Case A26040668

J. B. FREEMAN · 2026 · Case ID: A26040668

MIXED

Summary

The veteran, who served in the Army from June 2020 to January 2023, appeals the denial of service connection for headaches and bilateral arm joint pain, and the effective date for his PTSD award. The Board dismissed appeals related to lumbar spine disability and chronic bronchitis as duplicative, as these issues were addressed in a prior Board decision. The veteran's initial claim for PTSD was filed within one year of separation, and subsequent actions were found to constitute continuous pursuit of the claim. The Board reviewed the evidence, including service treatment records and VA treatment records, which indicated severe symptoms of anxiety, depression, chronic sleep impairment, nightmares, irritability, and passive suicidal ideation. Despite these severe symptoms, the Board found that the evidence did not demonstrate total occupational or social impairment, nor did it indicate an imminent danger to himself or others. The Board concluded that the Veteran's symptoms were consistent with a 70 percent disability rating for PTSD throughout the period on review, granting this rating. The claim for an earlier effective date for PTSD was denied as the earliest possible date had already been awarded. The Board remanded the claims for headaches and bilateral arm joint pain due to inadequate VA examinations and opinions, requiring new examinations to determine the nature and etiology of these conditions.

Service Branch

ARMY

Special Benefit

TDIU

Docket No.

250523-550274

Full Decision Text

Citation Nr: A26040668
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250523-550274
DATE: April 30, 2026

ORDER

Entitlement to a disability rating higher than 20 percent for spondylosis of the lumbar spine is dismissed.

Entitlement to service connection for chronic bronchitis (claimed as shortness of breath) is dismissed.

Entitlement to an effective date prior to January 4, 2023, for service connection for posttraumatic stress disorder with major depressive disorder and panic disorder (hereinafter, PTSD) is denied.

Entitlement to an initial disability rating of 70 percent, but no higher, prior to December 19, 2024, for PTSD is granted.

REMANDED

Entitlement to service connection for a headache disorder is remanded.

Entitlement to service connection for joint pain in the bilateral arms is remanded.

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

FINDINGS OF FACT

1. The appeal of the denial of a disability rating higher than 20 percent for lumbar strain and service connection for chronic bronchitis (claimed as shortness of breath) under the above-cited docket number is a duplicate appeal, as these issues were adjudicated in a separate appeal by a September 2025 Board decision under docket number 241024-485701.

2. The Veteran filed his claim for service connection for PTSD in June 2023, within one year of separating from service on January 3, 2023.

3. Prior to December 19, 2024, the Veteran's service-connected PTSD has caused social and occupational impairment with deficiencies in most areas, but not total impairment.

CONCLUSIONS OF LAW

1. The criteria for the dismissal of the appeal of entitlement to a disability rating higher than 20 percent for spondylosis of the lumbar spine and chronic bronchitis (claimed as shortness of breath) are met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for an effective date earlier than January 4, 2023, for service connection for PTSD are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.

3. The criteria to an initial disability rating of 70 percent, but no higher, prior to December 19, 2024, for PTSD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 2020 to January 2023.

This matter comes before the Board of Veterans' Appeals (Board) on an appeal from a December 2024 higher-level review decision following a November 2024 rating decision and from an April 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ).

The Veteran elected the Board's evidence submission docket. See VA Form 10182. This restricts the Board's review to the evidence of record at the time of the November 2024 and April 2025 rating decisions and evidence submitted with, or within 90 days of filing of, the Notice of Disagreement initiating appellate review. 38 C.F.R. § 20.303.

Procedural history

By way of background, the Veteran was discharged from the Army in January 2023. Within one year, he filed various claims for service connection, including claims for service connection for PTSD, headaches, shortness of breath, and disabilities of the bilateral arms and back. In February 2024, the AOJ issued a rating decision that granted service connection for chronic adjustment disorder with mixed disturbance of emotions and conduct from January 4, 2023, and denied service connection for PTSD, a back injury, headaches, joint pain in the bilateral arms, and shortness of breath.

Following the February 2024 rating decision, the Veteran filed a supplemental claim in May 2024 with respect to PTSD and the back and a request for higher-level review in July 2024 with respect to the back, headaches, arms, PTSD, and shortness of breath. In response to the May 2024 supplemental claim, the AOJ granted service connection for spondylosis, lumbar region from January 4, 2023, and denied service connection for
decision that granted service connection for chronic adjustment disorder with mixed disturbance of emotions and conduct from January 4, 2023, and denied service connection for PTSD, a back injury, headaches, joint pain in the bilateral arms, and shortness of breath.

Following the February 2024 rating decision, the Veteran filed a supplemental claim in May 2024 with respect to PTSD and the back and a request for higher-level review in July 2024 with respect to the back, headaches, arms, PTSD, and shortness of breath. In response to the May 2024 supplemental claim, the AOJ granted service connection for spondylosis, lumbar region from January 4, 2023, and denied service connection for PTSD in an August 2024 rating decision. In a separate August 2024 rating decision that responded to the higher-level review request, the AOJ denied service connection for headaches and shortness of breath but identified a duty-to-assist issue with respect to the arm issues. Subsequently, the AOJ performed additional development before issuing an October 2024 rating decision that again denied service connection for bilateral arm joint pain.

In October 2024, the Veteran submitted a Notice of Disagreement on the Board's direct review docket seeking to appeal various issues, including service connection for PTSD, the arms, headaches, and shortness of breath, and the disability evaluation for his back disability. On the same day, he submitted a supplemental claim form with respect to the PTSD, arms, headaches, and shortness of breath issues.

In November 2024, the AOJ issued another decision denying service connection for PTSD, headaches, and the arms. Following this decision, the Veteran requested higher-level review of the November 2024 rating decision in December 2024. Later that month, the AOJ issued a December 2024 rating decision denying service connection for the disabilities once more.

Later in December 2024, the Veteran submitted a fully development claim form seeking service connection for PTSD, among other disabilities, as well as evidence regarding the connection between his PTSD and service. In an April 2025 rating decision, the AOJ granted service connection for the PTSD claim, recharacterized the already-service connected chronic adjustment disorder with mixed disturbance of emotions and conduct as PTSD, and awarded a 70 percent disability rating from December 19, 2024.

In May 2025, the Veteran submitted the Notice of Disagreement that led to this appeal and selected the evidence submission docket. On the Veteran's Notice of Disagreement, he identified the issues on appeal as the disability evaluation and effective date for the award for PTSD, lumbosacral strain, and service connection for migraines, limitation of arm motion in his right and left arms, and chronic bronchitis.

With respect to PTSD, the date of decision on appeal was identified as "12/19/2024." No decision was issued on that date. In an April 2025 rating decision, however, the AOJ awarded service connection for PTSD, recharacterized his existing service-connected mental health disorder as PTSD, and awarded a 70 percent disability rating from December 19, 2024. The Board has thus liberally construed the Veteran's Notice of Disagreement as an appeal of the April 2025 rating decision to the extent that it awards service connection for PTSD and increases his disability evaluation for PTSD as of the date identified on the form. See 38 C.F.R. § 20.202(a).

With respect to the other issues listed on the Notice of Disagreement, the Veteran did not identify the date of any specific decisions with which he disagreed. At the time the Notice of Disagreement was submitted, however, the most recent relevant decisions were issued in December 2024 (migraines, left arm, and right arm), August 2024 (shortness of breath), and August 2024 (lumbar spine). The Board will thus assume that these are the rating decisions the Veteran intended to appeal with respect to these issues. See id. Although the Veteran appealed the issue of "chronic bronchitis," the AOJ had not issued any rating decisions that denying service connection for chronic bronchitis. However, the Board will interpret the claim for "chronic bronchitis" as encompassed within the claim for service connection for shortness of breath that was most recently denied in the August 2024 rating decision.

On the same day that the Veteran submitted his May 2025 Notice of Disagreement, he also submitted an application for a TDIU. See May 2025 VA Form 21-8940. He indicated on the form that various disabilities, including PTSD, had precluded him from securing and maintaining substantially gainful employment since February 2025. He resubmitted this form in June
bronchitis," the AOJ had not issued any rating decisions that denying service connection for chronic bronchitis. However, the Board will interpret the claim for "chronic bronchitis" as encompassed within the claim for service connection for shortness of breath that was most recently denied in the August 2024 rating decision.

In September 2025, the Board issued a decision that responded to the Notice of Disagreement the Veteran filed in October 2024 (as opposed to Notice of Disagreement he filed in May 2025). With respect to the lumbar spine issue, the Board interpreted the May 2025 Notice of Disagreement as an untimely request to modify the September 2025 Notice of Disagreement by choosing another Board docket that allowed evidence submission, which did not meet the requirements of 38 C.F.R. § 20.202(c)(2). The Board thus adjudicated the Veteran's appeal regarding the disability rating for his lumbar spine disability in its September 2025 decision under docket number 241024-485701, as he had not properly switched the docket on review to review for that issue to docket number 250523-550274 (the docket in the instant appeal).

Additionally, in its September 2025 decision, the Board found that the Veteran had submitted a supplemental claim application on the same day as his October 2024 Notice of Disagreement and that this supplemental claim listed various issues, including service connection for shortness of breath. The Board concluded that because the Veteran never withdrew his October 2024 Notice of Disagreement, the supplemental claim for shortness of breath was a prohibited concurrent election of review of the August 2024 rating decision under 38 C.F.R. § 3.2500. As a result, the Board addressed the shortness of breath issue in the September 2025 decision under docket 241024-485701, which remanded the issue for further development. At the same time, however, the Board explained that it would not be addressing the PTSD, headaches, or arm issues in the September 2025 decision because the AOJ had already readjudicated these issues and the Veteran had continuously pursued appeals via his May 2025 Notice of Disagreement instead.

In response to the Board's September 2025 remand, the AOJ performed additional development regarding the shortness of breath issue. In November 2025, the AOJ granted service connection for respiratory airway disease.

The Veteran attempted to change his representation in February 2026 by submission of a new VA Form 21-22 to appoint a different veterans service organization as his representative. The form was not co-signed by the organization. The AOJ send February 19 and 23, 2026 letters informing the Veteran that the form was not valid because it was not co-signed. 38 C.F.R. § 14.631. The Veteran has not responded with a properly executed form. The Board continues to recognize the representative appointed in a May 2024 VA Form 21-22.

Applicable evidentiary windows

The Board may only consider the evidence of record before the AOJ at the time of the decisions on the issues on appeal, as well as any evidence that is submitted by the Veteran or his representative with the Notice of Disagreement (VA Form 10182) or within 90 days following receipt of the Notice of Disagreement. 38 C.F.R. §§ 20.300(a), 20.303. If additional evidence was submitted between the dates of the AOJ decision and VA's receipt of the May 2025 Notice of Disagreement, the Board will not consider it unless it was resubmitted during the 90 days following VA's receipt of the Notice of Disagreement. If the evidence was not resubmitted, the Veteran is welcome to file a supplemental claim to have this evidence considered. Id.; Cook v. McDonough, 36 Vet. App. 175 (2023).

Scope of PTSD appeal

Given the confusion in the Veteran's pleadings, it is necessary to clarify the scope of the present appeal regarding PTSD. In the Veteran's Notice of Disagreement, he listed the areas of disagreement as the evaluation and effective date of his award for PTSD. It is unclear whether the Veteran is requesting an earlier effective date for his increased 70 percent rating for PTSD (essentially, a request for an increased disability rating throughout the period on review), or whether he is requesting an earlier effective date for entitlement to service connection for PTSD. Because the Veteran separately discussed both a higher rating and the effective date of his award on the Notice of Disagreement, the Board will address both the propriety of the assigned disability rating for PTSD throughout the period on review, as well as whether an earlier effective date is available for entitlement to service connection for PTSD. See 38 C.F.R. § 20.202(a).

Cervical spine

As a final matter, the Veteran's May 2025 Notice of Disagreement, he listed the issue of "lumbosacral or cervical strain" (emphasis added). However, the Veteran is not currently service connected for a cervical spine disability. To the extent he is seeking service connection for cervical strain in addition to a higher rating for his lumbar spine disability, this issue has not been explicitly addressed in any rating decision. A claimant has an appealable decision for a particular issue only if the decision gives explicit notice that the issue has been adjudicated and how it is being decided. See Hamill v. Collins, 166 F.4th 1030 (Fed. Cir. 2026). As a result, the cervical spine issue is not before the Board. The Veteran is encouraged to contact the AOJ or file a new claim to have this issue addressed in the first instance.

Dismissal

As set forth in the discussion of the procedural history above, the Veteran first appealed the issues of shortness of breath and the disability rating for his lumbar spine disability in a Notice of Disagreement received in October 2024. The Board addressed these issues in a September 2025 decision under docket number 241024-485701. For the reasons discussed bellowed, the instant appeal of these issues arising from the May 2025 Notice of Disagreement is a redundant appeal subject to dismissal. See 38 U.S.C. §§ 5104C, 7104(a); 38 C.F.R. §§ 3.2500(b), 20.202.

A rating decision is subject to one review on appeal by the Secretary. 38 U.S.C. § 7104(a). As a general matter, for that one review on appeal, a claimant may elect one of three review options within one year of the date the AOJ issues a decision, as follows: (i) higher-level review by the AOJ; (ii) a supplemental claim, or (iii) an appeal to the Board. 38 U.S.C. § 5104C(a)(1). If a request for review under one of these three lanes is pending final adjudication, the claimant may not file a request for review under a different option without first withdrawing the pending review request. 38 U.S.C. § 5104(a)(2)(A); 38 C.F.R. §§ 3.2500(b), 20.205.

As discussed above, the Board addressed the Veteran's appeals regarding August 2024 rating decisions on shortness of breath and the rating for his lumbar spine disability in its September 2025 decision under docket number 241024-485701. In that decision, the Board determined that the Veteran's May 2025 Notice of Disagreement had been an untimely attempt to have the lumbar spine disability rating issue addressed on the Board's Evidence Submission docket and that the issue would be addressed on the Direct Review docket instead. Additionally, in that decision the Board determined that because the Veteran's appeal for the shortness of breath issue was still pending under docket number 241024-485701, the supplemental claim he filed with respect to shortness of breath in October 2024 was an impermissible concurrent election of review options. To reiterate, this is impermissible because simultaneous review of the same decision under different review options is prohibited under 38 C.F.R. § 3.2500(b).

Ultimately, although the Veteran listed the lumbar spine disability rating issue and chronic bron
imely attempt to have the lumbar spine disability rating issue addressed on the Board's Evidence Submission docket and that the issue would be addressed on the Direct Review docket instead. Additionally, in that decision the Board determined that because the Veteran's appeal for the shortness of breath issue was still pending under docket number 241024-485701, the supplemental claim he filed with respect to shortness of breath in October 2024 was an impermissible concurrent election of review options. To reiterate, this is impermissible because simultaneous review of the same decision under different review options is prohibited under 38 C.F.R. § 3.2500(b).

Ultimately, although the Veteran listed the lumbar spine disability rating issue and chronic bronchitis (which is encompassed within the claim for shortness of breath) on the most recent Notice of Disagreement that he submitted in May 2025, these issues were already addressed by the Board in a decision issued under docket number 241024-485701. Therefore, the instant appeal of the August 2024 rating decisions on these issues is a duplicate appeal that must be dismissed. 38 U.S.C. § 7105.

Stated differently, this decision dismisses only the instant, now duplicative, appeal stream at the Board. To be clear, this dismissal is not prejudicial to the Veteran because the Board already addressed the issues of entitlement to a higher disability rating for the lumbar spine and entitlement to service connection for a respiratory disability in a September 2025 decision in connection with the Veteran's one appeal of right of the relevant August 2024 rating decisions under 38 U.S.C. § 7104. Additionally, with respect to the respiratory disability, the AOJ has granted service connection for respiratory airway disease. As a result, no case or controversy over these issues remains.

Increased Rating

Prior to December 19, 2024, the Veteran's disability rating for PTSD was 50 percent. Thereafter, the AOJ increased his disability rating to 70 percent. The Veteran asserts that he is entitled to a higher initial disability rating for PTSD. The Board has interpreted to mean that he is also requesting a higher disability rating for PTSD prior to December 19, 2024.

Continuous pursuit

Before determining whether an effective date prior to December 19, 2024, may be warranted for the 70 percent PTSD evaluation, the Board must first determine whether the Veteran continuously pursued his claim for service connection for PTSD. If he has continuously pursued the claim since initially filing his service connection claim within one year of separation from service, then it would be possible for him to receive a higher initial disability rating for his service-connected mental health condition, effective as far back as January 4, 2023. See 38 C.F.R. § 3.400(o).

Continuous pursuit is achieved by timely filing a supplemental claim, requesting higher-level review, or appealing to the Board following notice of an initial claim or a supplemental claim. 38 C.F.R. § 3.2500(d). After the Veteran initially filed a claim for service connection for PTSD in June 2023, he filed a timely supplemental claim to appeal a February 2024 rating decision, which resulted in an August 2024 rating decision. He filed an October 2024 supplemental claim to appeal this rating decision, which resulted in a November 2024 rating decision that was subject to higher-level review in December 2024. After this decision was issued, however, the Veteran filed a VA Form 21-526EZ requesting service connection for PTSD rather than the proscribed supplemental claim form.

While a supplemental claim must be filed on a form prescribed by the Secretary, it does not need to be filed on the designated supplemental claim form. Chisholm v. Collins, 38 Vet. App. 140 (2025). Here, the Board finds that although he did not file a supplemental claim on the designated supplemental claim form, the Veteran's December 2024 VA Form 21-526EZ nonetheless constitutes a supplemental claim that was timely filed after the December 2024 rating decision that denied service connection for PTSD.

In this regard, the Veteran's December 2024 VA Form 21-526EZ was filed less than a month after the December 2024 rating decision. Additionally, new and relevant evidence was added to the record with the VA Form 21-526EZ. More specifically, on the same day as submitting the claim, the Veteran submitted a letter from his treating doctor confirming his PTSD diagnosis. As a result, the Veteran's VA Form 21-526EZ meets the criteria of a supplemental claim with respect to service connection for PTSD, and he continuously pursued his initial service connection claim since filing his initial claim in June 2023. Thereafter, the AOJ awarded service connection in the April 202
denied service connection for PTSD.

As a result, the Veteran has continuously pursued service connection for PTSD since June 2023, hence the Board may consider whether it is possible to award a 70 percent rating for PTSD as far back as January 4, 2023, the day after the Veteran separated from service.

Applicable law

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14.

Where, as here, entitlement to service connection 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, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

The Veteran's PTSD disorder is rated under diagnostic code 9411 under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130.

Under the General Rating Formula, a 50 percent disability rating is warranted where the disorder is manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms 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; difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent disability rating is warranted where the disorder is manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech that is 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. Id.

A 100 percent disability rating is warranted when there is a total occupational and social impairment, due to such symptoms as 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 and place; memory loss for names of close relatives, own occupation, or own name. Id.

A veteran "may only qualify
, 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. Id.

A veteran "may only qualify for a given disability rating under section 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Symptoms listed in the General Rating Formula serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. They are not intended to constitute an exhaustive list. Mauerhan v. Principi, 16 Vet. App. 436, 442-44 (2002).

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 each piece of evidence submitted by the appellant or on his behalf. See Gonzales v. West, 218 F.3d 1378 (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, or fails to show, with respect to the claim. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000).

Evidence

Here, the evidence indicates that shortly before he was discharged from service, the Veteran was seen at the Army's behavioral health clinic in Baumholder, Germany, for worsening anxiety symptoms, depression, and suicidal ideation.

On an October 2022 separation examination, for instance, he reported that he had panic attacks very frequently and that they were so bad that he would start hyperventilating and throwing up. Additionally, in October 2022 he was found to be at an increased risk for harming himself and others due to suicidal thoughts, suicidal and homicidal threats, and other behaviors. At that time, he was brought to the emergency room by his unit after saying, "I am going to shoot up you all and make more money." He also told military police that he wanted to kill himself. The Veteran reported to emergency room personnel that he had experienced passive suicidal ideation since joining the Army and that he had a current plan to cut himself. He also reported that he attempted suicide the week prior by cutting himself. Although scratches were present on his wrist, they were superficial.

In November 2022, he was found to be at an intermediate risk for suicide based on current suicidal or homicidal thoughts of moderate to high frequency and duration, although he did not appear to be at imminent risk of suicide based on protective factors. Nonetheless, he continued to report mild passive suicidal ideation, depression, and anxiety prior to being discharged on January 3, 2023.

After discharge, the Veteran received mental health treatment through VA facilities in Atlanta and in Texas. Soon after being discharged, he reported that he wished he were dead or that he could go to sleep and not wake up, that he had actual thoughts of killing himself, that he intended to act on those thoughts, and that he had taken steps to end his life. See, e.g., June 6, 2023, VA Treatment Note. For example, he reported that in May 2023, he put a gun to his head but decided not to shoot it and put it in storage instead. Id. The clinical impression at that time was that the acute risk of suicide was high due to untreated depression, suicidal thoughts, and chronic hopelessness, although several protective factors were noted such as responsibilities to his wife and unborn child. A high risk for suicide flag was placed in his health records due to his recent suicidal gestures, mental health concerns, and recent military discharge. See June 14, 2023, VA Treatment Record.

After the Veteran moved from Atlanta to Texas in summer of 2023, VA treatment providers found that he remained at a high risk for suicide. See, e.g., September 12, 2023, VA Treatment Record; August 8, 2023, VA
and put it in storage instead. Id. The clinical impression at that time was that the acute risk of suicide was high due to untreated depression, suicidal thoughts, and chronic hopelessness, although several protective factors were noted such as responsibilities to his wife and unborn child. A high risk for suicide flag was placed in his health records due to his recent suicidal gestures, mental health concerns, and recent military discharge. See June 14, 2023, VA Treatment Record.

After the Veteran moved from Atlanta to Texas in summer of 2023, VA treatment providers found that he remained at a high risk for suicide. See, e.g., September 12, 2023, VA Treatment Record; August 8, 2023, VA Treatment Record. In August 2023, he reported a depressed mood, decreased sleep, decreased appetite, feelings of hopelessness and worthlessness, and passive suicidal thoughts. He was prescribed medication. See August 9, 2023, VA Treatment Records. In September 2023, he reported that although his symptoms had somewhat improved, he still occasionally experienced suicidal ideation. See September 22, 2023, VA Treatment Record.

In October 2023, the Veteran reported that his medication was not working and that his depression symptoms were worsening. See October 23, 2023, VA Treatment Record. During an October 2023 VA examination, he reported that he did not have any friends and that he rarely socialized. See October VA 2023 VA Examination. The VA examiner noted symptoms including a depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, and difficulty in establishing and maintaining work and social relationships but did not make any notes regarding the Veteran's suicidal ideation.

The Veteran again reported thoughts of wishing to be dead less than a week after his VA examination, as well as active thoughts of driving his car into something; his acute and chronic risk of suicide were noted to be intermediate, although protective factors such as meaningful family relationships and child-related responsibilities were also present. See October 31, 2023, VA Treatment Record.

During a November 2023 mental health appointment, he again reported that his medications were not improving his symptoms and that he felt jittery, unenergetic, unable to sleep, unable to focus, and intermittently suicidal. He reported that he often had suicidal thoughts while driving and that he worked as a pizza delivery driver. He also reported a daily baseline level of anxiety that was exacerbated by being around other people. His treatment provider noted that the Veteran's chronic risk of suicide was intermediate, as his risk factors were offset by protective factors, coping skills, reasons for living, and relative psychosocial stability suggesting an ability to endure future crisis without resorting to self-directed violence or suicide. See November 1, 2023, VA Treatment Record. Later that month, the Veteran reported that he had an anxiety attack so severe that he could not breathe and threw up, and that he would often "get so furious and lose [his] sanity" when he was stressed. See November 22, 2023, VA Treatment Record.

At the end of November, he reported that he had engaged in suicide-related behavior within the last three days and endorsed thoughts of cutting himself. His chronic risk for suicide was found to be high, based on factors such as his history of two suicide attempts in the past two years, depression, and anxiety, although his acute risk was low, evidenced by protective factors such as the absence of active suicidal plans or intent, future-oriented goals, history of seeking helping, and a supportive spouse. See November 27, 2023, VA Treatment Record. On a suicide related coping scale questionnaire, the Veteran scored low, indicating poor coping skills. For instance, the Veteran somewhat disagreed that he had places he could go to help take his mind off his problems when feeling suicidal, knew that it was important to limit access to weapons or other ways to hurt himself when suicidal, and that he can distract himself by doing other things when he is feeling suicidal. He strongly agreed with the statement that it was useless to talk to anyone about his suicidal thoughts. Id.

In December 2023, the Veteran reported that he was struggling to reintegrate to civilian society, which made him feel depressed and anxious. See December 4, 2023, VA Treatment Record. Later that month, he again reported passive suicidal ideation. See December 11, 2023, VA Treatment Record. During a mental health appointment with a new VA provider, the Veteran reported that he found it hard to adjust to civilian life and that his overall mood was depressed. He also indicated that he felt anxious, had nightmares and flashbacks about once a week, and avoided places and people that reminded him of his past. Additionally, he endorsed passive thoughts of wanting to die every other day. See December
suicidal thoughts. Id.

In January 2024, the Veteran's wife gave birth to his first child. The day after he was born, he attended another VA examination. During that VA examination, he reported that he had no hobbies and did not socialize with anyone except for his wife. The VA examiner noted decreased motivation and passive suicidal ideation, as well as a depressed mood, suspiciousness, anxiety, panic attacks more than once a week, chronic sleep impairment, mild memory loss, impaired judgment, disturbances in motivation or mood, and difficulty in establishing and maintaining effective work relationships.

During a later January 2024 VA mental health appointment, he reported that he had nonspecific suicidal thoughts that were a 7/10 in intensity since his last appointment. On a scale from 0 to 10, with 10 being completely hopeless, he rated his average level of intensity of feelings of hopelessness to be a 9, on average. His treatment provider noted that he was still at a high chronic risk for suicide. See January 22, 2024, VA Treatment Record. A week later, he reported that he had experienced some thoughts about "wanting to die due to issues with the military and his wife giving birth." However, his treatment provider noted that the Veteran did not appear to be imminent danger of harming himself or others at the time and that his risk level was low. See January 29, 2024, VA Treatment Record.

In a separate treatment note, the Veteran reported that over the past two weeks, he felt little interest or pleasure nearly every day, felt down, hopeless, or depressed more than half the days, had trouble sleeping more than half the days, felt tired or low energy nearly every day, had a poor appetite or average more than half the days, felt feelings of failure or guilt more than half the days, had trouble concentrating nearly every day, and had thoughts that he would be better off dead or of hurting himself on several days, indicative of moderately severe symptoms of depression. See January 30, 2024, VA Treatment Record.

In May 2024, the Veteran's status was reviewed, and he was determined to show a clinical reduction of suicide risk, which meant he was no longer classified as a high acute risk. See May 6, 2024, VA Treatment Record. Less than a month later, however, the Veteran reported that his insomnia was worsening, that he was having night terrors again, and that he was having "overwhelming moments of depression and anxiety" at least three times a week and vivid dreams of hurting himself. See May 29, 2024, VA Treatment Record.

During a June 2024 appointment, he again reported having nightmares about hurting himself and increased anger and irritability. See June 6, 2026, VA Treatment Record. He attended a VA examination a few days later. During that examination, the VA examiner noted symptoms including depressed mood, anxiety, chronic sleep impairment, panic attacks more than once a week, disturbances in mood or motivation, difficulty in establishing and maintaining effective work and social relationships, and suicidal ideation. He endorsed passive suicidal ideation, and his mood was anxious and depressed.

At the end of June 2024, the Veteran reported ongoing issues with sleeping and anger. See June 27, 2024, VA Treatment Record. In July 2024, he began attending an anger management group. See July 11, 2024, VA Treatment Record. In August 2024, however, he reported that he would have random bursts of anger and that he did not feel empathy for others. He also reported high anxiety that caused him to go mute, as well as passive suicidal ideation and thoughts of wanting to die. See August 5, 2024, VA Treatment Record. His treatment provider noted the Veteran denied thoughts of harming himself or others when asked directly, and that he did not appear to be in imminent danger of hurting himself or others, meaning his risk level was low. Id.

About two weeks later, the Veteran reported that there had been a "deterioration"
he began attending an anger management group. See July 11, 2024, VA Treatment Record. In August 2024, however, he reported that he would have random bursts of anger and that he did not feel empathy for others. He also reported high anxiety that caused him to go mute, as well as passive suicidal ideation and thoughts of wanting to die. See August 5, 2024, VA Treatment Record. His treatment provider noted the Veteran denied thoughts of harming himself or others when asked directly, and that he did not appear to be in imminent danger of hurting himself or others, meaning his risk level was low. Id.

About two weeks later, the Veteran reported that there had been a "deterioration" of his mental health, and that over the past several days he had thought about killing himself by cutting his wrists. He indicated in a questionnaire that over the past month, he had thoughts about killing himself, had thought about how he might do it, had some intention of acting on those thoughts, and had started to work out the details of how to kill himself. The Veteran described worsening symptoms of depression and irritability. Although he at one point expressed openness to the idea of admitting himself to the hospital for inpatient treatment, he then refused do so because he said that it would make him more suicidal and depressed. See August 19, 2024, VA Treatment Record. His treatment providers noted that he had a history of non-suicidal self-directed violence and passive suicidal ideations, but also noted protective factors and reasons for living, which gave rise to a clinical impression of an intermediate acute risk and low chronic risk of suicide. Id. The Veteran's wife also indicated that she was not concerned about him hurting himself. Id.

In December 2024, the Veteran submitted a letter from Dr. A.K., his VA treatment provider. Dr. A.K. indicated that the Veteran was being treated for PTSD, major depressive disorder, and panic disorder, and that even with treatment and medication, he continued to have ongoing symptoms secondary to these disorders. His disorders were triggered and modulated by stress due to the physical demands of his job, and that he experiences daytime fatigue and emotional lability. As a result, his provider indicated that he had a poor ability to adapt to changes in his environment or routine, irritability, argumentativeness, fatigue, and a poor working memory that affected both his relationships at home and his work performance.

At the end of December 2024, the Veteran stated to a treatment provider that if it were not for his wife or son, he would have killed himself and that he could barely work because of his physical and mental health issues. See December 30, 2024, VA Treatment Record. He also reported that he felt more depressed, was less in control, and had more outbursts over the past month or two. See December 31, 2024, VA Treatment Record. His treatment provider noted that the Veteran denied being in acute crisis and denied thoughts of harming himself or others when asked directly, which meant there was no imminent danger of harm to himself or others. Id.

The Veteran was afforded another VA examination in January 2025. At that examination, his VA examiner diagnosed PTSD, major depressive disorder, and a panic disorder and indicated that it was not possible to differentiate what symptoms were attributable to which disorder or what level of impairment was attributable to each diagnosis. The Veteran indicated that his marriage had become "rocky" and that he did not have a social life, but that he was not thinking about divorce or separating; he also said that his distrust and angry outbursts made it hard for him to be socialize. He reported having problems at work due to anger and irritability. The VA examiner noted symptoms including a depressed mood, anxiety, suspiciousness, panic attacks more than once a week, near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, chronic sleep impairment, mild memory loss, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, and suicidal ideation.

In February 2025, the Veteran was terminated from his job and reported difficulty with his PTSD symptoms. He also discussed passive thoughts of suicide. See February 18, 2025, VA Treatment Record. In March 2025, he reported that he was beginning to have suicidal thoughts again and that he was having vivid dreams because of depression and frustration. See March 26, 2025, VA Treatment Record.

Analysis

The Board has carefully considered the evidence in the record and concludes that a disability rating of 70 percent, but no higher, is warranted for PTSD from January 4, 2023. To that end, the evidence consistently and repeatedly demonstrates that the Veteran's mental health symptoms are consistent with a 70 percent rating throughout the period on review.

For instance, both
job and reported difficulty with his PTSD symptoms. He also discussed passive thoughts of suicide. See February 18, 2025, VA Treatment Record. In March 2025, he reported that he was beginning to have suicidal thoughts again and that he was having vivid dreams because of depression and frustration. See March 26, 2025, VA Treatment Record.

Analysis

For instance, both the Veteran's service treatment records from the months immediately prior to separating from service and his VA treatment records following separation reflect that he has frequently struggled with debilitating anxiety attacks, feelings of depression and hopelessness, chronic sleep impairment, nightmares, angry outbursts, responding to stressful situations, and establishing and maintaining effective work and social relationships. Additionally, the Veteran has reported that he does not socialize with anyone besides his wife, which reflects deficiencies in his ability to establish or maintaining relationships. Moreover, relevant service treatment and post-service records indicate that he has frequently experienced passive suicidal ideation and dreams of hurting himself during the relevant timeframe, which further detracts from his ability to adapt to stressful circumstances. The severity, frequency, and duration of his passive suicidal ideation and other symptoms are consistent with occupational and social impairment in most areas. See Bankhead v. Shulkin, 29 Vet. App. 10 (2017); see also Vazquez-Claudio, 713 F.3d 112.

However, the evidence before the Board does not suggest that the Veteran has been unable to establish and maintain work or social relationships altogether due to his service-connected mental health issues. This is evident based on his relationships he has maintained with his wife and son. Although Dr. A.K. indicated in her December 2024 letter that certain accommodations would be necessary with respect to his employment due to his difficulty adapting to stressful situations, she did not indicate that the Veteran was totally occupationally impaired due to his PTSD.

Further, the post-service evidence that is before the Board predominantly indicates that the Veteran has behaved appropriately and has been oriented to all spheres without homicidal thoughts, hallucinations, or delusions. Despite his self-reported angry outbursts and irritability, VA examiners and treatment providers found that he was at a low risk for violence to others. See, e.g., January 2025 VA Examination; August 19, 2024, VA Treatment Record; September 20, 2023, VA Treatment Record. Likewise, although the record indicates that the Veteran made violent threats towards other servicemembers in his unit in October 2022, he has otherwise consistently denied homicidal ideation or wanting to harm others, indicating that this is not typically a manifestation of his psychiatric disorders.

Although the Veteran has experienced frequent passive suicidal ideation, the intensity of his suicidal ideation is not severe enough to be considered total impairment. Indeed, his treatment providers have routinely noted that despite an intermittently elevated acute and chronic risk for suicide, there are various protective factors in place that mitigate his risk for suicide as well. These factors include the Veteran's ability to maintain safety plans and engage with his treatment providers, and having a significant other, responsibilities to others, including his son, a strong desire to live, and future plans and goals. See, e.g., November 27, 2023, VA Treatment Record; October 31, 2023, VA Treatment Record; June 6, 2023, VA Treatment Record.

Furthermore, although he was at times encouraged by providers to consider seeking inpatient psychiatric treatment, the Veteran's treatment providers did not find that he needed to be involuntarily admitted for inpatient treatment because he was a danger to himself or others. Likewise, he has consistently denied that he was in acute crisis or had any active suicidal intent. These statements are exceptionally trustworthy, as they were made for the purpose of medical treatment. White v. Illinois, 502 U.S. 346, 356 (1992). Although the Veteran reported taking steps to act on suicidal ideation in October 2022, May 2023, and August 2024, such as by making superficial cuts to his arms or putting a gun to his head, he ultimately did not act on these thoughts and took steps to mitigate these thoughts, such as by locking his gun in a safe and seeking medical treatment. This reflects that, despite the frequency of his symptoms of suicidal ideation, these symptoms did not ultimately rise to the level of severity contemplated by the rating criteria for total impairment.

Essentially, the record indicates that, throughout the review period, although the symptoms attributable to
treatment. White v. Illinois, 502 U.S. 346, 356 (1992). Although the Veteran reported taking steps to act on suicidal ideation in October 2022, May 2023, and August 2024, such as by making superficial cuts to his arms or putting a gun to his head, he ultimately did not act on these thoughts and took steps to mitigate these thoughts, such as by locking his gun in a safe and seeking medical treatment. This reflects that, despite the frequency of his symptoms of suicidal ideation, these symptoms did not ultimately rise to the level of severity contemplated by the rating criteria for total impairment.

Essentially, the record indicates that, throughout the review period, although the symptoms attributable to his service-connected mental health disorders were severe, they were not typically intense enough to warrant concern for safety for himself or others. See, e.g., June 6, 2023, VA Treatment Record; November 2022 Service Treatment Record. Stated differently, his symptoms of suicidal ideation did not occur with the severity, frequency, and duration that would warrant a total rating.

Ultimately, the Board finds that the Veteran exhibited occupational and social impairment with deficiencies in most areas, consistent with a 70 percent disability rating. Although his mental health symptoms were severe, these difficulties are reflected by the 70 percent evaluation. Notwithstanding his mental health symptoms, the Veteran has remained married. The Veteran's mood has been congruent with his affect during his mental health appointments and VA examinations, where he was oriented to all spheres. Notably, there is a lack of other indicia of total and social impairment as reflected by the criteria listed above.

As a result, the severity, frequency, and duration of the Veteran's service-connected PTSD is more consistent with a 70 percent rating throughout the period on review, rather than a total disability rating.

Effective Date

The Veteran has also asserted, without submitting any specific argument, that his award for service connection for PTSD should be earlier. See May 2025 VA Form 10182.

Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increased compensation will be the date of receipt of the claim or the date entitlement arose, whichever is the later.? 38?U.S.C. §?5110; 38?C.F.R. §?3.400. If a claim for disability compensation is received within one year after separation from service, the effective date of entitlement is the day following separation. 38?C.F.R. §?3.400(b)(2). Otherwise, it is the date of receipt of the claim or the date entitlement arose, whichever is later. 38?C.F.R. §?3.400.

Here, the Veteran submitted his initial claim for service connection for PTSD in June 2023, within one year of being discharged from service in January 2023. In the April 2025 rating decision on appeal, the AOJ recharacterized the mental health issue for which service connection had already been awarded as PTSD. Notably, this service connection award is effective from January 4, 2023 (i.e., the day following separation). As a result, the earliest possible effective date for PTSD has already been awarded, and no earlier effective date is available. The claim for an earlier effective date for service connection for PTSD is thus denied as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

REASONS FOR REMAND

1. Headaches and bilateral arms

The Veteran has asserted that he is entitled to service connection for headaches and joint pain in his bilateral arms. Although the Board has carefully considered the evidence in the record, remand is necessary to cure duty to assist errors that took place prior to the rating decision on appeal.

In this regard, VA has duties to assist claimants in substantiating their claims, including obtaining VA examinations and medical opinions. 38 C.F.R. § 3.159(c). Here, the Veteran underwent VA examinations for headaches and the arms in September 2024 and January 2024.

In the January 2024 VA examinations, the Veteran reported that he had headache symptoms that began during service after ruck marching and after being hit in the head after a car accident. The Veteran reported headache pain as well as symptoms such as sensitivity to light, which caused functional limitations such as difficulty concentrating, using a computer, and interacting with family, friends, coworkers, and customers. The January 2024 VA examiner found that the Veteran's symptoms were subjective only and that he had not yet been clinically diagnosed with a headache condition. However, this examination report is inadequate, as a clinical diagnosis is not required where there are symptoms of a disability and functional
VA examinations for headaches and the arms in September 2024 and January 2024.

In the January 2024 VA examinations, the Veteran reported that he had headache symptoms that began during service after ruck marching and after being hit in the head after a car accident. The Veteran reported headache pain as well as symptoms such as sensitivity to light, which caused functional limitations such as difficulty concentrating, using a computer, and interacting with family, friends, coworkers, and customers. The January 2024 VA examiner found that the Veteran's symptoms were subjective only and that he had not yet been clinically diagnosed with a headache condition. However, this examination report is inadequate, as a clinical diagnosis is not required where there are symptoms of a disability and functional limitations. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Further, the VA examiner failed to provide etiology opinions regarding the relationship between the Veteran's headache symptoms and service.

Similarly, the January 2024 VA examiner found that the Veteran had no current arm disabilities, despite his reports of aching shoulder pain. However, the VA examiner's finding is inconsistent with the Veteran's August 2024 VA treatment records, which indicate that sometimes the Veteran experiences weakness and numbness in his hands. Moreover, the January 2024 VA examination is at odds with the Veteran's September 2024 VA examination, which reflects a diagnosis of right shoulder strain. Confusingly, the September 2024 VA examiner stated that the Veteran's right shoulder condition was unrelated to his reported arm pain but did not explain why.

When VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). If an examination report is inadequate or does not contain sufficient detail, the Board is required to return the report in a remand. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001). In the interest of assembling clear and reliable findings, remand is necessary to obtain new VA examinations and opinions regarding the nature and etiology of the Veteran's claimed headache and bilateral arm disabilities. See 38 C.F.R. § 20.802(a).

2. TDIU

As discussed in the procedural history above, the Veteran has submitted a TDIU claim while this matter has been pending. For instance, in June 2025 he submitted a copy of a VA Form 21-8940 that was first submitted in May 2025, which indicated that he was unable to secure and maintain substantially gainful employment as a result of multiple disabilities, including PTSD. As a result, the issue of entitlement to a TDIU has been explicitly raised while this appeal has been pending. Rice v. Shinseki, 22 Vet. App. 447, 453-55 (2009).

At this juncture, however, the Board cannot adjudicate the merits of entitlement to a TDIU, as it is inextricably intertwined with another issue being remanded. To that end, the Veteran has also indicated that he experiences headaches that impair his ability to perform tasks like concentrating, working on a computer, and interacting with coworkers. See January 2024 VA Examination. This raises the possibility that the Veteran's headaches could contribute to his claimed inability to secure or maintain substantially gainful employment. Entitlement to a TDIU may be affected by the potential grant of service connection sought for migraines, as well as the assignment of any potential disability ratings. Because the Board is remanding the claim for entitlement to service connection for a headache disorder, adjudication of the TDIU issue should thus be deferred until the headaches issue is readjudicated. Smith v. Gober, 236 F.3d 1370 (Fed. Cir. 2001); Harris v. Derwinski, 980 F.2d 37 (Fed. Cir. 1990).

The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file.

Accordingly, the matters are REMANDED for the following action:

Schedule new VA examinations with respect to the Veteran's claimed headache and bilateral arm disabilities. The Veteran's claims folder must be made available to the examiner. All diagnostic testing deemed necessary by the examiner should be accomplished.

Based on a review of the record, the examiner is asked to do the following:

(a.) Determine whether the Veteran has headache disorder. The examiner is reminded that symptoms that result in functional limitation can constitute a disability, even absent a formal diagnosis.

(b.) Determine whether the Veteran has a disability related to symptoms of pain, weakness, and numbness in his bilateral arms and hands. The examiner is reminded that symptoms that result in functional
of any statements on file.

Accordingly, the matters are REMANDED for the following action:

Based on a review of the record, the examiner is asked to do the following:

(a.) Determine whether the Veteran has headache disorder. The examiner is reminded that symptoms that result in functional limitation can constitute a disability, even absent a formal diagnosis.

(c.) For each identified disability, opine as to whether it had its onset during or is otherwise related to service.

The examiner must provide a detailed rationale for all opinions expressed, including citations to any medical and/or scientific research relied upon, and must explain how the evidence supports the conclusions in the context of the Veteran's individual medical history and lay statements.

J. B. FREEMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board E. Rademacher, 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.

Analyze in VA Law Explorer