SCHIZOPHRENIA

T. RAYMOND · 2026 · Case ID: A26033257

MIXED

Summary

The Veteran, a Navy Veteran who served from February 1982 to January 1992, appeals the evaluation of his psychiatric disability. The primary issue before the Board was entitlement to a higher initial evaluation for unspecified schizophrenia spectrum and other psychotic disorder, which was granted service connection in an earlier decision. The Veteran sought an evaluation of 70 percent. The Board reviewed extensive treatment records from July 2018 through December 2020, noting fluctuating symptoms including tangential and disorganized thought processes, passive suicidal ideation, and occasional hallucinations, alongside periods of fair judgment and intact insight. A June 2024 VA examination diagnosed unspecified schizophrenia spectrum and other psychotic disorder, noting occupational and social impairment with reduced reliability and productivity, including disorganized thinking, depressed mood, and difficulty maintaining relationships. The Board found that the Veteran's symptoms, particularly the presence of hallucinations and passive suicidal ideation, along with tangential and disorganized thinking, more closely approximated the criteria for a 70 percent evaluation. Applying the benefit of the doubt, the Board granted a 70 percent evaluation for the period on appeal, finding it did not meet the criteria for total occupational and social impairment. The Board also remanded the issue of entitlement to Total Disability based on Individual Unemployability (TDIU), citing a duty-to-assist error by the agency of original jurisdiction for failing to develop this claim, given the evidence suggesting the Veteran's service-connected disabilities impacted his ability to work.

Rationale

Symptoms more closely approximate criteria for 70% rating; Benefit of the doubt afforded to Veteran; Symptoms include hallucinations and passive suicidal ideation

Service Branch

NAVY

Special Benefit

TDIU

Docket No.

210614-165695

Full Decision Text

Citation Nr: A26033257
Decision Date: 04/09/26 Archive Date: 04/09/26

DOCKET NO. 210614-165695
DATE: April 9, 2026

ORDER

Entitlement to an initial evaluation of 70 percent, and no higher, for unspecified schizophrenia spectrum and other psychotic disorder, is granted, subject to the rules and regulations governing the award of monetary benefits.

REMANDED

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. The severity, frequency, and duration of the Veteran's symptoms, including delusions, hallucinations, and passive suicidal ideation, more closely approximate occupational and social impairment with deficiencies in most areas.

2. The severity, frequency, and duration of the Veteran's symptoms do not more closely approximate total occupational and social impairment.

CONCLUSION OF LAW

The criteria for an initial evaluation of 70 percent, and no higher, for unspecified schizophrenia spectrum and other psychotic disorder disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 8045-9201.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the United States Navy from February 1982 to January 1992.

The rating decision on appeal was issued in April 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the June 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. In November 2024, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the April 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 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 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.

The Board notes that the initial VA Form 10182 dated in June 2021 states that the Veteran was appealing decision on the issue of unspecified schizophrenia spectrum and other psychotic disorder adjudicated in an April 2021 rating decision. The April 2021 rating decision granted service connection and assigned an effective date and initial evaluation for this disability. As such, the VA Form 10182 was unclear at to the nature of the Veteran's disagreement. However, in a statement dated in February 2025 the Veteran's representative clarified that the Veteran sought a higher evaluation for his psychiatric disability, specifically, an evaluation of 70 percent. Therefore, the Board has considered the issue of entitlement to a higher initial evaluation for the Veteran's psychiatric disability.

1. Entitlement to an initial evaluation in excess of 50 percent for unspecified schizophrenia spectrum and other psychotic disorder.

The Veteran seeks entitlement to a higher evaluation for his service-connected psychiatric disability.

Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings
with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Initially, the Veteran was assigned an evaluation of 50 percent pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9201, for schizophrenia. However, after the rating decision on appeal, in July 2024 the Veteran was granted entitlement to service connection for traumatic brain injury (TBI), effective October 26, 2017. The evaluation for TBI and the Veteran's psychiatric disability were combined effective the date of the grant of the Veteran's psychiatric disability of July 12, 2018, as an examiner could not delineate the symptoms between the Veteran's psychiatric disability and TBI.

The rating currently in effect for the Veteran's disability is assigned pursuant to 38 C.F.R. § 4.130, Diagnostic Code 8045-9201. The hyphenated diagnostic code in this case indicates that the symptomatology of the traumatic brain injury residuals are manifested as the Veteran's psychiatric disability pursuant to Diagnostic Code 8045, with Diagnostic Code 9201 representing the evaluation of the schizophrenia as the primary symptomatology of the traumatic brain injury.

As set forth in Diagnostic Code 8045, there are three main areas of dysfunction that may result from a TBI and have profound effects on functioning: cognitive (which is common in varying degrees after a traumatic brain injury), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation. Here, however, the Veteran has specifically appealed the evaluation of his psychiatric disability and when service connection was granted for TBI it was determined that an examiner could not delineate separate disabilities. Accordingly, the Board will consider solely the psychiatric symptomatology attributed to the schizophrenia that the Veteran exhibited during the time period on appeal. To that end, the Board notes that Diagnostic Code 9201 provides that schizophrenia is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130.

Under the General Formula for Mental Disorders (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. § 4.130. 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, 114-118 (Fed. Cir. 2013).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. § 4.130, Diagnostic Code 9201.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work
work and social relationships cause occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. § 4.130, Diagnostic Code 9201.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. See id.

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; or memory loss for names of close relatives, own occupation, or own name. See id.

Affording the Veteran the benefit of the doubt, the Board finds that the Veteran is entitled to an evaluation of 70 percent, and no higher, for the entire period on appeal.

The Veteran underwent a VA examination for residuals of a TBI in February 2018. The Veteran was noted to have no complaints of impairment of memory, attention, concentration, or executive functions; normal judgment; routinely appropriate social interaction; always oriented; normal motor activity; and normal visual spatial orientation.

The Veteran has undergone consistent VA treatment for his psychiatric disability during the period beginning July 2018. In July 2018 the Veteran was noted to have no suicidal or homicidal ideation. He had adequate sleep for rest and functioning. His appetite was good and energy was adequate for activities of daily living.

In March 2019 the Veteran reported that he was not suicidal but that he had suicidal thoughts in the past. In another note dated in the same month, the Veteran reported fleeting suicidal ideations in the past with no plan or intent to act on them.

The Veteran repeated that he had a history of fleeting thoughts of suicidality in April 2019. He described these as introspective thoughts as to why he was there and would he get better. He denied any specific plan or intent to harm himself. The Veteran was alert and oriented, had slightly anxious mood, and a broad affect. He was tangential and often spoke off topic. He had a fair difficulty with answering specific questions. Speech was within normal limits. Capacity for insight appeared fair and the Veteran's judgment was intact.

In July 2019 the Veteran reported that his mood was okay. His affect was congruent. There was no indication of hallucination. Thought process was tangential with appropriate content. Judgment, insight, and memory were good. The Veteran admitted to suicidal ideation; however, he denied intent and plan.

In October 2019 the Veteran was noted to be oriented times four, have tangential thought process, and have a euthymic affect/mood. The Veteran's interpersonal style was intellectualizing, avoidant, and cooperative. His speech and gait were normal. The Veteran reported passive suicidal ideation more than half of the days. He denied any active suicidal ideation or any historical suicide attempts. He denied any intent or plan for suicide. He did not report homicidal ideation or hallucinations.

Thereafter, in November 2019 the Veteran again had tangential thought process with flight of ideas and incongruous idea associations. However, the Veteran did not report any suicidal ideation, suicide attempts, homicidal ideation, or hallucinations.

In December 2019 the Veteran denied suicidal ideation. However, the Veteran reported possible auditory hallucinations. He denied command hallucinations. In January 2020 the Veteran endorsed daily passive suicidal ideation without intent or plan. In February 2020 the Veteran did not express any hallucinations, suicidal ideation, or homicidal ideation.

The Veteran again expressed hallucinations in April 2020. At that time they were commands in nature but not to harm himself or others. At that time the Veteran was oriented. His thought process was tangential with flight of ideas and incongruous idea associations. His mood and affect were anxious. In May 2020 the Veteran denied current suicidal ideation and hallucinations.

The Veteran underwent an extensive consultation in May 2020. The mental status examination and behavioral observations were noted to show that the Veteran was pleasant and cooperative during the assessment and maintained appropriate eye contact. His mood shifted during the session. He began with an elevated mood with an increased rate of speech that at times seemed pressured. As the session progressed the Veteran's mood drained and his speech became more labored with audible sighs before answering questions. The Veteran's speech was within normal limits. His thought process was disorganized and tangential, often straying away from the topic in an attempt to connect unrelated topics. He would need to be reminded of questions at times. There were no clear indicators of hallucinations and the Veteran denied current suicidal and homicidal ideations. However, he stated that he often did not care if he lived.

In the summary provided, the evaluator reported that the Veteran's providers had identified a current symptom profile that included disorganized thinking/speech with flight of ideas and loose associations, potential auditory hallucinations, paranoia, delusions, and passive suicidal ideations. The evaluator indicated that the Veteran's speech and thought processes were disorganized and tangential throughout each of his interactions, and that he reported disorganized behaviors, depressed mood, and inability to form and maintain relationships.

The evaluator noted that the Veteran's records prior to October 2019 did not identify disorganized or delusional thinking. It was stated that this incongruence between the Veteran's reports and the record called into question the Veteran's ability to accurately recall his history. The evaluator noted that it was clear that the Veteran had delusional thinking throughout his interactions with the evaluator, first found in the record in October 2019.

In July 2020 the Veteran was casually dressed and maintained good eye contact. Thoughts were very tangential and loosely connected. Insight and judgement were fair. He reported feeling anxious with depressed mood. The Veteran was noted to smile at times when discussing stressors, it was discussed that this is used a coping skill. He was oriented, had no current suicidal ideation, homicidal ideation, or hallucinations. In addition, the Veteran was noted to have a suicide risk. He reported that he sometimes struggled with passive thoughts of suicide.

In some subsequent treatment notes it was identified that the Veteran had suicidal thoughts, intermittent, and intermittent passive suicidal ideation. See VA Treatment, July 2020, October 2020. In other treatment notes, the Veteran denied suicidal ideation. See VA Treatment, February 2020, May 2020, June 2020, July 2020, August 2020, September 2020, October 2020, and December 2020.

The Veteran was afforded a VA examination regarding his claimed psychiatric disability in March 2021. The Veteran was diagnosed with unspecified schizophrenia spectrum and other psychotic disorder. The examiner noted that a mental condition had been formally diagnosed but that symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. The Veteran reported that he had a distant relationship with his family. He was divorced with three children. He did not have a relationship with his children. He had part time jobs. The Veteran's symptoms were noted to be persistent delusions or hallucinations. The Veteran was cooperative. He was well groomed and his posture and motor behavior were normal. Eye contact was appropriate. His speech was fluent and quality of voice was clear. His thought process was coherent and goal directed with no evidence of hallucinations, delusions, or paranoia in the evaluation setting. His affect was appropriate to speech and thought content. He was alert and oriented. Attention and concentration were intact. His recent and remote memory were intact. His insight and judgment were fair.

In February 2025, within 90 days of the withdrawal of the request for a hearing, the Veteran's representative submitted a VA examination report dated in June 2024. This report diagnosed the Veteran with unspecified schizophrenia spectrum and other psychotic disorder. The examiner noted that the Veteran had occupational and social impairment with reduced reliability and productivity. The Veteran was noted to be living alone. He had been divorced for 14 years and had three children with whom he had no contact. The Veteran reported a small group of friends and some connection with family. The Veteran was noted to have symptoms of depressed mood, anxiety, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and persistent del
His insight and judgment were fair.

Affording the Veteran the benefit of the doubt, the Veteran's symptoms more nearly approximate the criteria for an evaluation of 70 percent, and no higher, for the entire period on appeal. During the period on appeal the Veteran's psychiatric disability's symptoms have varied. However, during the period on appeal the Veteran's disability manifested symptoms of hallucinations as well as passive suicidal ideation. Although treatment in July 2018 does not indicate that the Veteran had suicidal ideation, in March 2019 the Veteran reported that he had a history of suicidal ideation in the past without a plan or intent to act. During the period on appeal the Veteran's symptoms also included tangential and disorganized thought process and speech, and difficulty answering questions, and delusional thinking. In an examination report dated in June 2024 the Veteran had disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and persistent delusions. Furthermore, during the period on appeal the Veteran isolated himself; however, he reported a small group of friends and some employment. The Board finds, affording the Veteran the benefit of the doubt, his symptoms more nearly approximate an evaluation of 70 percent, during the entire period on appeal.

However, the Board further finds that entitlement to an evaluation in excess of 70 percent is not warranted. The Veteran's disability does not manifest symptoms of total occupational and social impairment. Although it is clear that the Veteran's disability impacts his ability to work, the Veteran has reported some employment during the period on appeal. In addition, the Veteran has reported that he had a small group of friends.

Therefore, entitlement to an initial evaluation of 70 percent, and no higher, for unspecified schizophrenia spectrum and other psychotic disorder, is granted, subject to the rules and regulations governing the award of monetary benefits.

REASONS FOR REMAND

1. Entitlement to a TDIU is remanded.

The record shows that during the period on appeal the Veteran was in receipt of service connected disability benefits for unspecified schizophrenia spectrum and other psychotic disorder, lumbar spine degenerative arthritis and degenerative disc disease, degenerative right hip disability, scar on the trunk of the body, and TBI. The record shows that the symptoms of the Veteran's disabilities, including his unspecified schizophrenia spectrum and other psychotic disorder impact his ability to work. See, e.g., VA Examinations March 2018, March 2021, and June 2024.

A request for a total disability rating based on individual unemployability (TDIU), whether expressly raised by a Veteran or reasonably raised by the record, is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability as part of a claim for increased compensation. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). In other words, if either the Veteran or the evidence of record reasonably raises the question of whether a Veteran is unemployable due to a disability for which an increased rating is sought, then "part and parcel" with the increased rating claim is the issue of whether a TDIU is also warranted because of that disability. Id.

Here, the Veteran sought a higher evaluation for a psychiatric disability and the record indicates that the Veteran's disability impacts his ability to work.

Under the AMA, the Board may only remand an issue for the correction of (1) duty-to-assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty-to-assist errors) and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802 (a).

Under these circumstances, as the evidence of record demonstrates a reasonable possibility that the Veteran may have been unable to secure and follow substantially gainful employment due to his service-connected disabilities, including his unspecified schizophrenia spectrum and other psychotic disorder, lumbar spine degenerative arthritis and degenerative disc disease, degenerative right hip disability, scar on the trunk
(1) duty-to-assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty-to-assist errors) and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802 (a).

Under these circumstances, as the evidence of record demonstrates a reasonable possibility that the Veteran may have been unable to secure and follow substantially gainful employment due to his service-connected disabilities, including his unspecified schizophrenia spectrum and other psychotic disorder, lumbar spine degenerative arthritis and degenerative disc disease, degenerative right hip disability, scar on the trunk of the body, and TBI, the AOJ should have developed a claim for TDIU in accordance with Rice prior to the rating decision on appeal, and its failure to do so represents a pre-decisional duty-to-assist error that must be rectified on remand. 22 Vet. App. at 453-54. In this respect, clarifying information regarding the Veteran's educational and occupational history is also needed for adjudication of the claim for a TDIU.

The matters are REMANDED for the following action:

Send the Veteran a VA Form 21-8940, Veteran's Application for Increased Compensation Based on Unemployability, and request that he provide the necessary employment and education history to develop and adjudicate the claim for a TDIU.

T. RAYMOND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Robert J. Burriesci, 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.

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