POSTTRAUMATIC STRESS DISORDER (PTSD)

L. B. CRYAN · 2026 · Case ID: A26040708

DENIED

Summary

The Veteran, who served from October 1969 to October 1971, appeals the denial of an increased rating for his service-connected Posttraumatic Stress Disorder (PTSD), seeking a rating higher than the current 50 percent. The Board reviewed the evidence of record at the time of the January 2024 rating decision, which included a March 2026 Notice of Disagreement and a VA examination from April 2023, along with VA treatment records. The Veteran attended group therapy, was not on psychotropic medication, had no inpatient admissions, maintained strong family ties, and was employed in housekeeping with a planned retirement. The VA examiner found his symptoms approximated the criteria for a 30 percent rating, noting fair judgment and insight, and no suicidal ideation or psychosis. Treatment records showed symptoms consistent with 30-50 percent ratings, including nightmares, hypervigilance, and anxiety, but generally without suicidal ideation with plan or intent. The Board found the Veteran's symptoms more closely approximated the criteria for a 50 percent rating, citing his ability to maintain family relationships and employment, and lack of severe impairment in most areas. While acknowledging some memory deficits and mood disturbances, the Board concluded these did not meet the criteria for a 70 percent rating, which requires deficiencies in most areas and inability to function independently. The Board found the Veteran's arguments regarding suicidal ideation and interpersonal relationship issues unpersuasive, deeming a remand for further examination wasteful. Ultimately, the Board determined the evidence persuasively weighed against a higher rating, denying the appeal.

Rationale

Symptoms approximated criteria for 30-50% rating.; No severe impairment in most areas (70% criteria).; Maintained family ties and employment.; Judgment and insight were fair.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260331-642470

Full Decision Text

Citation Nr: A26040708
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260331-642470
DATE: April 30, 2026

ORDER

An initial rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD) is denied.

FINDING OF FACT

For the period on appeal, the Veteran's service-connected PTSD is manifested by symptoms of occupational and social impairment with reduced reliability and productivity; the severity, frequency, and duration of his symptoms do not more nearly approximate occupational and social impairment with deficiencies in most areas.

CONCLUSION OF LAW

The criteria for an initial rating in excess of 50 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (Code) 9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The appellant is a Veteran who served on active duty from October 1969 to October 1971. This case comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 Higher-Level Review (HLR) rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which continued the 50 percent rating for PTSD that was initially granted in a January 2024 rating decision effective January 13, 2021.

In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2024 AOJ decision, which was subsequently subject to higher-level review in April 2025. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Entitlement to an initial rating in excess of 50 percent for service-connected PTSD

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule). The percentage ratings 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 conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

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).

When evaluating the level of disability of
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).

When evaluating the level of disability of a mental disorder, the rating agency shall consider the extent of social impairment but shall not assign an evaluation based solely on social impairment. The focus of the rating process is on industrial impairment from the service-connected psychiatric disability, and social impairment is significant only insofar as it affects earning capacity. 38 C.F.R. §§ 4.126, 4.130.

Ratings are assigned according to the manifestation of particular symptoms, but the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms listed following that phrase are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Therefore, the evidence considered in determining the level of impairment from the service-connected psychiatric disorders under 38 C.F.R. § 4.130 is not restricted to symptoms listed in the rating criteria. Instead, VA must consider all symptoms of a claimant's condition that affect occupational and social impairment, including, if applicable, those identified in DSM-5.

The Veteran's PTSD has been rated at 50 percent ever since service connection was established effective January 13, 2021, under 38 C.F.R. § 4.130, Code 9411. The applicable criteria are as follows.

A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when 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.

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).

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.

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.

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.

The issue in this appeal is whether the Veteran's symptoms associated with his PTSD caused the level of impairment required for a disability rating of 70 percent or higher. After review of the evidence and the Veteran's contentions, the Board concludes that the Veteran's symptoms do not cause the level of impairment required for a higher rating. See Mauerhan
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.

The pertinent medical evidence for the period on appeal (i.e., that evidence of record considered by the AOJ in the January 2024 rating decision) consists of a VA examination report in April 2023, as well as VA treatment records. The medical evidence shows that the Veteran's PTSD was manifested by symptoms associated with a 30 percent rating (depressed mood, anxiety, chronic sleep impairment) and with a 50 percent rating (flattened affect, disturbances in motivation and mood). In other words, his symptoms mainly (more nearly) typify those contemplated for a rating of either 30 percent or 50 percent, as seen on the following examination and outpatient records.

On the April 2023 VA examination, the Veteran reported that has been attending group (not individual) therapy at the VA for about a year, which he found to be helpful. He was not taking any psychotropic medications and had no history of inpatient psychiatric admissions. He stated that he had been married for over 40 years and that he and his wife maintained regular contact with all of their children and grandchildren. He was employed in housekeeping and planned to retire in October 2023. Examination revealed he was alert times three (person, place, and time). He was well groomed and dressed appropriately. His speech was normal. His mood was euthymic to mildly depressed with congruent affect. He was cooperative throughout the examination. He denied any current suicidal or homicidal ideation and psychotic symptoms. His insight and judgment were fair. For rating purposes, the examiner noted the following symptoms that applied to his diagnosis: depressed mood, anxiety, chronic sleep impairment, flattened affect, and disturbances of motivation and mood. He was competent to manage his own financial affairs. The examiner summarized the level of the Veteran's occupational and social impairment as approximating the criteria for a 30 percent rating.

VA outpatient treatment records reflect symptomatology that is consistent with that reported on the VA examination and approximated the type of symptoms contemplated for a 30 percent or 50 percent rating. For example, the Veteran generally denied any suicidal or homicidal ideation. In November 2021, the Veteran requested to be seen for PTSD because he did not sleep well, had flashbacks from Vietnam, and became easily upset with noises. On a December 2021 consult, he reported often feeling depressed, endorsed generalized anxiety and indicated that he often worried about life in general including his family. He also endorsed hypervigilance including anxiety in crowds and in response to loud noises. He experienced nightmares related to Vietnam (currently three to four times a week). He appeared guarded at times. He reported poor memory at times but had difficulty in elaborating on the topic. He reported chronic, vague suicidal ideation without plan or intent. In February 2022, he reported difficulty for years dealing with memories of Vietnam to include loud noises that would trigger fear and anxiety in him. On a May 2022 PTSD screening, he reported nightmares, avoidance behaviors, and being constantly on guard, watchful, or easily startled. On a May 2022 mental health consult, he noted always feeling "amped up" with worries much of the time. His mind was "running" when he tried to sleep, and he had nightmares "off and on." He reported some hypervigilance, noting that he was jumpy and distressed by loud noises. He thereafter attended group counseling on a variety of topics, including anxiety and stress management, and anger management.

As to the level of impairment caused by the Veteran's symptoms, the Board finds it more nearly approximates the level associated with a 50 percent rating than a higher rating. That is, he experienced occupational and social impairment with reduced reliability and productivity, including difficulty in establishing and maintaining effective work and social relationships. He does not have occupational and social impairment with deficiencies in most areas including an inability to establish and maintain effective relationships, which is indicative of the criteria contemplated for a 70 percent rating. For example, he had a long marriage and maintained ties with his five children and his grandchildren. As for employment, he worked in housekeeping, and there were no reports of any difficulties there in terms of maintaining effective relationships before a planned retirement in late 2023. Throughout the period on appeal, the Veteran has reported difficulty with sleeping, depression, and anxiety, but they were not shown to be so severe that he was unable to function independently, appropriately, and effectively (as would be commensurate with the criteria for a 70 percent rating). He also reported on occasion some memory deficits, but his level of memory problems (deemed "subjective" in December 2021) is contemplated by the 30 percent criteria relevant to mild memory loss (e.g., forgetting names, directions, recent events), or at the most the 50 percent criteria relevant to short- and long-term memory impairment (e.g., retention of only higher learned material, forgetting to complete tasks). Furthermore, to approximate the criteria for a 70 percent rating, there should be evidence of occupational and social impairment with deficiencies in most areas, such as judgment, thinking, and mood. Here, the VA examiner and treatment providers generally found that the Veteran's judgment was fair and that his thinking was without delusions, hallucinations, or other thought disorders. His mood was described variably as euthymic to mildly depressed (on VA examination) and as depressed and "amped up" (on treatment records). Even with a depressed mood, it was not commensurate with near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, as contemplated by the criteria for a 70 percent rating. A September 2022 group therapy note indicates that the Veteran reported he was more social and had noticed improvement in his mood as a result.

Symptoms and level of impairment, as reflected in mental status examinations on the VA compensation examination in April 2023 and treatment records, particularly in December 2021, February 2022 and May 2022, are consistent with the criteria contemplated for a rating of no higher than 50 percent. In general, they indicate that the Veteran was alert and oriented times three (place, person, and time), and he did not neglect his personal appearance as it was described as appropriate in terms of dress and grooming. He had good eye contact (with some anxiety in February 2022). His speech was either normal or quiet (soft spoken) and slow. His affect was variously described as appropriate, full range, congruent with his mood, tearful at times, and pleasant and kind. His mood was congruent with affect (tearful, pleasant, depressed) or "amped up." There was no indication of psychosis or mania. On one occasion (in February 2022), his thought process was described as "overwhelmed," which is when he was in the process of seeking mental health services at the VA, but generally it was within normal limits. His judgment and insight were fair. He endorsed chronic, vague suicidal ideation without plan or intent (in December 2021), but mostly he denied suicidal/homicidal ideation. On balance, these mental status examination findings do not more nearly approximate the severity of symptoms or level of impairment contemplated by a 70 percent rating, which includes such criteria as suicidal ideation, obsessional rituals that interfere with routine activities, speech abnormalities (e.g., illogical, obscure, or irrelevant), spatial disorientation, and neglect of personal appearance and hygiene.

It has been argued by the Veteran's attorney, in statements in January 2025 and March 2026, that the Veteran's PTSD meets the criteria for a higher rating. He stated that the VA did not consider the Veteran's "regular discussion about his suicidal ideation leading up to his claim." He also asserted that the April 2023 VA examination was not entirely complete because the examiner failed to inquire about the Veteran's interpersonal relationships at work and with friends. As for suicidal ideation, the Veteran denied it on the whole, despite a vague report of it on a treatment record for which he did (or could) not elaborate, and otherwise any reported ideation was without plan or intent. The last time he gave serious consideration to it including an attempt was in 2019, which is well before the review period. As for interpersonal relationships, the Veteran did not describe any problems or issues that would impact his ability to function appropriately, and the evidence does not suggest an inability to establish or maintain effective relationships. His long-term marriage and keeping in touch with his extended family are a testament to his ability to maintain meaningful connections with others. (To remand this case for another examination to determine the nature of his relationships with co-workers or friends more than a couple of years ago would be wasteful of VA resources without any increased benefit accruing to the Veteran. To approximate the 70 percent rating criteria, there would need to be evidence of an inability to establish and maintain effective relationships, inclusive of familial relations, and such is clearly not in demonstrated here.) In short, the Veteran's disability picture does not approximate the one contemplated for a 70 percent rating.

Furthermore, when specifically asked to opine on the level of impairment that best summarized the Veteran with regard to his mental disorder, the VA examiner in April 2023 concluded that his disability was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation normal. That is, the examiner found his mental disorder presentation was in conformity with the criteria contemplated for a 30 percent rating. While the foregoing assessment is not dispositive of the ultimate disability rating to assign the Veteran's PTSD, it is an insightful appraisal from a mental health clinician whose conclusion is entitled to substantial probative weight in terms of discerning the level of severity of the Veteran's PTSD impairment. The outpatient records show the Veteran was seen mainly for counseling in a group, not individual, setting, and the notations about his group therapy (e.g., arriving on time, supporting other veterans, actively participating when asked to do so, and denying suicidal/homicidal ideation) do not evoke the symptoms and level of impairment that approximates a 70 percent rating.

As described above, the Veteran has symptoms that are not listed with a specific rating, and these include problems with nightmares, insomnia, hypervigilance, hyperstartle response, and avoidance behaviors. Many of these symptoms are associated with, or similar in nature to, the criteria provided in the 30 percent rating (namely, chronic sleep impairment, suspiciousness) and in the currently assigned 50 percent rating (namely, disturbances of motivation and mood). They are not shown to have affected his ability to function independently, appropriately, and effectively, as would satisfy the criteria for a higher rating. In other words, the severity, frequency, and duration of the Veteran's symptoms - both listed and unlisted - more nearly approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. See 38 C.F.R. § 4.126. In short, a holistic review of his type of symptoms and level of impairment indicates that his disability picture is more aligned with the criteria for a 50 percent rating than a 70 percent rating.

In conclusion, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's PTSD symptoms resulted in the level of impairment required for the assignment of a 70 percent rating. As the most probative evidence persuasively weighs against a higher rating for the period on appeal, the benefit-of-the-doubt rule does not apply, and the appeal must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed

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