a 50 percent disability rating.  This is supported by VA treatment records, the June 2025 VA PTSD examination report, and the Veteran's lay statements. Specifically, VA treatment records show that the Veteran repeatedly called or sent messages to the Veteran's Crisis Line and his providers, expressing anger and frustration about VA, compensation, and perceived racism and disparity in treatment and award of benefits. See, e.g., May 2024, February 2024, and October 2023 VA Treatment Records. Some of these calls ended when the Veteran hung up on VA providers. See, e.g., February 2025 and October 2024 VA Treatment Records. Other times, however, the Veteran calmed down during the course of the conversation. See, e.g., February 2025 and February 2024 VA Treatment Records. The Board finds that the frequency, severity, and duration of the Veteran's reported and documented anger and irritability are
 repeatedly called or sent messages to the Veteran's Crisis Line and his providers, expressing anger and frustration about VA, compensation, and perceived racism and disparity in treatment and award of benefits. See, e.g., May 2024, February 2024, and October 2023 VA Treatment Records. Some of these calls ended when the Veteran hung up on VA providers. See, e.g., February 2025 and October 2024 VA Treatment Records. Other times, however, the Veteran calmed down during the course of the conversation. See, e.g., February 2025 and February 2024 VA Treatment Records. The Board finds that the frequency, severity, and duration of the Veteran's reported and documented anger and irritability are akin to disturbances of motivation and mood contemplated by a 50 percent rating.

Additionally, an October 2023 VA treatment record shows that he "remained fixated" on complaints about VA. A February 2025 VA treatment record notes suspected cognitive problems as the Veteran was tangential and perseverative in conversation. The June 2025 VA PTSD Examination Report shows that the Veteran perseverated on anger towards VA. The Board finds that the Veteran's tangential, perseverated conversation is akin to circumstantial, circumlocutory, or stereotyped speech associated with a 50 percent rating.

The Board further acknowledges the Veteran's contention, through his attorney, that a 70 percent rating is warranted based on a documented history of a prior suicide attempt, impaired impulse control, including episodes of yelling and breaking objects, and significant irritability and anger outbursts. Further, the attorney contends that the record reflects social withdrawal, a guarded and angry presentation on examination, and clear deficiencies in mood and interpersonal functioning, and notes that the Veteran stated that he was "not suicidal, but may be homicidal." See Attachment to March 2026 VA Form 10182.

On examination, the Veteran reported that one or two days a week he felt irritable or angry, during which times he yelled, screamed, and broke things. See June 2025 VA PTSD Examination Report. While impaired impulse control is associated with the 70 percent rating criteria, the Board finds that the overall occupational and social impairment shown does not rise to the level of deficiencies in most areas as contemplated by the 70 percent criteria. A January 2025 VA treatment record shows that the Veteran reported anger and irritability and that he stayed in his room because he was irritable, but that meaningful activities (e.g., social, recreational, etc.) were limited by mobility. Significantly, the record shows that throughout the rating period on appeal, the Veteran remained married, reported good relationships with his wife, children, and grandchildren, and reported friends with whom he had contact at least once a month, including friends from military service. See June  2025 VA PTSD Examination Report and October 2024 VA Treatment Record. A March 2025 VA treatment record shows that the Veteran was accompanied by his new friend. 

Concerning the Veteran's reported homicidal ideation and past suicidal ideation, which is contemplated by the 70 percent criteria, it is also notes that such symptoms are similar to persistent danger of hurting self or others, which is contemplated by the 100 percent criteria. Bankhead, 29 Vet. App. at 19. 

A November 2023 VA Form 27-0820, Report of Information, shows that the Veteran threatened death and/or mutilation (castration) to the individual who closed a claim after he missed a VA examination. A May 2024 VA treatment record shows that the Veteran confirmed a suicidal attempt while in service. VA treatment records show that the Veteran consistently denied current suicidal ideation, preparation, and plan, as well as previous suicidal ideation or attempt. See, e.g., January 2024 and October 2023 VA Treatment Records. October 2024 VA treatment records show that the Veteran stated that he was angry and homicidal and wanted to hurt somebody, but was not suicidal, and spoke at length about receiving a letter explaining who to call about compensation and pension. He initially expressed frustration with the VA system and anger about his current service connection rating. He said that he was being sarcastic when he stated that he was not suicidal but may be homicidal and repeated many times that he was not homicidal. The October 2024 VA treatment records also show that he was married for 58 years and was very close to his wife, children, and grandchildren. It was noted that he was calmer and friendlier toward the end of the call. See October 2024 VA Treatment Records.

Here, the Veteran both reported and denied a remote suicide attempt and consistently denied current suicidal ideation in existing treatment records and during the June 2025 VA examination. Further, the Veteran reported that his October 2024 statements were sarcastic, and he subsequently and repeatedly stated that
 service connection rating. He said that he was being sarcastic when he stated that he was not suicidal but may be homicidal and repeated many times that he was not homicidal. The October 2024 VA treatment records also show that he was married for 58 years and was very close to his wife, children, and grandchildren. It was noted that he was calmer and friendlier toward the end of the call. See October 2024 VA Treatment Records.

Here, the Veteran both reported and denied a remote suicide attempt and consistently denied current suicidal ideation in existing treatment records and during the June 2025 VA examination. Further, the Veteran reported that his October 2024 statements were sarcastic, and he subsequently and repeatedly stated that he was not homicidal. While the Veteran did not retract his November 2023 threat of death and castration, in this case, the Board finds that the severity, frequency, and duration of the Veteran's suicidal and homicidal ideation has not risen to the level contemplated by the 70 percent or 100 percent ratings.

Upon review of the record, the Board finds that the disability picture presented by the Veteran's insomnia disorder shown by the evidence as discussed above more closely approximates occupational and social impairment with reduced reliability and productivity as contemplated by the 50 percent rating criteria.

In sum, in consideration of the evidence as discussed above and resolving reasonable doubt regarding degree of disability in the Veteran's favor, the Board finds that the Veteran's insomnia disorder to warrant a separate 50 percent rating, but not higher, under DC 9422. The appeal is granted to this extent.

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JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Battaile

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.