Case A26040526

Summary

The Veteran, an Army Veteran who served from February 1995 to November 2000 and March 2004 to June 2005, appeals the denial of an earlier effective date for his 100 percent rating for PTSD. The Veteran was initially rated at 50 percent for PTSD, effective January 23, 2024, and later increased to 100 percent effective December 4, 2024. The Board found the Veteran continuously pursued the issue. The core of the appeal is determining when entitlement to the 100 percent rating arose, meaning when the Veteran's PTSD caused total occupational and social impairment. The July 2024 VA examination diagnosed PTSD and opined a 50 percent severity level, noting symptoms like hyper-vigilance, anger outbursts, and mild memory issues, but the Veteran maintained employment as a police officer and had generally adequate social interactions. The December 2024 VA examination, however, found total social and occupational impairment, with symptoms including neglect of hygiene, difficulty concentrating, memory issues, flattened affect, and suicidal ideation. The Board concluded that total occupational and social impairment was not demonstrated by the evidence prior to December 4, 2024, and therefore denied an earlier effective date. The Board found the evidence weighed against an earlier effective date, making the benefit-of-the-doubt rule inapplicable.

Rationale

Evidence did not demonstrate total occupational and social impairment before December 4, 2024.; July 2024 VA exam indicated symptoms consistent with 50% rating.; December 2024 VA exam indicated total impairment.

Full Decision Text

Citation Nr: A26040526
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 251021-592889
DATE: April 30, 2026

ORDER

Entitlement to an effective date earlier than December 4, 2024, for the 100 percent increased evaluation for posttraumatic stress disorder (PTSD), is denied.

FINDING OF FACT

The probative evidence of record demonstrates that the Veteran's PTSD did not manifest with total occupational and social impairment before December 4, 2024.

CONCLUSION OF LAW

The criteria for an effective date earlier than December 4, 2024, for the 100 percent rating for PTSD have not been met. 38 U.S.C. §§ 1155, 5101, 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.156, 3.160, 3.321, 3.340, 3.341, 3.400, 4.1, 4.2, 4.7, 4.130, Diagnostic code (DC) 9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from February 1995 to November 2000 and from March 2004 to June 2005 with additional inactive periods in the Army National Guard.

In the October 2025 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 agency of original jurisdiction (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 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.

Effective Date

Except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400.

As for the "date entitlement arose," there is no regulatory definition of the phrase. However, in Wright v. Gober, 10 Vet. App. 343 (1997), the phrase "date entitlement arose" was found to be similar to the phrase "facts found". The phrase "facts found" includes the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation." DeLisio v. Shinseki, 25 Vet. App. 45, 51 (2011). These cases, along with the regulatory context, strongly suggest that the "date entitlement arose" is the date on which the facts in the case demonstrate that the entitling criteria are first met.

To preserve an effective date, an intent to file may be submitted to VA. 38 C.F.R. § 3.155(b). If VA receives a complete application form prescribed by the Secretary, appropriate to the benefit sought, within one year of receipt of the intent to file, VA will consider the complete claim filed as of the date the intent to file was received. Id.

A claim for an effective date is not a freestanding claim, it is part of the underlying claim for increase. See Calhoun v. McDonough, 37 Vet. App. 96 (2024); Rudd v. Nicholson, 20 Vet. App. 296, 299 (2006).

An exception that may allow for an earlier effective date is continuous pursuit. Under the Appeals Modernization Act (AMA), the effective date for a continuously pursued claim shall be the date of receipt of the initial claim or date entitlement arose, whichever is later, if the claimant continuously pursued the issue by timely filing any of the available review options. 38 C.F.R. § 3.2500(c) and (h).

PTSD

The Veteran, through counsel, contends that he is entitled to an earlier effective date for his 100 percent rating for PTSD
 v. McDonough, 37 Vet. App. 96 (2024); Rudd v. Nicholson, 20 Vet. App. 296, 299 (2006).

An exception that may allow for an earlier effective date is continuous pursuit. Under the Appeals Modernization Act (AMA), the effective date for a continuously pursued claim shall be the date of receipt of the initial claim or date entitlement arose, whichever is later, if the claimant continuously pursued the issue by timely filing any of the available review options. 38 C.F.R. § 3.2500(c) and (h).

PTSD

The Veteran, through counsel, contends that he is entitled to an earlier effective date for his 100 percent rating for PTSD. See October 2025 Notice of Disagreement.

However, there is no basis upon which to grant an earlier effective date than December 4, 2024, for the 100 percent rating for the PTSD.

The Veteran was initially rated at 50 percent disabling for his PTSD, effective January 23, 2024, the date of his intent to file associated with the original claim for service connection and was increased to 100 percent disabling effective December 4, 2024.

First, the Board addresses whether there was continuous pursuit. Starting from the decision that is on appeal and working backwards, the April 2025 rating decision was of a December 2024 supplemental claim, which was a challenge of a November 2024 rating decision, the initial rating decision that granted service connection for the PTSD. The Board concludes that there was continuous pursuit.

Thus, the effective date is the later of the date of receipt of the initial claim (or in this case, the intent to file, January 23, 2024) or the date entitlement arose. Also, the period on appeal extends to include all evidence prior to the April 2025 rating decision.

Thus, the question is when entitlement arose, that is, when did the facts in the case demonstrate that the entitling criteria were met. Those entitling criteria, in this case, are when the evidence demonstrated that the Veteran's PTSD caused total occupational and social impairment.

In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss every piece of evidence submitted by the Veteran. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows with respect to the claim. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

In adjudicating these claims, the Board must assess the competence and credibility of the Veteran. Washington v. Nicholson, 19 Vet. App. 362 (2005). Lay testimony is competent to establish the presence of observable symptomatology. Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995). Reasonable doubt regarding the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

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); 38 C.F.R. § 4.126(a).

The list of symptoms under the rating criteria are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific evaluation. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). On the other hand, if the evidence shows that a veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Id. at 443
 v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013); 38 C.F.R. § 4.126(a).

The list of symptoms under the rating criteria are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific evaluation. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). On the other hand, if the evidence shows that a veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Id. at 443.

A 100 percent evaluation 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); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130.

There are no medical records between the January 2024 intent to file and the July 2024 VA examination relevant to PTSD.

The Veteran was provided a July 2024 VA examination at which examiner A.S. diagnosed PTSD and opined that the PTSD was at an overall severity of reduced reliability and productivity, characteristic of a 50 percent rating. A.S. noted symptoms of intrusions, marked reactivity in physiological arousal, avoidance and negative alterations in cognition and mood in the diagnostic comments. The Veteran reported being married to his current wife since 2005, with two children from the current marriage, and a daughter from the previous marriage. The Veteran reported being close to all his children but having some issues with his oldest daughter. The Veteran reported attending a co-worker's event, where he "blew up" and "yelled at somebody for doing something dumb, except it wasn't dumb. I was blowing it up out of proportion." The Veteran reported trouble making and keeping friends throughout adulthood. The Veteran reported hyper-vigilance, "I'm always on guard. If we go to church, go to movies. I can't let my guard down. I'm looking for the exits. It's tough." The Veteran reported doing well in school. The Veteran reported working as a police office for the last nineteen years. The Veteran reported a chronic history of taking days off from work because of his mental health symptoms. He stated, "I spend days where I can't do what I want to," and "I'll call out of work for days sometimes." He endorsed difficulty focusing, low motivation, fatigue, intrusions, and taking many breaks throughout his day. He socialized adequately at work but has lost his temper. His intrusions, physiological reactivity, and negative emotions caused him concentration problems and memory issues. He's made mistakes at work and jumped from task to task without completing one.

The Veteran reported a worsening of his psychiatric symptoms in 2002-2003, when he had a depressed mood with suicidal thoughts and not eating or sleeping. The Veteran reported getting a divorce from his first wife in 2002-2003 and reported trouble coping with his divorce at the time.

The Veteran described heightened psychological distress and physiological anxiety from internal and external cues that remind him of his trauma. He reported, "I was at one of the appointments before this and felt anxious all through my body." He noted "depressed mood," "feelings of anger," "I get angry for no reason," "difficulty getting out of bed," "I'd rather be asleep," "I don't have to talk to anybody," and loss of interest or pleasure in usual activities. He reported, "It's been so long, I don't know what good sleep is" and "I've learned to live with sleeping at 2 am and getting up at 7." The Veteran reported, "When I'm tired, it boils over," and "I get more depressed." The Veteran reported "I don't trust anyone" and described ruminating and having guilty feelings when he thinks about his oldest daughter and "our issues."

The examiner noted symptoms of anxiety, depression, suspiciousness, chronic sleep impairment, mild memory loss such as forgetting names, directions or recent events, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Behavioral observations were that the Veteran was alert and oriented, with an anxious mood. The Veteran presented with adequate eye contact and normal speech. The Veteran had fair insight and judgment with intact thought process. Mild memory issues were identified. The Veteran denied suicidal, homicidal or self-harm ideations and also denied any audio or visual hallucinations or delusions. The
 The Veteran reported "I don't trust anyone" and described ruminating and having guilty feelings when he thinks about his oldest daughter and "our issues."

The examiner noted symptoms of anxiety, depression, suspiciousness, chronic sleep impairment, mild memory loss such as forgetting names, directions or recent events, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Behavioral observations were that the Veteran was alert and oriented, with an anxious mood. The Veteran presented with adequate eye contact and normal speech. The Veteran had fair insight and judgment with intact thought process. Mild memory issues were identified. The Veteran denied suicidal, homicidal or self-harm ideations and also denied any audio or visual hallucinations or delusions. The Veteran denied any mental health hospitalizations.

The Veteran was provided a December 2024 VA examination at which examiner J.C. confirmed the diagnosis of PTSD and opined that the level of severity of the PTSD was now total social and occupational impairment. The Veteran reported missed workdays, late attendance, reduced performance, poor concentration, poor interpersonal function, with a history of confrontations with co-workers and supervisors and verbal and written reprimands. The Veteran reported neglecting nutrition and hygiene, difficulty retrieving information, difficulty sustaining attention and concentration, and forgetting to complete tasks. The Veteran reported flashbacks, apathy, exaggerated startle response, lack of empathy, nightmares, fatigue, intrusive thoughts, insomnia, anxiety social isolation, depression, suspiciousness, lack of motivation, hypervigilance, irritability with anger outbursts and decreased libido. The Veteran also reported hallucinations and morbid thoughts of death without plan or intent. Examiner J.C. noted symptoms of depressed mood, anxiety, suspiciousness, near continuous panic or depression, chronic sleep impairment, mild memory loss, impairment of short and long term memory while forgetting to complete tasks, flattened affect, impaired judgement, impaired abstract thinking, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, inability to establish and maintain effective relationships, suicidal ideation, impaired impulse control, such as unprovoked irritability with periods of violence, persistent delusions or hallucinations, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene.

In the five months between the two examinations, the Veteran had one treatment encounter for his PTSD. In an October 2024 telephone contact note the Veteran reported depression and anxiety "for many years" and endorsed mood swings. In the November 2024 VA Medical Center (VAMC) record the Veteran denied any active suicidal or homicidal ideation, formulated plan, or intent. The Veteran described being in touch with two friends from the Army and childhood friends he is still in touch with. He described having a good relationship with his family including his daughter from his first marriage. Behavioral observations included that his appearance was appropriate, eye contact and speech were normal, and his behavior was cooperative with a euthymic mood, and a logical and linear thought process. The Veteran's insight and judgment was adequate and his cognition and orientation normal.

Total occupational and social impairment was not shown by the evidence before December 2024.

The symptoms identified in the July 2024 VA examination are characteristic of a 50 percent evaluation or a 30 percent evaluation. Anxiety, depression, suspiciousness, chronic sleep impairment, and mild memory loss such as forgetting names, directions or recent events are all symptoms listed in the schedule as characteristic of a 30 percent evaluation at their typical duration, severity and frequency. Disturbances of motivation and mood, difficulty in understanding complex commands, forgetting to complete tasks, difficulty in establishing and maintaining relationships, these are all symptoms listed in the schedule for a 50 percent evaluation for occupational and social impairment with reduced reliability and productivity. Also, the July 2024 VA examiner opined that the degree of severity of the PTSD was occupational and social impairment with reduced reliability and productivity. While the opinion of this examiner is not binding on the Board, the opinion is given weight due to their training, expertise and thorough examination of the Veteran.

The Veteran has never been hospitalized for psychiatric reasons. While the Veteran did report suicidal ideation at the July 2024 VA examination, it was referenced as a history of suicidal ideation in 2002-2003 while getting a divorce from his first wife. The Veteran affirmatively denied current suicidal ideation at the July 2024 VA examination and at the November 2024 VAMC encounter. He did not report suicidal ideation until the December 2024 VA examination. The Veteran denied homicidal or self-harm ideations and also denied any audio or visual hallucinations or delusions. The Veteran has been gainfully employed as a police officer in the same job for the last nineteen years and married to the same woman since 200
 Veteran has never been hospitalized for psychiatric reasons. While the Veteran did report suicidal ideation at the July 2024 VA examination, it was referenced as a history of suicidal ideation in 2002-2003 while getting a divorce from his first wife. The Veteran affirmatively denied current suicidal ideation at the July 2024 VA examination and at the November 2024 VAMC encounter. He did not report suicidal ideation until the December 2024 VA examination. The Veteran denied homicidal or self-harm ideations and also denied any audio or visual hallucinations or delusions. The Veteran has been gainfully employed as a police officer in the same job for the last nineteen years and married to the same woman since 2005.

Behavioral observations of the Veteran at the July 2024 VA examination indicated that the Veteran presented with adequate eye contact and normal speech. The Veteran had fair insight and judgment with intact thought process. And in the November 2024 VAMC encounter behavioral observations indicate appearance was appropriate, eye contact and speech were normal, and his behavior was cooperative with a euthymic mood, and a logical and linear thought process. The Veteran's insight and judgment was adequate and his cognition and orientation normal.

Therefore, the answer to the question, when did entitlement arise, that is, when did the facts in the case demonstrate that the Veteran's PTSD caused total occupational and social impairment, is at the December 2024 VA examination. There is no evidence prior to this examination which shows that the Veteran suffered from total occupational and social impairment.

The probative evidence of record does not show that the Veteran suffered from total social and occupational impairment before December 4, 2024, and thus there is no basis for an earlier effective date for the 100 percent rating for PTSD.

In conclusion, the Board finds that the evidence of record persuasively weighs that an effective date before December 4, 2024, for the 100 percent evaluation for PTSD is not shown. As the evidence of record persuasively weighs against an effective date prior to December 4, 2024, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

 

 

JOHN Z. JONES

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Schneider, Joan K.

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.