## Facts

- Luis A. Martinez-Bodon, a U.S. Army veteran (Aug. 1967–Mar. 1969), sought VA disability benefits in 2016 for diabetes mellitus and a secondary “mental condition.”
- At a VA psychiatric examination, he reported sleep problems, anxiety, and physical symptoms that made him anxious.
- The examiner concluded his symptoms did not meet DSM-5 criteria for a mental disorder and therefore did not provide a DSM-5 psychiatric diagnosis.
- The VA regional office granted service connection for diabetes (20% rating) but denied service connection for any mental disorder based on the absence of a DSM-5 diagnosis.
- The Board of Veterans’ Appeals denied service connection for an anxiety disorder, finding no current diagnosed psychiatric disability under DSM criteria and concluding the veteran was not competent to self-diagnose a psychiatric disorder.
- On appeal, Martinez-Bodon argued that compensation should be available for functionally impairing psychiatric symptoms even without a formal diagnosis, relying on the statutory “disability” definition recognized in Saunders v. Wilkie; alternatively, he sought separate compensation for anxiety and sleep problems secondary to diabetes.

## Issues

1. Whether the statutory meaning of “disability” under 38 U.S.C. § 1110, as “functional impairment of earning capacity,” applies beyond pain to include undiagnosed psychiatric conditions producing functional impairment.
2. Whether 38 C.F.R. §§ 4.125(a) and 4.130 require a DSM-5-conforming diagnosis as a prerequisite to compensating a psychiatric disability.
3. Whether the court has jurisdiction to invalidate or review VA’s policy choice in the rating schedule to require DSM-5 diagnoses for compensable psychiatric disabilities.
4. Whether anxiety and sleep symptoms can be separately compensated absent a DSM-5 psychiatric diagnosis.

## Decision

- The court held that the § 1110 definition of “disability” as functional impairment of earning capacity is not limited to pain and may include psychiatric conditions as a general statutory matter.
- The court interpreted 38 C.F.R. §§ 4.125(a) and 4.130 to require a DSM-5 diagnosis to compensate a psychiatric disability.
- The court held it lacked jurisdiction to review or second-guess the Secretary’s substantive policy choice in the rating schedule to impose the DSM-5 diagnosis requirement.
- Because Martinez-Bodon had no DSM-5 diagnosis, the court affirmed the Board’s denial of service connection for a psychiatric disability and rejected separate compensation for the symptoms absent a DSM-5 diagnosis.

## Legal Principles

- Under 38 U.S.C. § 1110, “disability” means functional impairment of earning capacity, and this definition applies to conditions generally, not only to pain.
- For VA compensation of mental disorders, 38 C.F.R. § 4.125(a) (DSM-5 conformity) and § 4.130 (mental-disorder rating formula) operate as a threshold requirement: a DSM-5 diagnosis is required for a compensable psychiatric disability.
- The court may interpret VA regulations, including those in the rating schedule, but lacks jurisdiction to review the content of the rating schedule as a policy matter or to decide whether the schedule’s DSM-5 requirement is consistent with § 1110.
- Lay evidence is competent to describe observable psychiatric symptoms but cannot substitute for a DSM-5 diagnosis where regulations require one for compensation.

## Conclusion

The court recognized that § 1110’s concept of “disability” extends to any condition causing functional impairment of earning capacity, including psychiatric conditions, but held that VA’s mental-disorder regulations require a DSM-5 diagnosis for compensation; with no DSM-5 diagnosis, the denial of service connection for a psychiatric disability was affirmed.


Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020)