PSYCHOSES

Summary

The Veteran, who served from June 1993 to December 1996 and October 2000 to October 2005, appeals the denial of an initial rating in excess of 70 percent for a service-connected acquired psychiatric disorder prior to April 18, 2024. The Board reviewed the evidence of record as of the October 30, 2024 supplemental statement of the case, as the Veteran elected the Direct Review docket. The Veteran's claim for an increased rating was untimely for docket switching. The Board considered evidence including lay statements, VA treatment records, and VA examinations from 2007 through 2024. While the record documented symptoms such as depression, anxiety, sleep impairment, memory loss, decreased concentration, irritability, and suicidal ideation, the Board found the evidence persuasively weighed against entitlement to a 100 percent rating. The Board noted intermittent inability to perform daily activities and suicidal ideation, but found these did not rise to the level of total occupational and social impairment required for the maximum rating, particularly given the Veteran's consistent employment and denial of intent or plan for self-harm. The Board concluded that the Veteran's symptoms most closely approximated the criteria for a 70 percent rating throughout the period under review. Therefore, the claim for an initial rating in excess of 70 percent for the psychiatric disorder prior to April 18, 2024, was denied.

Rationale

Evidence did not demonstrate total occupational and social impairment.; Symptoms did not rise to the level required for 100% rating.; Impairment most closely approximated 70% rating criteria.

Full Decision Text

Citation Nr: A26037317
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 241119-495072
DATE: April 21, 2026

ORDER

An initial rating in excess of 70 percent for the Veteran's service-connected acquired psychiatric disorder prior to April 18, 2024 is denied. 

FINDING OF FACT

Throughout the claim period prior to April 18, 2024 (i.e., from June 16, 2008), the symptoms and overall impairment associated with the Veteran's service-connected acquired psychiatric disorder most closely approximated occupational and social impairment with deficiencies in most areas.

CONCLUSION OF LAW

Prior to April 18, 2024, the criteria for an initial disability rating in excess of 70 percent for an acquired psychiatric disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DCs 9411, 9434.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1993 to December 1996 and from October 2000 to October 2005. 

In October 2024, following a Board of Veterans' Appeals (Board) remand, the agency of original jurisdiction (AOJ) issued a supplemental statement of the case (SSOC) readjudicating this issue. The Veteran opted the claim into the modernized review system, also known as the Appeals Modernization Act (AMA) system, by submitting the November 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) associated with this appeal. Therefore, the October 30, 2024 SSOC is the decision on appeal.

In the November 2024 Notice of Disagreement, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the October 30, 2024 SSOC. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the October 30, 2024 SSOC, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 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, 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 Notice of Disagreement associated with this appeal also requested review of the effective dates assigned for the award of service connection for female sexual arousal disorder and the award of associated special monthly compensation based on loss of use of a creative organ under 38 U.S.C. § 1114(k). On November 4, 2025, the Veteran submitted a Notice of Disagreement requesting review of all of these issues on the evidence docket, which the Board has interpreted as a docket switch request.  As to the female sexual arousal disorder and special monthly compensation claims, the request has been granted, and those issues will be addressed in a separate decision. See February 12, 2026 BVA Letter. Regarding the claim for an increased rating for the Veteran's psychiatric disorder addressed herein, however, the request to switch dockets was untimely. 38 C.F.R. § 20.202(c)(2). The request was received on November 4, 2025, and the decision on appeal is the October 30, 2024 SSOC, as noted above. Good cause has not been shown for extending the time of filing. As the Veteran's modification request as to this issue was untimely, it has been denied as discussed in the February 12, 2026 Board letter, and the issue remains on the Direct Review docket and will be addressed herein. 

An initial rating in excess of 70 percent for the Veteran's service-connected acquired psychiatric disorder prior to April 18, 2024 is denied.

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155
 the time of filing. As the Veteran's modification request as to this issue was untimely, it has been denied as discussed in the February 12, 2026 Board letter, and the issue remains on the Direct Review docket and will be addressed herein. 

An initial rating in excess of 70 percent for the Veteran's service-connected acquired psychiatric disorder prior to April 18, 2024 is denied.

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. 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.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41. However, where an increase in the disability rating, rather than the propriety of the initial rating, is at issue, the present level of disability is of primary importance, and past medical reports should not take precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Regardless of whether an appeal stems from disagreement with the initial rating assigned following an award of service connection or from disagreement with the rating assigned following a claim for increase, separate ratings can be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)).

The criteria for rating psychiatric disabilities, other than eating disorders, are set forth in the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. Under the General Rating Formula, the following ratings are provided:

100 percent rating (the maximum schedular rating) - 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.

70 percent - 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 work like setting); inability to establish and maintain effective relationships.

50 percent - Occupational and social impairment with reduced reliability and productivity due to such symptoms 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; difficulty in establishing and maintaining effective work and social relationships.

30 percent - Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).

10 percent - Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013).
 normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).

10 percent - Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.

When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442.

Nevertheless, all ratings in the General Rating Formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be "due to" those symptoms; a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. The Board recognizes that the United States Court of Appeals for Veterans Claims (Court) in Mauerhan, 16 Vet. App. 436, stated that the symptoms listed in VA's General Rating Formula are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. However, the Court further indicated that without those examples, differentiating between rating evaluations would be extremely ambiguous.

In the March 5, 2026 decision associated with Board docket number 20-16 715, the Board awarded an effective date of June 16, 2008 for the Veteran's 70 percent initial rating for a psychiatric disability, finding that the claim period associated with her current appeal extended to a June 16, 2008 request to reopen a claim for service connection for a psychiatric disability. The Veteran was granted a 100 percent rating for her service-connected acquired psychiatric disorder effective April 18, 2024. Thus, the period for review in this appeal is from June 16, 2008, through April 17, 2024. 

While the evidence of record documents psychiatric symptoms that include depression, anxiety, chronic sleep impairment, memory loss and decreased concentration, impaired judgement, irritability, impaired impulse control, neglect of hygiene, insomnia, social isolation, suicidal and homicidal ideation, inability to maintain and establish effective social and work relationships, lack of interest, lack of motivation, and difficulty adapting to stress, the evidence also persuasively weighs against entitlement to an initial rating in excess of 70 percent. The clinical records do not support symptoms of the severity or frequency to more closely approximate the criteria for a 100 percent rating. Again, it is not the mere presence of a symptom listed as an example in the rating criteria which warrants that rating, but how those symptoms or symptoms of similar severity, frequency, and duration impaired the Veteran's occupational and social functioning.

In that regard, an October 10, 2007 lay statement from a former partner of the Veteran noted that she exhibited abrupt outbursts and "inadequate" behavior. In November 9, 2007 correspondence, the Veteran stated, "I am at the point in my life that I cry most of the time. I am sad often and I do not feel like being bothered with people. I do not have the desire to do things I used to do. My sex life has changed I do not have the desire to have relations with anyone. I just want to scream. I cannot sleep at night and I have problems concentrating." 

During an April 2009 VA examination, the Veteran reported being depressed, frustrated, and irritable due to her physical limitations. She described being unable to play with her children, exercise, or perform many previously enjoyable leisure and recreational activities. The Veteran noted constant insomnia and daytime sleepiness. She identified symptoms of negativity, poor self-image and self-esteem, decreased concentration, and very few non-familial friends. She was employed full time and had lost 4 weeks of time from work in the last 12-month period. She described decreased concentration and increased absenteeism/tard
 sex life has changed I do not have the desire to have relations with anyone. I just want to scream. I cannot sleep at night and I have problems concentrating." 

During an April 2009 VA examination, the Veteran reported being depressed, frustrated, and irritable due to her physical limitations. She described being unable to play with her children, exercise, or perform many previously enjoyable leisure and recreational activities. The Veteran noted constant insomnia and daytime sleepiness. She identified symptoms of negativity, poor self-image and self-esteem, decreased concentration, and very few non-familial friends. She was employed full time and had lost 4 weeks of time from work in the last 12-month period. She described decreased concentration and increased absenteeism/tardiness. The examiner found that total occupational and social impairment was not present but that the Veteran did have deficiencies in most areas.

During a June 2009 VA examination, the Veteran reported supportive parents and being close with multiple siblings, most of whom lived nearby. She reported having two children, a 12 year old and a 9 year old, from her first marriage who lived with her and with whom she was very close. She indicated she did not have many non-familial friends but did have a small number of close friends with whom she had frequent contact, although they did not live nearby. She reported that she was currently single and that her last relationship, which lasted for 18 months, had ended she believed in part due to her lack of sexual desire. Regarding symptoms, the Veteran reported fleeting suicidal ideation without intent and planning, sleep impairment, and daytime sleepiness and irritability. She was observed to be clean, neatly groomed, and appropriately dressed. She reported taking medications to treat her psychiatric symptoms.

A December 2010 VA examination report noted reduced reliability and productivity due to the Veteran's limited interactions with others. The Veteran reported she had been in her current job for 4 years, with 6 weeks of work missed in the last 12 months due to pain and depression. She reported more frustration and irritability, including with her children, and no regular social activity. She noted her family helped with her children and that she sometimes avoided phone calls from her friends. She was again noted to have suicidal ideation but was deemed able to maintain minimal personal hygiene, and have no inappropriate behavior, obsessive/ritualistic behavior, significant memory impairment, hallucinations, or disorientation. 

The Veteran also underwent a VA examination in August 2015. She continued to report irritability, trouble concentrating, anxiety, and difficulty maintaining relationships. However, she also noted that she had some close friends and family she talked to occasionally. The Veteran reported that despite outbursts at work and missing days due to her disabilities, she mostly functions well when she is at work. The August 2015 examiner noted, "Reckless behavior was denied. No frequent behaviors consistent with hypervigilance or exaggerated startle were reported." 

An October 5, 2016 VA treatment record indicated that the Veteran was having problems recalling words and feels depressed and stressed all the time. However, the note also reports that the Veteran had good insight and judgment, reported no hallucinations, had normal speech, good grooming, and no suicidal ideation.

In an April 24, 2018 VA treatment record the Veteran continued to report memory problems and had begun writing things down to stay on track. However, there is no indication she was unable to remember her own name, occupation, or familiar people or places. 

A June 21, 2021 VA treatment record indicated that the Veteran felt anxious most days, had trouble sitting still, and trouble focusing. She reported mostly noticing difficulty concentrating at work. However, she also reported that she did not feel depressed, manic, or suffer from panic. She expressed that she considered herself the "go to person" of the family and was loved by all the family, noting that she was "the aunt everyone can talk to." She also reported having a grandchild who was a great joy for her and who kept her grounded.

A subsequent July 19, 2021 VA treatment record indicated that the symptoms of the Veteran's PTSD "come and go," and that her mood was better controlled. She reported that she was married and that she planned on dieting with her husband, denied substance abuse, and suicidal ideation. 

During a September 2022 VA mental health telephone med check, the Veteran reported that she had been doing pretty well. She reported she was exercising and was busy with her job. The provider noted her to sound upbeat, clear, and organized, with good insight and judgment, and without suicidal or homicidal ideation.

During a September 2023 VA mental health telephone med check, the Veteran said she was doing pretty well. She noted her anxiety had been controlled despite stress associated with a new supervisor and stress over both of her
 the Veteran's PTSD "come and go," and that her mood was better controlled. She reported that she was married and that she planned on dieting with her husband, denied substance abuse, and suicidal ideation. 

During a September 2022 VA mental health telephone med check, the Veteran reported that she had been doing pretty well. She reported she was exercising and was busy with her job. The provider noted her to sound upbeat, clear, and organized, with good insight and judgment, and without suicidal or homicidal ideation.

During a September 2023 VA mental health telephone med check, the Veteran said she was doing pretty well. She noted her anxiety had been controlled despite stress associated with a new supervisor and stress over both of her kids moving out and missing her old routine. The provider noted she sounded fine and was alert, oriented, and calm, with normal speech. 

During a March 2024 VA mental health telephone med check, the Veteran reported she was functioning ok at work and home. She stated she enjoyed her family and her cats. She denied feeling hopeless or experiencing suicidal ideation. She was noted to sound alert, oriented, and calm, with normal speech. She was observed to have good insight and judgment. She requested a psychotherapy consult, which was placed.

The requested consult was conducted on March 22, 2024. The Veteran indicated her desire to reinitiate prolonged exposure therapy, as she had previously dropped out due to other stressors in her life but now felt ready to reengage. The clinician noted the Veteran was alert and oriented. Her mood was euthymic, with a consistent affect. Her speech was clear and coherent, with normal rate and productivity. She did not report or endorse suicidal or homicidal ideation, intent, or plans, and hallucinations and delusions were not reported and were not observed by the clinician. Participation in prolonged exposure treatment across both virtual and in-person modalities was planned. 

The Board acknowledges that some symptoms included in the criteria for a 100 percent disability rating are documented in the evidence of record associated with the period under review. Specifically, the record includes a report of intermittent inability to perform activities of daily living (including home maintenance and inability to get out of bed). It also includes reports of suicidal ideation and occasional inappropriate outbursts. 

Regarding suicidal ideation, the Board acknowledges that persistent danger of self-harm is contemplated by the 100 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017).  However, the Board finds the severity, frequency, and duration of the Veteran's suicidal ideation did not rise to the level contemplated by the 100 percent disability rating, as the Veteran also regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records.

Regarding intermittent inability to perform activities of daily living, the record also does not support the conclusion that this symptom results in total occupational and social impairment being more closely approximated at any point. Notably, the Veteran was able to maintain steady employment throughout the claim period and was consistently noted as well-groomed and appropriate during treatment. Further, the Veteran did not report difficulty with activities of daily living during treatment. 

As to the Veteran's outbursts and reports of "inadequate behavior," the record does not establish that this behavior rose to the level of grossly inappropriate behavior or a persistent danger of hurting others. Notably, the Veteran has maintained employment and some social and family relationships throughout the claim period. 

In short, the Board finds the level of impairment caused by the Veteran's psychiatric symptoms throughout the period prior to April 18, 2024 most closely approximates that associated with a 70 percent rating.  While the Veteran did experience some symptoms contemplated by a 100 percent rating as discussed above, the evidence overall, including related to symptoms not specifically listed in the rating criteria, does not demonstrate the level of impairment associated with a 100 percent rating.  The majority of the Veteran's symptoms were either contemplated by or more consistent with a 70 percent rating or ratings lower than 70 percent.  In other words, the Board finds that the Veteran's symptoms during the review period did not create an overall disability picture that more closely approximates the criteria for a 100 percent rating. As the evidence is persuasively against finding that the Veteran's psychiatric symptoms caused total occupational and social impairment to warrant a schedular rating of 100 percent, the benefit of the doubt rule does not apply, and the claim for a rating in excess of 70 percent for a psychiatric disorder prior to April 18, 2024 must be denied.

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Barbato

The Board's decision in this case is binding only with respect to the instant matter decided.
 Board finds that the Veteran's symptoms during the review period did not create an overall disability picture that more closely approximates the criteria for a 100 percent rating. As the evidence is persuasively against finding that the Veteran's psychiatric symptoms caused total occupational and social impairment to warrant a schedular rating of 100 percent, the benefit of the doubt rule does not apply, and the claim for a rating in excess of 70 percent for a psychiatric disorder prior to April 18, 2024 must be denied.

 

 

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Barbato

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.