ANXIETY DISORDER

Summary

The Veteran, a Veteran who served from September 2010 to September 2011, appeals the denial of service connection for insomnia disorder. The Veteran claims this insomnia is secondary to his service-connected lumbar spine disability, citing chronic back pain that disrupts his sleep. The case falls under the modernized review system (AMA). The Board reviewed evidence of record up to the November 2020 supplemental claim decision. A February 2021 VA examination found no mental health diagnosis and issued a negative nexus opinion, stating the insomnia was less likely than not proximately due to the service-connected lumbar spine condition, but also acknowledged the link. The Board found this opinion inadequate because it recognized the connection but issued a negative nexus, failing to address the insomnia as a recognized mental health diagnosis. In contrast, a private medical opinion from October 2024 diagnosed insomnia disorder and opined it was at least as likely as not a result of the service-connected back condition, noting the pain's impact on sleep and functioning. The Board found this private opinion probative and persuasive, concluding the evidence favors service connection for insomnia secondary to the lumbar spine disability. Service connection for insomnia disorder is granted.

Rationale

Private medical opinion found insomnia likely resulted from service-connected back condition.; VA opinion was inadequate as it acknowledged the link but issued a negative nexus.; Insomnia disorder is a recognized mental health diagnosis.

Full Decision Text

Citation Nr: A26040718
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210217-141509
DATE: April 30, 2026

ORDER

Service connection for an insomnia disorder is granted.

FINDING OF FACT

The evidence favors a finding that the Veteran's insomnia disorder is caused by his service-connected lumbar spine disability.

CONCLUSION OF LAW

The criteria for service connection for an insomnia disorder as secondary to the service-connected lumbar spine disability are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 2010 to September 2011.

The rating decision on appeal was issued in November 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In August 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for sleep disturbances, most recently addressed in a December 2016 rating decision.  In November 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

In the February 2021 VA Form 10182, Decision Review Request:  Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held on September 17, 2024.  A transcript of the hearing is of record.

Therefore, the Board may only consider the evidence of record at the time of the November 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Service connection for an insomnia disorder is granted.

The Veteran contends that he has insomnia secondary to his service-connected lumbar spine disability.  The Veteran and his representative report that his service-connected lumbar spine disability makes it difficult for him to sleep.  See September 2024 Hearing Transcript.

The Veteran is currently diagnosed with insomnia disorder.  October 2024 Private Examination Report.

The Veteran is service connected for degenerative disc disease of the lumbar spine.

In October 2020, a VA physician provided a mental health examination to the Veteran and concluded that the Veteran did not have a mental health diagnosis.  The examiner reviewed the Veteran's claims file and opined that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected degenerative disc disease of the lumbar spine.  The VA examiner noted that the Veteran does have insomnia, which is due to the service-connected diagnosis of degenerative disc disease of the lumbar spine; however, the VA examiner found that there was no mental health diagnosis for the Veteran, and thus the VA examiner issued a negative nexus opinion.  This opinion is inadequate, as it acknowledges the link between the Veteran's insomnia and his service-connected lumbar spine disability, but issues a negative nexus in a determination that the Veteran's insomnia is not a mental disorder.  Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence...is essential for a proper appellate decision").  Notably, insomnia disorder is a recognized mental health diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  Thus, the Board affords no weight of probative value to this opinion.

In an October 2024 private medical opinion, Dr. A.H. diagnosed insomnia disorder and opined that the Veteran's insomnia disorder is at least as likely as not a result of his service-connected back condition.  Dr. A.H. rationalized that the Veteran has chronic back pain that wakes him up frequently during the night, and his sleep disturbance causes problems and impairment in important areas of his functioning.  While the opinion is not flawless, the opinion has a clear conclusion and rationale based on the provider's examination of the Veteran and his medical history and serves to
 diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).  Thus, the Board affords no weight of probative value to this opinion.

In an October 2024 private medical opinion, Dr. A.H. diagnosed insomnia disorder and opined that the Veteran's insomnia disorder is at least as likely as not a result of his service-connected back condition.  Dr. A.H. rationalized that the Veteran has chronic back pain that wakes him up frequently during the night, and his sleep disturbance causes problems and impairment in important areas of his functioning.  While the opinion is not flawless, the opinion has a clear conclusion and rationale based on the provider's examination of the Veteran and his medical history and serves to link the claimed insomnia disorder to the service-connected lumbar spine.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Therefore, the Board assigns this opinion probative weight.

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As such, the Board concludes that the evidence favors a finding that the Veteran's insomnia disorder is caused by his service-connected lumbar spine disability.  Therefore, the Board grants service connection for an insomnia disorder.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

 

 

M. SORISIO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Knerr

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.