The veteran sought a rating higher than 30 percent for service-connected PTSD. The record contained multiple examinations and reports with different descriptions of severity and employability, including VA clinicians who noted improvement with treatment and a private psychologist who described severe chronic PTSD with severe work-related impairment. The Board denied an increase, emphasizing selected findings of orientation, logical thought, and memory, but did not meaningfully address the conflicting evidence or the private psychologist’s report. The Court held that the Board was required to thoroughly analyze and reconcile all relevant evidence and that its selective treatment of the record was inadequate. The Court also held that, given the wide divergence in the medical evidence, the Board’s refusal to order a complete psychoneurological examination violated the duty to assist. The decision was vacated and remanded for a new examination by different examiners with access to the relevant records.

The Board must consider, analyze, and reconcile all materially relevant evidence when rating psychiatric disability, and where the record contains substantial conflict about severity, VA’s duty to assist may require a new examination.

A rating decision is vulnerable when the Board cherry-picks favorable findings and ignores contrary evidence that materially supports a higher evaluation. Counsel should use Cousino to demand full evidentiary reconciliation and, when warranted, a new examination.

Cousino is a practical reminder that PTSD ratings cannot rest on isolated normal findings when the record contains evidence of severe symptoms and occupational impairment. It strengthens challenges to inadequate Board factfinding and supports remand requests for a fresh examination when the evidence is internally inconsistent.

The Board relies on selected favorable findings while failing to reconcile contrary medical evidence supporting a higher PTSD rating.

A veteran has several VA notes describing improvement, but a private psychologist reports severe PTSD symptoms and major occupational impairment. The Board denies a higher rating based only on orientation, memory, and coherent speech without discussing the private report. Cousino supports remand.

Cite this case to argue that the Board must address every materially favorable examination and explain why conflicting evidence does not support a higher rating. It is also helpful when seeking a new exam due to inconsistent severity findings across providers.

38 C.F.R. § 4.2, 38 C.F.R. § 4.130, 38 C.F.R. § 3.327(a), 38 U.S.C. § 5107(a)