## Facts

- A Vietnam combat veteran served in Vietnam from roughly 1968 to 1970.
- After discharge, he experienced longstanding alcohol abuse and did not seek mental-health treatment at that time.
- In 1988, he was involved in a workplace explosion that rendered him unconscious, after which he developed psychological symptoms.
- He sought VA disability compensation for a psychiatric disorder claimed as PTSD.
- A VA examiner attributed his symptoms to combat-related experiences but diagnosed generalized anxiety disorder rather than PTSD.
- A private psychiatrist diagnosed delayed-onset PTSD linked to combat service.
- The VA denied service connection, and the Board of Veterans’ Appeals affirmed, concluding the psychiatric condition was not service-connected.
- The veteran appealed the Board’s decision to the United States Court of Veterans Appeals.

## Issues

1. Whether the Board erred by denying service connection for a psychiatric disability first formally diagnosed after service despite medical evidence relating the condition to combat service.
2. Whether the Board improperly focused on diagnostic labels (PTSD versus generalized anxiety disorder) rather than evaluating whether competent evidence established a nexus between current disability and in-service events.

## Decision

- The Court held that service connection is not limited to conditions diagnosed during service.
- The Court stated that service connection may be granted based on a post-service diagnosis when competent medical evidence relates the current condition to active service.
- The Court required readjudication under the correct legal standard, rejecting an approach that effectively demanded contemporaneous in-service diagnosis and inadequate consideration of favorable nexus evidence.

## Legal Principles

- Direct service connection may be established even if a disease is first diagnosed after discharge, if competent evidence links the current disability to service.
- The temporal gap between service and diagnosis is not dispositive; the key inquiry is whether the evidence establishes a medical nexus to an in-service event, injury, or disease.
- Adjudicators must assess the substance of medical nexus evidence and may not deny solely because clinicians use different diagnostic labels when the evidence attributes the current psychiatric condition to service.

## Conclusion

The case confirms that a veteran can obtain direct service connection for a disability diagnosed after service when competent medical opinion links the current condition to service, and it requires the Board to evaluate nexus evidence without treating the absence of an in-service diagnosis or delayed onset as a categorical bar.


Cosman v. Principi, 3 Vet. App. 503 (1992)