MAJOR DEPRESSIVE DISORDER

K. L. WALLIN · 2026 · Case ID: A26030348

MIXED

Summary

The veteran, who served in the Army from March 1992 to June 1997, appealed the denial of an increased rating for his service-connected major affective disorder, bipolar, mixed. The Board reviewed the evidence, including VA outpatient treatment records, a February 2020 VA examination, and testimony from the veteran's wife at a July 2024 hearing. The VA examiner found the veteran's symptoms of major affective disorder to be moderate, with some overlap with a personality disorder, and noted that while symptoms could interfere with demanding work, the veteran could likely perform in a modified sedentary or solitary environment. The veteran's wife testified about his nightmares and mood swings. The Board found the evidence, particularly VA treatment records and the VA examination, persuasively weighed against total occupational and social impairment. It concluded that the veteran's symptoms, while accounting for his history of suicidal attempts and current aggressivity, did not more nearly approximate the criteria for a 100 percent rating, thus denying the increased rating. The case also involved a remand for entitlement to service connection for adenocarcinoma of the rectum and colon cancer, based on the possibility of outstanding private medical records from St. Vincent Cancer Center that were not considered by the AOJ.

Rationale

Board found evidence persuasively weighed against total occupational and social impairment.; Symptoms of aggressivity, impulsiveness, nightmares, and sleep problems accounted for in 70% rating.; No evidence of gross impairment in thought processes, persistent delusions, or grossly inappropriate behavior.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200218-116975

Full Decision Text

Citation Nr: A26030348
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 200218-116975
DATE: April 2, 2026

ORDER

Entitlement to an evaluation in excess of 70 percent for major affective disorder, bipolar, mixed (major affective disorder) is denied.

REMANDED

Entitlement to service connection for adenocarcinoma of rectum is remanded.

Entitlement to service connection for colon cancer is remanded.

FINDING OF FACT

Throughout the review period, the Veteran's major affective disorder more closely approximated occupational and social impairment with deficiencies in most areas; there has been no evidence that his major affective disorder resulted in total occupational or social impairment.

CONCLUSION OF LAW

The criteria for entitlement to an evaluation in excess of 70 percent disabling for major affective disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9432.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served in the Army from March 1992 to June 1997. The Veteran died in April 2020. The Appellant is the Veteran's spouse.

This case is before the Board of Veterans' Appeals (Board) on appeal from a February 2020 rating decision.

In the February 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 29, 2024.

Therefore, the Board may only consider the evidence of record at the time of the February 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Appellant [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Appellant 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 claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Rating

Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the disability. 38 C.F.R. § 4.1.

Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3.

1. Entitlement to a rating in excess of 70 percent for major affective disorder

The Appellant asserts that the Veteran is entitled to a higher evaluation for his service-connected major affective disorder.

The Veteran's major affective disorder is rated under Diagnostic Code (DC) 9432. All psychiatric disorders are evaluated under the General Rating Formula for Mental Disorders (General Rating Formula) 38 C.F.R. § 4.130.

1. Entitlement to a rating in excess of 70 percent for major affective disorder

The Appellant asserts that the Veteran is entitled to a higher evaluation for his service-connected major affective disorder.

Under DC 9432, a 70 percent rating is assigned for 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 worklike setting); inability to establish and maintain effective relationships.

A 100 percent rating is assigned for 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; memory loss for names of close relatives, own occupation, or own name.

The symptoms listed in the rating schedule are not intended to constitute an exhaustive list but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002).

Under the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.126. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-18 (Fed. Cir. 2013). VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a).

The Board notes that, because the General Rating Formula explicitly references medication in rating mental disorders (specifically under the 10 percent rating criteria, which contemplates "symptoms controlled by continuous medication," see 38 C.F.R. § 4.130), the holdings of Jones and Ingram, which provide that the Board must discount beneficial medication effects when assigning an evaluation, are inapplicable. Jones v. Shinseki, 26 Vet. App. 56, 63 (2012); Ingram v. Collins, 38 Vet. App. 130, 131 (2025).

After reviewing the evidence of record, the Board has determined the evidence of record persuasively weighs against a finding that the Veteran's major affective disorder resulted in total and occupational social impairment. In this regard, VA outpatient treatment records indicate the Veteran's mood and affect were routinely normal, though there were some mood swings. There was no evidence of hallucinations. See e.g. April 2019, June 2019, July 2019. The Veteran denied any psychosocial distress in December 2019.

While January 2019 treatment notes from the Veteran's social worker indicate the Veteran's major affective disorder had worsened as a result of his life limiting cancer diagnosis, the February 2020 VA examiner noted only active symptoms of depressed mood and disturbances of motivation and mood. The examiner found that the Veteran's bipolar was only moderate in nature. However, the examiner did indicate it was not possible to differentiate what symptoms were attributed to the bipolar disorder as opposed to the personality disorder. Specifically, the examiner stated that there exists some potential for overlap of symptoms across the two disorders including impulsivity, agitation/aggressivity, grandiosity, making clear differentiation of portions of impairment speculative.

The February 2020 examiner found that the Veteran exhibited occupational and social impairment
2019 treatment notes from the Veteran's social worker indicate the Veteran's major affective disorder had worsened as a result of his life limiting cancer diagnosis, the February 2020 VA examiner noted only active symptoms of depressed mood and disturbances of motivation and mood. The examiner found that the Veteran's bipolar was only moderate in nature. However, the examiner did indicate it was not possible to differentiate what symptoms were attributed to the bipolar disorder as opposed to the personality disorder. Specifically, the examiner stated that there exists some potential for overlap of symptoms across the two disorders including impulsivity, agitation/aggressivity, grandiosity, making clear differentiation of portions of impairment speculative.

The February 2020 examiner found that the Veteran exhibited occupational and social impairment with reduced reliability and productivity. There was no indication of total impairment. In regard to relationships with others, the Veteran reported that outside of his current CNA, he had two friends that would come and visit him. The Veteran denied current suicidal ideation. He had a history of attempts in the past, which is accounted for in the 70 percent rating. The Veteran was appropriately dressed and his hygiene was ok. The examiner noted that the Veteran was grossly cooperative (noncooperative in terms of participating in objective psychological assessment using MMPI2RF, as Veteran refused to follow instructions, hand wrote many responses to the test booklet, with such appearing rather petulant).

The Veteran was verbally aggressive at times, cursed frequently, expressed annoyance with examiner questions, refused to answer some, was vague/evasive at times, and gave answers that were clearly contradicted by cited records at times. But the Veteran's speech was coherent. His mood was dysphoric and his affect irritable. The Veteran endorsed auditory hallucinations in the past. His thought process was logical and goal directed. He was oriented in all spheres; his recent and remote memory was intact. The Veteran denied homicidal ideation. The examiner found that the Veteran's attention was poor to fair, his intelligence estimate was average range, his judgment and insight were poor as the examiner indicated he likely had difficulties understanding outcome of his behaviors and the nature of his problems. The Veteran's overall psychiatric symptoms were considered moderate. The examiner stated that while his symptoms could interfere with tasks in a demanding and rigid work environment, the Veteran would still be able to perform work tasks in a sedentary and/or solitary environment. The examiner concluded his psychiatric symptoms alone would not preclude him from engaging in some type of modified work environment.

The Veteran's wife (the Appellant) testified during the July 2024 Board hearing that the Veteran had horrible nightmares. She also testified that she could not touch him when entering the room, and she had to announce herself, if not he would punch and come up fighting while he was sleeping. The Veterans wife testified that every day was a different day, different mood and the Veteran only socialized with family. She testified that the Veteran saw a psychiatric doctor and was on medication.

Based on the above, the Board finds that the signs and symptoms associated with the Veteran's affective disorder did not for any of the period on review more nearly approximate total occupational and social impairment as required for a 100 percent disability rating. 38 C.F.R. § 4.130. Specifically, the frequency, severity, and duration of the Veteran's impairment did not totally preclude him from obtaining and maintaining social and occupational opportunities. Symptoms of aggressivity, impulsiveness, nightmares, and sleep problems, as well as a history of suicidal attempts are accounted for in the current 70 percent rating.

There was no evidence of gross impairment in thought processes or communication. The Veteran did not have persistent delusions. Auditory hallucinations were in the past. There was no evidence of grossly inappropriate behavior or persistent danger of hurting self or others. The Veteran was able to perform activities of daily living, and his hygiene was routinely noted as ok. The Veteran was oriented in all spheres. The Veteran's memory, both recent and remote, were intact.

The Board is aware that the symptoms listed under the 70 and 100 percent ratings are essentially examples of the type and degree of symptoms for that evaluation, and that the Veteran need not demonstrate those exact symptoms to warrant a 100 percent rating. See Mauerhan v. Principi, 16 Vet. App. at 442. However, the Board finds that the persuasive weight of the evidence, including the VA treatment records and the February 2020 VA examination, shows that the symptomology and degrees of social and occupational impairment more nearly approximated the criteria for a 70 percent rating for the entire review period but did not more nearly approximate the higher 100 percent disability rating criteria; thus, the appeal must be denied.

REASONS FOR REMAND

1. Entitlement to service connection for
percent ratings are essentially examples of the type and degree of symptoms for that evaluation, and that the Veteran need not demonstrate those exact symptoms to warrant a 100 percent rating. See Mauerhan v. Principi, 16 Vet. App. at 442. However, the Board finds that the persuasive weight of the evidence, including the VA treatment records and the February 2020 VA examination, shows that the symptomology and degrees of social and occupational impairment more nearly approximated the criteria for a 70 percent rating for the entire review period but did not more nearly approximate the higher 100 percent disability rating criteria; thus, the appeal must be denied.

REASONS FOR REMAND

1. Entitlement to service connection for adenocarcinoma of rectum

2. Entitlement to service connection for colon cancer

The Appellant asserts that the Veteran was entitled to service connection for adenocarcinoma of the rectum and for colon cancer. As an initial matter, the Board notes that the February 2020 rating decision included the favorable findings that the Veteran had diagnoses of adenocarcinoma of the rectum and metastatic colon cancer.

During the July 2024 Board hearing, the Appellant testified that the Veteran told her that he developed cancer when he had to throw out waste without masks or gloves into the Indian Ocean. She further testified that his treating physician from St. Vincent Cancer Center thought that the Veteran had been exposed to some sort of toxic chemical due to the growth of his cancer and the way it was in his body. The Appellant testified that the Veteran went to St. Vincent's Cancer Center and got a second opinion and brought it back to his VA provider at the Indianapolis, VAMC.

A review of the Veterans treatment records includes a notation in a December 2019 CAPRI record that he met with a Dr. M at St. Vincent for another opinion. As such, it appears there were outstanding private records prior to the decision on appeal and a remand is warranted. See 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

Obtain records of the Veteran from St. Vincent Cancer Center. Make two requests for the authorized records unless it is clear after the first request that a second request would be futile. All requests for records and their responses must be documented in the claims file.

K. L. Wallin

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Vample, Erica

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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