An increased disability rating, in excess of 70 percent, for posttraumatic stress disorder (PTSD) with major depressive disorder and obsessive compulsive disorder is denied.

Citation Nr: A26069900 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 250417-536760 DATE: July 30, 2026 ORDER An increased disability rating, in excess of 70 percent, for posttraumatic stress disorder (PTSD) with major depressive disorder and obsessive compulsive disorder is denied. Service connection for hypoesthesia & paresthesia of the right lower extremity is denied. Service connection for right lower extremity restless leg syndrome is denied. Service connection for left lower extremity restless leg syndrome is denied. FINDINGS OF FACT 1. For the period on appeal, the severity, frequency, and duration of the Veteran's symptoms approximated occupational and social impairment with deficiencies in most areas; total occupational and social impairment is not shown. 2. Based on the probative evidence of record, the Veteran has not had a right lower extremity disability of hypoesthesia and/or paresthesia at any time during the pendency of the claim. 3. Based on the probative evidence of record, the Veteran has not had a right lower extremity disability of restless leg syndrome at any time during the pendency of the claim. 4. Based on the probative evidence of record, the Veteran has not had a left lower extremity disability of restless leg syndrome at any time during the pendency of the claim. CONCLUSIONS OF LAW 1. The criteria for a disability rating, in excess of 70 percent, for posttraumatic stress disorder (PTSD) with major depressive disorder and obsessive compulsive disorder 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 9411. 2. The criteria for service-connection for right lower extremity hypoesthesia & paresthesia have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service-connection for right lower extremity restless leg syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service-connection for left lower extremity restless leg syndrome have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2001 to October 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the evidence submission docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 RO decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the RO issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. An increased disability rating, in excess of 70 percent, for posttraumatic stress disorder (PTSD) with major depressive disorder and obsessive compulsive disorder is denied. The Veteran is seeking entitlement to an increased disability rating for his service-connected posttraumatic stress disorder. Specifically, he contends he is entitled to a rating of 100 percent. See April 2025 VA Form 10182. Law and Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 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. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the veteran's medical history. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). When determining the appropriate disability rating to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also, Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Rather, it is the effect of the symptoms which are present that determines whether the criteria for the next higher rating are met, and the Board must draw fact-based conclusions as to whether those symptoms, and their severity, frequency and duration, have caused the level of occupational and social impairment associated with a given rating. Bankhead v. Shulkin, 29 Vet. App. 10 (2017). A veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Under the General Formula for Mental Disorders (General Formula), a 70 percent rating is warranted when there is 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 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. 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411. The maximum schedular rating of 100 percent is warranted when there is 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, own occupation, or own name. Id. When evaluating the record, the VA shall consider all information and lay and medical evidence of record in a case, and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Analysis Initially, the Board observes that the Veteran was granted service connection for posttraumatic stress disorder (PTSD) with major depressive disorder and obsessive compulsive disorder in a 2019 rating decision, which assigned an initial disability rating of 50 percent, effective July 2018. In February 2024, the Veteran filed an Intent to File and within one year, in January 2025, he submitted a VA Form 21-526EZ, Fully Developed Claim, the Veteran sought an increased disability rating for this condition. As a result, this claim represents a noninitial claim for an increased rating. During the rating period, the Veteran received private and VA mental health examinations in October 2024 and February 2025. The results from these examinations along with the Veteran's medical records, lay statements, and other evidence, show that his posttraumatic stress disorder is manifested by symptoms associated with the 30, 50, and 70 percent rating criteria of the diagnostic code. Specifically, the Veteran presents with symptoms associated with the 30 percent rating including occasional impairment due to depressed mood, anxiety, suspiciousness, and chronic sleep impairment; mild memory loss; and panic attacks. He presents with symptoms associated with the 50 percent rating including disturbances of motivation and mood; flattened affect; and difficulty in establishing and maintaining effective work and social relationships. In the 70 percent disability rating he presents with symptoms of difficulty adapting to stressful circumstances including work or a work like setting; an inability to establish and maintain effective relationships; impaired impulse control; obsessional rituals interfering with routine activities; and suicidal ideation. The evidence of record also shows that the Veteran endorses symptoms not specifically listed with a rating, including loss of interest in activities that previously provided pleasure (anhedonia); daytime fatigue and difficulty falling or staying asleep; social withdrawal or a desire to isolate; hypervigilance or paranoia and hyperarousal or feeling jumpy; avoidance of crowds and loud noises; feelings of guilt, numbness, worthlessness, sadness, lack of control, hopelessness and helplessness; difficulty expressing emotion; racing thoughts, intrusive memories, nightmares and flashbacks; decreased energy, difficulty concentrating, and forgetfulness; outbursts of anger, irritability, or argumentativeness; and compulsive/ritualistic repetitive behaviors such as counting and checking doors. The Veteran's unlisted symptoms of a loss of interest in activities that previously provided pleasure (anhedonia); daytime fatigue and difficulty falling or staying asleep; social withdrawal or a desire to isolate; hypervigilance or paranoia and hyperarousal or feeling jumpy; avoidance of crowds and loud noises; feelings of guilt, numbness, worthlessness, sadness, lack of control, hopelessness and helplessness; racing thoughts, intrusive memories, nightmares and flashbacks; decreased energy, difficulty concentrating, and forgetfulness; difficulty expressing emotion; and outbursts of anger, irritability, or argumentativeness are similar to the symptoms of depressed mood, anxiety, and suspiciousness contemplated by the 30 percent rating criteria, or the disturbances of motivation or mood and difficulty establishing and maintaining effective relationships as contemplated by the 50 percent rating criteria. The Veteran's unlisted symptom of compulsive/ritualistic repetitive behaviors like counting or checking doors is similar to obsessional rituals interfering with routine activities contemplated by the 70 percent rating criteria. With respect to the Veteran's suicidal ideation, the Board recognizes that neither of the Veteran's medical examiners identified suicidal ideation among the list of the Veteran's symptoms. However, the Board acknowledges that the record includes a report of passive and fleeting suicidal ideation without intent or plan occurring on one occasion during the rating period, along with a history of active suicidal ideation in 2007 and 2017. While the occurrences in 2007 and 2017 are outside of the rating period on appeal, the Board has considered these reports as a part of its review of the "whole" record and finds it relevant to the present appeal, considering the recent report of passive suicidal ideation in the record. See Peyton v. Derwinski, 1 Vet. App. 282 (1991); see also, January 2025 Medical Treatment Record Non Government Facility. Nevertheless, given the totality of the record, the severity, frequency, and duration of the Veteran's suicidal ideation over the rating period is consistent with the symptomatology contemplated by the 70 percent rating; it has not risen to the level contemplated by the 100 percent rating. Aside from the isolated report of passive and fleeting suicidal ideation without specific intent or plan made to the Veteran's October 2024 private psychological examiner, there are no other reports during the rating period of such ideation, and neither of the Veteran's psychological examiners found that he experienced suicidal ideation among his documented symptoms. Moreover, there is no evidence over the rating period to suggest that the Veteran has required heightened psychological or medical intervention to address suicidal ideation, and no evidence that he presents an increased risk or danger to himself. Finally, while the record does include evidence that the Veteran experiences angry outbursts and was noted to have impulse control issues, neither the severity of his suicidal ideation nor documented impaired impulse control issues have risen to the level of presenting a persistent danger to himself or others as contemplated by the 100 percent disability rating. See "Persistent," Meriam-Webster Dictionary Online (defining persistent, among other entries, as "existing for a long or longer than usual time or continuously"). Regarding the overall level of social impairment caused by the Veteran's symptoms, the Veteran was generally described as well-groomed and cooperative, with normal speech, thought processes, and judgement during his mental health examinations. However, the Veteran's examinations and other records also make clear that he experiences significant social impairment as a result of his symptoms. Specifically, while the Veteran was previously married and has two stepchildren, the record indicates that he no longer has contact with his stepchildren following his divorce from his ex-wife. Currently, the Veteran lives alone and did not report any significant relationships nor friendships. While he indicated that he has contact with his parents and an adult sister, he reported that his irritability, paranoid thinking, isolative behaviors, and "interpersonal deficits" have negatively impacted these relationships. Further, the Veteran reported that his symptoms have led to a lack of interest in activities that he previously enjoyed, to the point he was unable to identify any current leisure activities or hobbies. Finally, the Veteran's symptoms of social withdrawal and avoidance of crowds and loud noises addressed above, have impacted his ability to frequent the environments where the activities he previously enjoyed had taken place. Taken together, the record supports a finding that the Veteran experiences significant social impairment due to his PTSD symptoms. Regarding the Veteran's occupational impairment, the record indicates that the Veteran has been gainfully employed with the Social Security Administration since 2011. Despite this encouraging finding, the record indicates that the Veteran struggles to interact with members of the population at large because of the distrust, suspiciousness, anxiety, and outbursts of anger and irritability manifested by his symptoms. Moreover, the Veteran's symptoms have affected his ability to maintain effective work relationships, resulting in his being disciplined for disputes with coworkers and supervisors. Finally, the Veteran's daytime fatigue from his chronic sleep impairment, and his need to complete obsessional rituals has impacted his energy, concentration, and ability to complete tasks and projects at work. Overall, the record establishes that the Veteran does experience significant occupational impairment due to his symptoms; however, the Veteran's general success and longevity in his position tends to contradict the notion that his symptoms are causing occupational impairment that exceeds what is contemplated by the symptoms within the 70 percent criteria. Putting it all together, the Veteran's February 2025 and October 2024 medical examiners found that his symptoms caused occupational and social impairment with deficiencies in most areas, which warranted the currently assigned 70 percent rating. Of note, determining the level of a veteran's occupational and social impairment is an adjudicative rather than a medical question. 38 C.F.R. § 4.126(a). Here, however, the Board agrees that the competent and credible evidence of record indicates that the Veteran experiences symptoms that present impairment with deficiencies in most areas, and thus his currently assigned 70 percent rating is appropriate. In reaching this conclusion, the Board acknowledges the Veteran's contention that he is entitled to a 100 percent rating for his disability. See April 2025 VA Form 10182. However, the record is devoid of any of the symptoms noted in the 100 percent criteria. There was no evidence in the claims file of active delusions, hallucinations, severe memory loss, disorientation to time or place, grossly inappropriate behaviors or grossly impaired thoughts or illogical speech. As previously noted, while the record did reflect a report of passive suicidal ideation without intent or plan during the rating period, the record does not reflect that the Veteran has been a "persistent" danger to himself or others. Ultimately, the Board must consider the severity, frequency, and duration of the Veteran's symptoms within the totality of the evidentiary record, which in this case does not otherwise support a finding that the Veteran has occupational or social impairment as characterized by the 100 percent criteria. To the contrary, the Veteran presents as generally well groomed, thoughtful, and coherent. While the record establishes that he has experienced significant social and occupational impairment during the rating period, he has been able to maintain lasting relationships with his family members and he has demonstrated an ability to maintain gainful employment with the Social Security Administration for approximately fifteen years, suggesting that his symptoms, taken together, do not correspond to the total social and occupational impairment contemplated by the 100 percent rating criteria. In rendering this decision, the Board is not minimizing the Veteran's symptoms nor his sincere belief that he is entitled to a higher rating. However, again, the record at this juncture does not demonstrate that the frequency, duration, and severity of the Veteran's symptoms impair him as contemplated by the 100 percent rating criteria. Given the foregoing, the Board finds that the Veteran's disability was manifested by psychiatric symptomatology productive of occupational and social impairment with deficiencies in most areas, without more severe manifestations resulting in total occupational and social impairment. Accordingly, a disability rating in excess of 70 percent must unfortunately be denied. Service connection for right lower extremity hypoesthesia & paresthesia is denied. Service connection for right lower extremity restless leg syndrome is denied. Service connection for left lower extremity restless leg syndrome is denied. The Veteran seeks service connection for right lower extremity hypoesthesia and paresthesia and bilateral lower extremity restless leg syndrome, that he generally contends is related to his service. See January 2025 VA Form 21-526EZ, Fully Developed Claim. Law and Regulations Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). When considering the existence of a disability, VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009); 38 U.S.C. § 1154(a). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). When the evidence is in approximate balance in the veteran's favor or nearly equal 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; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). Analysis Turning to the first element of service connection, or the existence of a disability, the Veteran was afforded a VA medical examination to evaluate his claimed conditions in March 2025. During the examination, the examiner documented the Veteran's lay reports that he experiences the feeling of an "electrical charge" from both knees down to his lower legs, that his legs move involuntarily while laying down, and that he feels occasional aching discomfort in both legs. See March 2025 VA Peripheral Nerve Disability Benefits Questionnaire (DBQ). Further, the Veteran indicated that the onset of these symptoms was 2015, and that he did not receive any treatment, medication, or diagnostic testing of the claimed conditions. Following their review of the Veteran's lay reports, the examiner completed a thorough examination of the Veteran's peripheral nerves, noting that his muscle strength, reflexes, and sensation to light touch were normal. Further, that there were no trophic changes attributable to peripheral neuropathy, that the Veteran's gait was normal, and that he did not use any assistive devices for mobility. Finally, the examiner evaluated the Veteran's upper and lower extremity nerve groups for evidence of paralysis, but determined that each nerve group was normal. Ultimately, following their examination, the examiner concluded that the available evidence did not support a finding that the Veteran's reported symptoms were associated with a peripheral nerve disability. Consequently, the examiner determined that the Veteran does not have a lower extremity peripheral nerve disability, to include restless leg syndrome, hypoesthesia, and/or paresthesia. Notably, the Board observes that the examiner's findings are generally corroborated by the remainder of the probative medical evidence within the record, which does not contain a current diagnosis for the claimed conditions. Among the evidence considered, the Board reviewed additional VA medical examinations addressing the Veteran's knees/lower legs in November 2018 and April 2019, and his thoracolumbar spine in April 2019, as these examinations do include a degree of overlapping or related inquiries. However, these examinations also do not include any evidence of complaints, treatment, or diagnoses for the claimed conditions. Moreover, the examinations were negative for any evidence of lower extremity radiculopathy, and the Veteran's reflexes and sensory examinations in his lower extremities were found to be normal. See April 2019 VA Back (Thoracolumbar Spine) DBQ; see also, November 2018 VA Knee/Lower Leg DBQ; April 2019 VA Knee/Lower Leg DBQ. Thus, after review, the Board finds the March 2025 peripheral nerve examination to be thorough and complete and concludes that it adequately considered the Veteran's lay reports. As such, this is an adequate opinion entitled to probative weight. Consequently, based on the probative medical evidence of record, the Board finds that the Veteran does not have a diagnosis for the claimed conditions. In reaching this conclusion, the Board considered an October 2024 private medical examination in which an examiner submitted positive nexus opinions for all the above-mentioned disabilities, offering a conclusory statement that he has diagnoses for hypoesthesia, paresthesia, and restless leg syndrome. See January 2025 Medical Treatment Record Non Government Facility. However, the examiner did not provide any information as to what evidence she reviewed and/or testing she conducted prior to reaching her conclusions, beyond reciting what the Veteran told her. See LeShore v. Brown, 8 Vet. App. 406, 409 (1995)(evidence that is simply information gleaned from a veteran and recorded by a medical examiner, unenhanced by any medical comment by that examiner, does not constitute competent medical evidence.). Consequently, the Board is unable to conclude that the October 2024 private examiner has applied their own valid medical analysis to the pertinent facts of the Veteran's case. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted."). As a result, the Board finds that the October 2024 private medical opinion is inadequate, and it is not entitled to probative weight. Despite the absence of a formal diagnosis of hypoesthesia, paresthesia, or restless leg syndrome, the Board considered whether the Veteran's lay reports, including that he experiences occasional aching discomfort, involuntary movements, and a feeling of "electrical charge" in his lower extremities, support a finding that his symptoms result in functional impairment of his earning capacity and thus rise to the level of a disability even absent a formal diagnosis. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). However, here the evidence does not support such a finding. Initially, the March 2025 medical examiner considered the Veteran's lay reports and concluded that the Veteran's reported symptoms did not cause functional impairment. See March 2025 VA Peripheral Nerve DBQ. Moreover, the record does not contain any lay statements by the Veteran, or any other evidence, that suggests that his symptoms result in any functional impairment of his earning capacity. Finally, the Board considered the VA's rating schedule for neurological conditions as relevant and instructive with regard to whether the Veteran's symptoms caused functional impairment. See Wait v. Wilkie, 33 Vet. App. 8 (2020); see also, 38?C.F.R. §?4.124a, Diagnostic Code (DC) 8520. However, as addressed above, on examination there was no evidence that the Veteran experienced any degree of lower extremity paralysis. See March 2025 VA Peripheral Nerve DBQ. Taken together, the Board concludes that the evidence does not support a finding that the Veteran experiences functional impairment sufficient to constitute a disability. Given the aforementioned findings, the Board concludes that the Veteran does not have a disability for the claimed conditions and the first element of service connection is not met. In the absence of a disability, there can be no valid claim for service connection, and the Board need not address the remaining elements of service connection. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). On a final note, the Board acknowledges the Veteran's sincere belief that he has current disabilities for the claimed conditions. Additionally, the Board recognizes that the Veteran is both competent and credible to speak to his current symptoms, as they are within the realm of his personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 471 (1994). However, the Board concludes that the Veteran is not competent to determine that the symptoms he has described rise to the level of a medical diagnosis of hypoesthesia, paresthesia, and restless leg syndrome, as these conditions represent complex peripheral nerve disabilities, a diagnosis of which is outside the realm of lay observation. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). ? In summation, as the competent and credible evidence of record is persuasively against the Veteran's position, the benefit of the doubt doctrine does not apply in this case and the claims for service connection must unfortunately be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Todd; Associate 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.