POSTTRAUMATIC STRESS DISORDER (PTSD)

K. CONNER · 2026 · Case ID: A26040846

MIXED

Summary

The appellant, a Navy Reserve veteran who served on active duty from March 1990 to June 1992, appeals the denial of service connection for treatment purposes only for PTSD and HIV. The veteran received an Other Than Honorable (OTH) discharge, which bars entitlement to compensation but not healthcare benefits under Chapter 17. The Board noted that the OTH discharge was based on willful and persistent misconduct and was not appealed. The appellant also mentioned disagreeing with a prior denial of a lung disease claim, but the Board found no appealable decision for that issue within the relevant timeframe. For the PTSD claim, the Board found no competent evidence of a current diagnosis. While the veteran reported some symptoms and had a positive PTSD/Depression screen in February 2019, the records lacked a formal diagnosis, and subsequent screenings were negative. The Board concluded that the evidence was persuasively against the claim and did not warrant a VA examination. For the HIV claim, the Board found that the veteran had a current diagnosis of HIV and reported unprotected sex during service, with STRs documenting a Gonorrhea diagnosis and unprotected sex. However, the Board determined that the evidence was insufficient to decide the claim without a medical opinion, particularly regarding the etiology of the HIV and its association with service. Therefore, the HIV claim was remanded for a medical opinion to determine its nature and etiology, and whether it was due to service, with specific attention to the notation of unprotected sex in the STRs.

Rationale

No competent evidence of current PTSD diagnosis; Recent treatment records show negative PTSD screenings; February 2019 positive screen lacked meaningful analysis or formal diagnosis

Service Branch

NAVAL RESERVE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230517-348810

Full Decision Text

Citation Nr: A26040846
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 230517-348810
DATE: April 30, 2026

ORDER

Entitlement to service connection for treatment purposes only under Chapter 17, Title 38, United States Code, for posttraumatic stress disorder (PTSD) is denied.

REMANDED

Entitlement to service connection for treatment purposes only under 38 U.S.C. Chapter 17 for human immunodeficiency virus (HIV) is remanded.

FINDINGS OF FACT

1. The appellant was discharged under Other than Honorable (OTH) conditions.

2. There has been no removal of any bar to VA compensation benefits via an upgrade to the appellant's character of discharge or evidence showing that the appellant was insane at the time of his misconduct.

3. The evidence of record is persuasively against a finding that the Veteran has had a diagnosis of PTSD at any time during, or approximate to, the pendency of the claim.

CONCLUSION OF LAW

The criteria for service connection for treatment purposes only under 38 U.S.C. Chapter 17 for PTSD have not been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.12, 3.303, 3.360, Chapter 17.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served in the United States Naval Reserve, which service included a period of active duty from March 9, 1990, to June 13, 1992. His DD Form 214 reflects that he received an "Other Than Honorable" discharge.

This appeal before the Board of Veterans' Appeals (Board) arose from a November 2022 Department of Veterans Affairs (VA) Regional Office (RO) decision denying service connection for treatment purposes only under 38 U.S.C. Chapter 17 for HIV and PTSD.

On May 17, 2023, the appellant filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), on which he identified the November 2022 decision, stated that he disagreed with the denial of service connection for treatment purposes for HIV and PTSD, and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 2022 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the appellant 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 denied 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.

Additionally, because the Board is remanding the claim of service connection for treatment purposes only for HIV, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

As a final preliminary matter, the Board notes that on his VA Form 10182, the appellant also indicated that he was disagreeing with an October 2022 decision pertaining to lung disease/pulmonary fibrosis. The Board notes that there in no October 2022 rating decision of record. Rather, the record contains an October 2022 letter informing the appellant that VA had received mail indicating that he wanted VA to review claims for lung disease, depression, and anxiety that were previously denied. (The Board notes that claims for service connection for treatment purposes only for lung disease, depression, and anxiety, were previously denied by the AOJ in July 2019). The letter informed the appellant that in order for VA to begin processing his request, he needed to file the proper form. The appellant was advised that no further action would be taken unless he submitted the proper form.

The Board notes that the October 2022 letter merely advises the appellant to submit the proper form for a claim that had been previously reviewed. The letter did not reach the merits of the claim of service connection for treatment purposes only for lung disease, or make any adverse findings. The Board finds that a letter explaining to the appellant that he submitted his request using the incorrect form is not an initial, appealable decision as the claim was not adjudicated by the AOJ. 38 C.F.R. §§ 3.151(c); 3.2400(a)(1); 3.2500(a). The Board has also engaged in administrative efforts to ensure that the AOJ did not issue a decision in October 2022 addressing entitlement to service connection for lung disease. In February 2022, the AOJ issued a deferred rating decision confirming that no rating decision addressing lung disease was issued in or around October 2022. Accordingly, because there is no appealable decision concerning entitlement to service connection for lung disease, for treatment purposes or otherwise, issued within a year prior to receipt of the May 2023 VA 10182, the issue of entitlement to service connection for lung disease is not before the Board as part of the current appeal.

The Board does note that the AOJ issued a rating decision in July 2025 in which it denied service connection for treatment purposes only under 38 U.S.C. Chapter 17 for lung disease. Should the appellant wish to appeal that decision to the Board, the appellant may do so by filing a VA Form 10182 as to that decision within a year from notification of that decision. If the appellant has not yet received notice of this decision, as there is no decision notification letter of record, the appellant should inquire with the AOJ and request that a copy of the decision be sent to him.

Service Connection for Treatment Purposes only for PTSD

In the instant case, the appellant is seeking service connection for PTSD. As an initial matter, the Board points out that the appellant has an Other than Honorable discharge status, barring entitlement to compensation for a disability. See 38 U.S.C. § 101(18); 38 C.F.R. § 3.12(a). In this regard, the Board notes that a VA administrative decision was issued in October 2022 confirming that the appellant's service was terminated under conditions that constituted a bar to entitlement to VA benefits, but that healthcare benefits were available under 38 C.F.R. Chapter 17. The VA administrative decision found that the bar to VA benefits remained, pursuant to 38 C.F.R. § 3.12(d), based on the appellant's character of discharge having been based on willful and persistent misconduct. The character of the appellant's discharge is not the subject of the current appeal, as he did not appeal the October 2022 administrative determination.

Although the appellant's Other than Honorable discharge does not allow for him to be eligible for service-connected compensation, it does allow for eligibility for VA health care for a current disability that is found to have been incurred or aggravated during his active-duty service. 38 C.F.R. § 3.360(a-b).

In making determinations of VA health-care eligibility, the same criteria will be used as is applicable to determinations of service connection when there is no character of discharge bar. 38 C.F.R. § 3.360(c). Service connection for PTSD, including service connection for treatment purposes only, will be granted when the record contains (1) a current medical diagnosis of PTSD, (2) credible supporting evidence that the claimed in-service stressor actually occurred, and (3) medical evidence establishing a nexus between the claimed in-service stressor and the current symptoms of PTSD. Cohen v. Brown, 10 Vet. App. 128, 138 (1997); 38 C.F.R. § 3.304(f); see Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010) ("[W]hile [38 C.F.R. § ] 3.303 mandates that there be a link between a current disability and military service, section 3.304(f) sets forth the evidence necessary, in the context of claims for PTSD disability compensation, to establish that link.").

With regard to medical evidence of a diagnosis of PTSD in
claimed in-service stressor and the current symptoms of PTSD. Cohen v. Brown, 10 Vet. App. 128, 138 (1997); 38 C.F.R. § 3.304(f); see Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010) ("[W]hile [38 C.F.R. § ] 3.303 mandates that there be a link between a current disability and military service, section 3.304(f) sets forth the evidence necessary, in the context of claims for PTSD disability compensation, to establish that link.").

With regard to medical evidence of a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a), this regulation provides that, for VA purposes, all mental disorder diagnoses must conform to the Fifth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5). Additionally, if a claimant did not engage in combat with the enemy, or the claimed stressors are not related to combat, and the stressor is not related to "fear of hostile military or terrorist activity," then the claimant's testimony alone is not sufficient to establish the occurrence of the claimed stressors, and his testimony must be corroborated by credible supporting evidence. Cohen, supra; Moreau v. Brown, 9 Vet. App. 389 (1996). Furthermore, service department records must support, and not contradict, the claimant's testimony regarding non-combat stressors. Doran v. Brown, 6 Vet. App. 283 (1994).

At the outset, the Board finds there to be no evidence of record indicative of combat service, and the appellant has not alleged otherwise.

The Veteran's service treatment records (STRs) reveal that at the time of his February 1990 enlistment examination, he was clinically evaluated as psychiatrically normal. The appellant similarly failed to report any psychiatric symptomatology on his report of medical history. His STRs then show treatment related to alcohol abuse and symptoms of sexually transmitted diseases (STDs). The STRs contain a diagnosis of Gonorrhea in September 1991, but are silent for any psychiatric symptoms. The appellant's June 1992 separation report of medical history then indicates that the appellant was not evaluated psychiatrically at the time of that examination. On the accompanying report of medical history, however, the appellant denied nervous trouble of any sort, depression or excessive worry, frequent trouble sleeping, or recent gain or loss of weight.

The Veteran's post-service VA treatment records show that in March 2006, PTSD and depression screens were negative. The appellant also denied any past military sexual trauma. On November 4, 2013, the appellant presented for an initial primary care evaluation at the Spring City VA clinic. His general appearance and mental status were described as alert, with no acute distress. An addendum report indicates that the appellant reported anxiety and irritability as emotional barriers that made it hard to learn. A depression screening was conducted and the appellant reported feeling down, depressed, or hopeless for several days; the reported score, however, was 2, which was noted to be negative for depression. On November 8, 2013, it was noted that there were no mood indicators of depression or anxiety. A PTSD screen done in November 2013 was also negative, as was one done in September 2018. A February 23, 2019, nursing note contains a depression screening score of 6, which is noted to "indicate[] a positive screen on the depression scale over the past two weeks." The appellant reported that over the past two weeks he had little interest or pleasure in doing things nearly every day, and that he felt down, depressed, or hopeless nearly every day. A February 23, 2019, primary care outpatient note shows that the appellant presented for follow-up primary care. His past medical history was noted to be significant for HIV, diagnosed in 2013, as well as interstitial lung disease. Notably, a depression screen conducted at that time shows that the appellant denied feeling hopeless or helpless and denied any suicidal or homicidal ideation. Following a notation of "Follow-up POS PTSD/Depression/SI", the VA clinician, a physician assistant, then stated that he reviewed the results of the Mental Health screen and had evaluated the appellant. The clinician stated that a routine, non-emergent mental health evaluation was needed.

Notably, additional depression screens done in April 2020 and September 2021 were negative and a November 2020 primary care outpatient note indicates that the appellant denied feeling hopeless or helpless. The appellant similarly denied such in December
2013, as well as interstitial lung disease. Notably, a depression screen conducted at that time shows that the appellant denied feeling hopeless or helpless and denied any suicidal or homicidal ideation. Following a notation of "Follow-up POS PTSD/Depression/SI", the VA clinician, a physician assistant, then stated that he reviewed the results of the Mental Health screen and had evaluated the appellant. The clinician stated that a routine, non-emergent mental health evaluation was needed.

In May 2023, the appellant submitted a VA Form 21-0781a, Statement in Support of Claim for Service Connection for PTSD Secondary to Personal Assault, wherein the appellant reported the stressful incidents as having unprotected sex with a women who gave him Chlamydia in July 1991 and having consensual sex with a woman in the Armed Forces, along with three other soldiers from another ship, in March 1990. As to the later incident, the appellant reported getting in trouble for indecent behavior, but being cleared of the charge. He further reported a number of behavioral changes following the incidents, to include tests for HIV, weight loss, lethargy, withdrawal from friends, substance abuse, changes in performance, and creating problems in his relationship, to include creating domestic abuse and being controlling of women.

Upon review of the evidence of record, the Board finds that service connection for treatment purposes only under 38 U.S.C. Chapter 17 for PTSD is not warranted. This is so because there is no competent evidence that the Veteran currently suffers from PTSD or from any other psychiatric disorder. The Veteran's recent treatment records reflect negative screenings for depression and PTSD, save for the February 2019 nursing note containing a positive screen for depression and the follow-up primary care note for "POS PTSD/Depression/SI". Notably, neither of these treatment entries contain an actual diagnosis of PTSD or depression. As to the assessment of "POS" PTSD, it is not clear whether this means "possible" or "positive", but, regardless, that reference is not persuasive evidence since it was made without any meaningful analysis as to how the criteria for such a diagnosis were met. Additionally, it was indicated that an additional, routine mental health evaluation was needed; the appellant, however, declined to participate in such at that time. As such, the Board cannot conclude that the appellant had a current diagnosis of PTSD.

The Board acknowledges that the presence of a disability at any time during the claim process can justify a grant of service connection, even when the most recent diagnosis is negative. McClain v. Nicholson, 21 Vet. App. 319 (2007). However, Congress specifically has limited entitlement to service connection, to include for treatment purposes only, for disease or injury to cases where such incidents have resulted in a current disability. Here, there is simply no indication in the record that the appellant has a current diagnosis of PTSD, or that he has had any psychiatric disability at any time during the appeal period.

The Board further notes that in Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the United States Court of Appeals for Veterans Claims (Court) held that the scope of a mental health disability claim includes any mental disorder that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. In reviewing the Veteran's claim for PTSD, the Board took this into consideration; however, there is no evidence of record to suggest any current mental health disorder during the course of the Veteran's appeal or in close proximity to his filing of a claim.

The Board also acknowledges that the appellant has not been provided with any VA examination in this case. In determining whether an examination is warranted, the framework does not require that the Veteran has a current diagnosis, but instead that there be competent evidence of persistent symptoms of a disability. In this case, beyond providing the bare contention of suffering from PTSD as related to in-service sexual encounters, the Veteran has not described any symptoms with sufficient particularity for the Board to determine what symptoms of a disability he may have. More importantly, there is no evidence of symptoms since his treatment records consistently show negative finding for depression or PTSD. Absent such evidence, a VA examination is not required. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).

For the reasons and bases set forth above, the Board finds
examination is warranted, the framework does not require that the Veteran has a current diagnosis, but instead that there be competent evidence of persistent symptoms of a disability. In this case, beyond providing the bare contention of suffering from PTSD as related to in-service sexual encounters, the Veteran has not described any symptoms with sufficient particularity for the Board to determine what symptoms of a disability he may have. More importantly, there is no evidence of symptoms since his treatment records consistently show negative finding for depression or PTSD. Absent such evidence, a VA examination is not required. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).

For the reasons and bases set forth above, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Regarding the appellant's claimed HIV, the appellant's VA treatment records confirm a current diagnosis of HIV. In claiming service connection for such, the appellant asserted that while in service, he had unprotected sex with numerous women. A review of the appellant's STRs shows that in September 1991, the appellant presented with symptoms of an STD. At that time, he reported a history of STDs, and noted that he had had unprotected sex three days prior. The appellant was diagnosed with Gonorrhea and advised on the proper use of condoms.

The Board notes that the appellant was not afforded a medical examination, nor did the AOJ obtain a medical opinion in connection with the current claim. Under the duty to assist, a medical examination or medical opinion is considered necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent medical evidence of a currently diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that the Veteran suffered an event, injury, or disease in service; and (3) indicates that the claimed disability or symptoms may be associated with an established event, injury or disease in service or with another service-connected disability. See McLendon, supra; 38 C.F.R. § 3.159(c)(4). Notably, the third McLendon element is a "low threshold". Id. at 83.

The Board acknowledges that a known risk factor for developing HIV is unprotected sex with an HIV-infected person. Although the appellant has not asserted that the sexual partners he had in service were known to have HIV, the fact remains that the appellant's STRs document unprotected sex while in service. Further, nothing in the appellant's post-service treatment records indicates a clear etiology of the appellant's diagnosed HIV. Thus, for the Board to conclude that the appellant's HIV was in no way associated with the appellant's service would constitute an impermissible medical determination. See Colvin v. Derwinski, 1 Vet. App. 171, 172 (1991) (requiring the Board to support its medical determinations with independent medical evidence), overruled on other grounds by Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). In other words, the competent medical evidence on file is insufficient for the Board to make a decision on the claim. As such, the Board finds that the "low threshold" necessary to trigger VA's duty to obtain a medical opinion has been satisfied in this case. See 38 U.S.C. § 5103A(d); McLendon, supra; 38 C.F.R. § 3.159 (c)(4). Accordingly, because the AOJ failed to obtain a medical opinion or afford the appellant with a medical examination prior to adjudicating the claim on appeal, the Board finds it necessary to remand the claim of service connection for HIV for treatment purposes only for correction of this pre-decisional duty to assist error. 38 C.F.R. § 20.802.

The matter is REMANDED for the following action:

1. Obtain a medical opinion to determine the nature and etiology of the Veteran's diagnosed HIV. The Veteran's claims file must be made available to the reviewing clinician. (If the clinician indicates that an opinion cannot be rendered without examination of the appellant, the AOJ should arrange for a medical examination to be conducted.)

Upon review of the claims file, the reviewing clinician is requested to provide an opinion as to whether the Veteran's diagnosed HIV had its onset during service or is otherwise due to an event or incident of the Veteran's active service.

Specific attention is directed
-decisional duty to assist error. 38 C.F.R. § 20.802.

The matter is REMANDED for the following action:

Specific attention is directed to notation of unprotected sex in the appellant's STRs.

A clear rationale for all opinions should be expressed, and the opinion should contain a discussion of the facts and medical principles involved.

K. Conner

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Neilson, 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.

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