POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The veteran, who served in the United States Navy from November 1990 to November 2010, appeals the denial of an increased rating for acquired psychiatric disorder, specifically posttraumatic stress disorder (PTSD). The veteran was previously granted service connection for anxiety disorder, claimed as PTSD, and currently holds a 70 percent rating. The appeal concerns whether the veteran's symptoms warrant an increased rating beyond 70 percent. The Board reviewed a VA C&P examination from August 2020, which diagnosed PTSD and noted deficiencies in most areas of occupational and social functioning, including depression, anxiety, suspiciousness, sleep impairment, and impaired impulse control. The examiner found the veteran's risk to himself and others to be low and did not find total occupational and social impairment. A private psychological evaluation from June 2025 opined that the veteran was unable to perform full-time competitive work due to PTSD, citing impacts on social interaction, fear, anxiety, impulsive reactions, sleep disturbances, and mood issues. However, the private opinion did not conclude total occupational and social impairment. The Board found the VA examiner's opinion clear, well-reasoned, and more probative, aligning with the existing 70 percent rating criteria. While acknowledging the veteran's lay statements and the private opinion, the Board determined the evidence did not demonstrate total occupational and social impairment required for a 100 percent rating. The Board also noted the benefit-of-the-doubt rule did not apply as the evidence persuasively weighed against total impairment. Service connection for PTSD remains at 70 percent.

Rationale

VA C&P exam diagnosed PTSD and noted deficiencies in most areas of occupational and social functioning.; Private psychological evaluation opined inability to perform full-time competitive work but did not conclude total impairment.; Board found VA examiner's opinion more probative and aligned with 70 percent criteria.

Full Decision Text

Citation Nr: A26040793
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210908-183311
DATE: April 30, 2026

ORDER

Entitlement to an initial evaluation in excess of 70 percent for acquired psychiatric disorder, to include posttraumatic stress disorder, is denied.

FINDING OF FACT

The severity, frequency, and duration of the Veteran's symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, impaired impulse control, and suicidal ideations did not result in total occupational and social impairment.

CONCLUSION OF LAW

The criteria for entitlement to an initial rating evaluation in excess of 70 percent for acquired psychiatric disorder, to include posttraumatic stress disorder, are not met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from November 1990 to November 2010.

In keeping with the holding of Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has re-characterized the issue on appeal as entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, (acquired psychiatric disorder) in order to provide the most favorable review of the Veteran's claim.

The Veteran filed his initial VA Form 21-526EZ, Fully Developed Claim (Compensation), in April 2012, in which he claimed service-connection for posttraumatic stress disorder.  The Department of Veterans Affairs (VA), Regional Office (RO) granted service-connection for anxiety disorder, claimed as posttraumatic stress disorder, in a June 2013 rating decision.  In June 2018, the Veteran filed a second VA Form 21-526EZ in which claimed an increased rating.  The RO granted rating of 70 percent for posttraumatic stress disorder, previously rated as anxiety disorder, in an August 2018 rating decision.  In July 2020, the Veteran filed a third VA Form 21-526EZ in which claimed an increased rating for posttraumatic stress disorder.  The RO continued its 70 percent rating for posttraumatic stress disorder, previously rated as anxiety disorder, in a September 2020 rating decision.

In April 2021, the Veteran filed a VA Form 20-0996, Decision Review Request: Higher-Level Review.  The RO continued its 70 percent rating for posttraumatic stress disorder, previously rated as anxiety disorder, in a July 2021 rating decision.  In September 2021, the Veteran appealed that decision to the Board of Veterans' Appeals (Board), by filing a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).  The Veteran selected the Hearing with a Veterans Law Judge review option.  In a letter received on April 4, 2025, the Veteran's attorney notified the Board of the Veteran's intent to withdraw his hearing request.

Therefore, the Board may only consider the evidence of record at the time of the RO's September 14, 2020 rating decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran's attorney within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b).  The Board's decision is based on a review of the evidence of record at the time of the decision on the issue on appeal and evidence submitted by the Veteran or his attorney and within 90 days following receipt of the withdrawal of the hearing request.  The Veteran's attorney submitted an independent medical opinion and the Veteran's statement during the post notice 90 day period.  Id.

If the Veteran would like VA to consider any evidence that was 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.

The Board considered whether a claim for a total rating based on individual unemployability (TDIU) has been raised by the Veteran during the pendency of this appeal.  In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court)
 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.

The Board considered whether a claim for a total rating based on individual unemployability (TDIU) has been raised by the Veteran during the pendency of this appeal.  In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that VA must address the issue of entitlement to a TDIU in increased rating claims when the issue of unemployability either is raised expressly or by the record.  The Veteran is in receipt of TDIU for the entire appeal period.  As such, the Board need not further address the claim.  

Increased Rating

Disability evaluations are determined by the application of the Schedule for Rating Disabilities, which allows for ratings based on the average impairment of earning capacity resulting from a service-connected disability.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized.  38 C.F.R. § 4.1.  Examination reports are to be interpreted considering the whole recorded history, and each disability must be considered from the point of view of a veteran working or seeking work.  38 C.F.R. § 4.2.

To evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of a veteran's condition.  Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).  Where entitlement to compensation 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 (1994).  Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made.  Hart v. Mansfield, 21 Vet. App. 505 (2007).

The Board must also assess the competence and credibility of lay statements and testimony.  Barr v. Nicholson, 21 Vet. App. 303, 308 (2007).  In increased rating claims, a veteran's lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, when such statements pertain to observable symptoms.  See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010).

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided.  38 C.F.R. § 4.14.  The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities may be duplicative or overlapping with the symptomatology of the other disability.  See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994).

Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is to be assigned.  38 C.F.R. § 4.7.

Entitlement to an initial evaluation in excess of 70 percent for acquired psychiatric disorder is denied. 

The Veteran asserts entitlement to an initial evaluation in excess of 70 percent for acquired psychiatric disorder.  

Under the General Schedule for Mental Disorders found at 38 C.F.R. § 4.130, the Board must conduct an "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria.  Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017).  The symptoms listed in the VA's general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002).  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
 must conduct an "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria.  Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017).  The symptoms listed in the VA's general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or their effects, which would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002).  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.  See Vazquez-Claudio, 713 F.3d at 114.

The pertinent sections for evaluation of the Veteran's posttraumatic stress disorder (PTSD) disability are as follows:

70 percent: 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); inability to establish and maintain effective relationships.  38 C.F.R. § 4.130, DC 9411.

100 percent: 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; and memory loss for names of close relatives, for the Veteran's own occupation, or own name.  38 C.F.R. § 4.130, DC 9411.

The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of symptoms, or their effects, which would justify a particular rating.  See Mauerhan 16 Vet. App. at 442.  It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings.  Id.  Rather, the use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation.  Id.

In Vazquez-Claudio, the Federal Circuit reiterated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration."  See Vazquez-Claudio, 713 F.3d at 112.  It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas."  Id.

Facts

In August 2020, the Veteran received a compensation and pension (C&P) examination for PTSD.  The examiner noted diagnosis of PTSD, and no other mental disorders.  The examiner summarized the Veteran's level of occupational and social impairment with regards to all mental diagnoses as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood.  He did not find total occupational and social impairment.  The examiner reported additional symptoms of depression, anxiety, suspiciousness, chronic sleep impairment, disturbance of motivation and mood, and impaired impulse control, such as unprovoked irritability with periods of violence.   

The examiner observed the Veteran was casually dressed, with adequate hygiene.  He displayed an irritable mood with a constricted range of affect.  The Veteran described his typical mood as, "okay when I'm left alone.  Okay when I'm not bothered."  He stated that he did not trust people so if people had tried to talk to him, he had ignored them the best he could unless it was a purposeful meeting with something that had needed to be accomplished.  Other than that, the
 total occupational and social impairment.  The examiner reported additional symptoms of depression, anxiety, suspiciousness, chronic sleep impairment, disturbance of motivation and mood, and impaired impulse control, such as unprovoked irritability with periods of violence.   

The examiner observed the Veteran was casually dressed, with adequate hygiene.  He displayed an irritable mood with a constricted range of affect.  The Veteran described his typical mood as, "okay when I'm left alone.  Okay when I'm not bothered."  He stated that he did not trust people so if people had tried to talk to him, he had ignored them the best he could unless it was a purposeful meeting with something that had needed to be accomplished.  Other than that, the Veteran did not like people and had not trusted them.  The examiner observed that the Veteran had been able to maintain appropriate attention and concentration.  He appeared to demonstrate adequate judgment and insight.  He was oriented to all spheres.  The Veteran displayed some paranoia, specifically related to individuals in authority positions.  The examiner noted no evidence of cognitive, or speech impairment was noted.  The Veteran's eye contact was within normal limits.  He denied and did not display signs of suicidal or homicidal ideation, intent, or plan.  He stated that he had thoughts of suicide daily, but did not have a plan, and was able to quickly dismiss them.  The Veteran stated that he had had thoughts of suicide right after his divorce and his last surgery.  He took his firearms to his father.  The Veteran noted that he had been a suicide counselor.  The examiner stated that, in his opinion, the Veteran was not a current imminent or increased risk.

An August 2020 mental health initial evaluation note documents the Veteran stated his goals as wanting to change, being motivated, maintaining his sobriety, and having a stable housing situation.  The Veteran reported unwanted intrusive memories and reported feeling notably distressed when memories were triggered.  He denied engaging in avoidance strategies to avoid thoughts, memories, sensations, or trauma reminders associated with his event.  The Veteran reported negative alterations in mood, particularly associated with a negative view of self and feelings of guilt and shame.  He reported alterations in arousal (hypervigilance, difficulty concentrating, and difficulties with sleep).  The Veteran denied symptoms associated with additional mental health diagnoses.  He stated that he had been able to manage his symptoms until his 2014 injury.  The symptoms resulting from his injury had caused relational conflict impacting his ability to engage in life activities.  

An August 2020 mental health note documented the Veteran was observed to be  casually dressed and appropriately groomed.  He described his mood as "ok," and was appropriate to content, with brief period of tearfulness and distress when discussing his traumatic stressors.  Affect was congruent, Veteran was very animated.  He spoke at a slightly increased pace and tone.  The Veteran was observed to be cooperative and engaged throughout the session.  He required slight redirection when he wanted to provide aspects about dissatisfaction to previous mental health encounters.  However, the psychologist found the Veteran amenable to redirection.  His eye contact was appropriate; and his thought processes were logical, linear, and predominantly goal-directed.  Thought content was relevant to topic.  The Veteran's memory and concentration were adequate for the current session.  There was no observed evidence or endorsement of psychotic symptoms.  His judgment and insight were fair.  When asked directly, the Veteran denied thoughts of suicide or homicide.  He stated that he had had occasional thoughts of death, but he had been "easily" able to "Get them out" with no plan or intent to follow through on thoughts.  Veteran denied a current ideation.  The psychologist assessed the Veteran's risk to himself and others as low.

In June 2025 the Veteran provided a private psychological evaluation.  The licensed clinical social worker stated that, in her opinion, the Veteran was unable to perform full-time competitive work due to his service-connected diagnosis of posttraumatic stress disorder.  His psychological symptoms impacted his ability to interact with others in an appropriate manner.  The Veteran struggled with fear and anxiety which contributed to his impulsive reactions.  This impacted the Veteran's success in full-time competitive work.

In her report, the social worker stated the Veteran reported he had to sit with his back against the wall in order to see all exits.  He had difficulty falling asleep and staying asleep, sleeping approximately 3 to 4 hours a night.  During the day, the Veteran had to take naps due to lack of energy.  His mind raced and he experienced flashbacks in which he recalled the faces of those he had hurt during his military service.  The Veteran had had visual hallucinations that resulted in increased anxiety. 

The Veteran reported his mood had been mostly somber, lethargic, and numb, "
 fear and anxiety which contributed to his impulsive reactions.  This impacted the Veteran's success in full-time competitive work.

In her report, the social worker stated the Veteran reported he had to sit with his back against the wall in order to see all exits.  He had difficulty falling asleep and staying asleep, sleeping approximately 3 to 4 hours a night.  During the day, the Veteran had to take naps due to lack of energy.  His mind raced and he experienced flashbacks in which he recalled the faces of those he had hurt during his military service.  The Veteran had had visual hallucinations that resulted in increased anxiety. 

The Veteran reported his mood had been mostly somber, lethargic, and numb, "until someone pisses [him] off."  He had experienced angry outbursts of screaming and slamming things.  He had imagined choking the people who made him mad.  

The Veteran stated that he had avoided activities that he once enjoyed.  He struggled with social isolation and had problems with dealing with people in general.  "They don't care about anyone or how to get over on me.  I don't think they care.  It's difficult to ever be around other people.  In Publix, this guy kept following me and I told him to go past, and he wouldn't pass me.  When I turned the corner, the guy still followed me, and I hip tossed him and the cops were called."

Analysis

It is well-settled that a veteran need not exhibit all the symptoms listed in the criteria for a certain rating percentage to be entitled to that rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002).  Rather, the Board must holistically assess the severity, frequency, and duration of the signs and symptoms of the Veteran's disability, quantify the level of impairment it causes, and assign the rating that most nearly approximates the Veteran's level of impairment.  See 38 C.F.R. § 4.126(a).  In doing so, the Board carefully considered the lay statements, objective and contemporaneous medical evidence, and medical opinions contained in the Veteran's record

In determining the probative value of medical opinions, the Board is to determine how much weight to assign the foundation upon which the medical opinion is based.  Reonal v. Brown, 5 Vet. App. 458, 461 (1993).  The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, her knowledge and skill in analyzing the data, and the medical conclusion.  As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator.  Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993).  Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits.  See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998).  To have probative value, a medical examination report submitted to the Board must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

In considering the lay evidence presented in this case, the Board acknowledges the Veteran, and others, are competent to report on matters observed or within their personal knowledge.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994).  Therefore, they are competent to provide statements of symptoms which are observable to their senses and there are no reason to doubt their credibility.  However, the Board must emphasize that the they are not competent to interpret accurately clinical findings pertaining to acquired psychiatric disorder as this requires highly

Based on the foregoing, the Board concludes that the Veteran's disability picture, to include the severity, frequency, and duration of his symptoms, as well as the resulting impairment of social and occupational functioning, approximates the currently assigned 70 percent criteria for the appeal period.  

The medical evidence substantiates that the Veteran has symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and impaired impulse control, which are contemplated under the 70 percent rating criteria. 

The Board also finds the examiner provided a clear and well-reasoned medical opinion with supporting data and reasoned medical explanations connecting the two.  Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Accordingly,
 the resulting impairment of social and occupational functioning, approximates the currently assigned 70 percent criteria for the appeal period.  

The medical evidence substantiates that the Veteran has symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and impaired impulse control, which are contemplated under the 70 percent rating criteria. 

The Board also finds the examiner provided a clear and well-reasoned medical opinion with supporting data and reasoned medical explanations connecting the two.  Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  Accordingly, the Board assigns significant probative value to the examiner's medical opinion.  The records contain little evidence contradicting her opinion.

The Board considered the social workers opinion, and found it clear and well-reasoned.  She stated that it was her opinion that the Veteran was unable to perform full-time competitive work due to his service-connected diagnosis of posttraumatic stress disorder.  However, she did not state that the Veteran exhibited total occupational and social impairment, due to such symptoms.  The Board finds her opinion would more closely support the Veterans symptoms resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

The evidence does not demonstrate that the Veteran's symptomology manifests in a higher 100 percent rating.  The Veteran does not present 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; disorientation to time or place; and memory loss for names of close relatives, for the Veteran's own occupation, or own name.  Records indicated the Veteran was not employed, and lived with his wife and stepson.  He was estranged from his oldest son, but is able to talk with his youngest son through phone calls and text, and had a few friend, one who played the guitar at the Veteran's church.  

The Board acknowledges the Veteran had frequent thoughts of suicide.  However, the evidence weighs heavily against finding the Veteran was a danger to himself.  It also weighs heavily against finding he was a danger to others.  As such, it cannot be said that the Veteran had total social and occupational impairment.  To the extent that symptoms associated with the 100 percent rating criteria may be shown or argued, the Board emphasizes that the disability has not been shown to be productive of both total social and occupational impairment.

In reaching its conclusion, the Board has considered and applied the benefit-of-the-doubt rule.  "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b).  "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001).  In this case, the evidence persuasively weighs against a finding the severity, frequency, and duration of the Veteran's symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, impaired impulse control, and suicidal ideations did not result in total occupational and social impairment.  Thus, the benefit-of-the-doubt rule does not change the outcome of this issue.  38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch, supra.

 

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Austin, L

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.