PSYCHOSIS

Summary

The veteran, who served from December 1988 to October 1996, appeals the denial of an initial disability rating in excess of 50 percent for generalized anxiety disorder with major depressive disorder (anxiety disorder with MDD) and the issue of Total Disability based on Individual Unemployability (TDIU). The Board reviewed evidence including VA examinations from August 2013 and October 2020, medical treatment records detailing suicide attempts and hallucinations, and the veteran's testimony from a November 2024 Board hearing. The veteran described significant social and occupational impairment, including reclusive behavior, panic attacks, angry outbursts leading to job termination, and persistent suicidal ideation. The Board found that the veteran's anxiety disorder with MDD met the criteria for a 100 percent disability rating for the entire period on appeal prior to November 24, 2024, resolving all doubt in the veteran's favor. The TDIU claim was dismissed as moot because the 100 percent rating for the psychiatric disorder already establishes total disability, and the veteran did not claim inability to work solely due to other service-connected conditions like fibromyalgia, tinnitus, or left ear hearing loss. Service connection for anxiety disorder with MDD is granted at 100 percent.

Rationale

Total occupational and social impairment; Persistent danger of hurting self; Gross impairment in thought processes or communication

Full Decision Text

Citation Nr: A26037696
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 210417-153383
DATE: April 22, 2026

ORDER

Entitlement to an initial rating of 100 percent for generalized anxiety disorder with major depressive disorder (hereafter anxiety disorder with MDD) prior to November 24, 2024, is granted, subject to the laws and regulations governing the payment of monetary benefits.

Entitlement to a total disability rating due to individual unemployability (TDIU) is dismissed as moot.

FINDINGS OF FACT

1. For the entire appeal period under consideration stemming from April 2, 2012, to November 24, 2024, the Veteran's anxiety disorder with MDD is manifested by psychiatric symptomatology including anxiety, depressed mood, irritability with angry outbursts, persistent delusions and hallucinations, persistent danger of hurting himself, memory loss, panic attacks, suicidal attempts and ideations, difficulty in adapting to stressful circumstances, and total social and occupational impairment. 

2. The Veteran has been provided a 100 percent schedular disability rating for his service-connected PTSD, and the evidence of record does not show that the Veteran is unable to obtain or maintain gainful employment solely due to his service-connected fibromyalgia, tinnitus, or left ear hearing loss.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 100 percent for anxiety disorder with MDD have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code (DC) 9440. 

2. The issue of TDIU is moot. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.16, 4.19. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1988 to October 1996.

These matters come before the Board on appeal from a rating decision issued in November 2020 by a VA Regional Office (RO), the Agency of Jurisdiction (AOJ). 

In the April 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held in November 2024.  Therefore, the Board may only consider the evidence of record at the time of the November 2020 decision on appeal, as well as any evidence submitted by the Veteran or his 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 decisions 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. 

The Veteran appeared for a Board hearing in November 2024 before the undersigned Veterans Law Judge (VLJ).  A copy of the transcript is associated with the record.

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  If the positive and negative evidence is in approximate balance or nearly equal-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt.  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

1. Entitlement to an initial disability rating in excess of 50 percent for anxiety disorder with MDD.

The Veteran and his attorney-representative contend he is entitled to an initial disability rating in excess of 50 percent for anxiety disorder with MDD.  

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity.  Separate DCs identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Each disability must be
 persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

1. Entitlement to an initial disability rating in excess of 50 percent for anxiety disorder with MDD.

The Veteran and his attorney-representative contend he is entitled to an initial disability rating in excess of 50 percent for anxiety disorder with MDD.  

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity.  Separate DCs identify the various disabilities.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized.  38 C.F.R. § 4.1.  Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work.  38 C.F.R. § 4.2.  All reasonable doubt will be resolved in the claimant's favor.  38 C.F.R. § 4.3.  Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is to be assigned.  38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).  Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings.  Id. 

The appeal period before the Board begins on April 2, 2012, the date service connection for anxiety disorder with MDD was awarded, as the record reflects the Veteran has continuously pursued the issue of the initial rating.  38 C.F.R. § 3.2500(c).  During the appeal period, such disability has been rated as 50 percent disabling from April 2, 2012, and 100 percent disabling from November 24, 2024, pursuant to DC 9440, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula).  38 C.F.R. § 4.130.  

The General Rating Formula provides a 10 percent rating when there is 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.  

A 30 percent rating is warranted when there is 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, mild memory loss (such as forgetting names, directions, recent events).  

A 50 percent rating is warranted when there is 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.  

A 70 percent rating is warranted when there is 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 work-like setting); and inability to establish and maintain effective relationships.

A 100 percent rating is warranted when there is 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and
 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 work-like setting); and inability to establish and maintain effective relationships.

A 100 percent rating is warranted when there is 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 ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name.

The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013).  The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating."  Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002).  In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118.

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation 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). 

On VA examination in August 2013, the Veteran was diagnosed with mood disorder with depressive features due to chronic pain, and attention deficit hyperactivity disorder (ADHD).  The examiner documented symptoms of depressed mood, fatigue, chronic sleep impairment, low self-concept, hopelessness, mild problems with long-term memory, such as forgetting names, directions or recent events, verbal anger, and constant anxiety.  The examiner determined the Veteran had 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 medication.

In an October 2014 Board hearing, the Veteran described debilitating social anxiety and difficulty concentrating. 

Medical treatment records reveal that the Veteran attempted suicide in approximately 2013 and again in 2017.  The 2017 suicide attempt resulted in in-patient treatment.  The Veteran reported that prior to the attempt, he had paranoia and auditory hallucinations.  In addition, the treatment records reveal that a concerned citizen reported to the police department that the Veteran has delusional concerns about white cars following him.  Additionally, from 2014 to 2016, the Veteran's medical treatment records show he had frequent panic attacks, sometimes three to four times per week. 

The Veteran was afforded a VA examination in October 2020, where he was diagnosed with unspecified anxiety disorder and unspecified depressive disorder.  The examiner documented symptoms of depressed mood, anxiety, panic attacks that occur weekly or less often, trouble concentrating, somatic complaints including difficulty breathing and tightness in chest, fatigue, disturbances of motivation and mood, and difficulty adapting to stressful circumstances, including work or a work like setting.  The Veteran reported that his last suicidal ideation was two months prior to the VA examination.  He also stated that he persistently felt anxious or nervous and got easily overwhelmed.  He lost focus easily when he felt anxious or overwhelmed.  The examiner concluded that the Veteran experienced occupational and social impairment with reduced reliability and productivity. 

At the Veteran's November 2024 Board hearing, the Veteran testified that he tried to take his own life in December 2023, and was subsequently hospitalized.  He also testified to having problems with memory, concentration, depressed mood, anxiety, and panic attacks.  The Veteran described his last panic attack when he spoke to his ex-girlfriend's son, and indicated that the non-stop talking overwhelmed him and caused
 The Veteran reported that his last suicidal ideation was two months prior to the VA examination.  He also stated that he persistently felt anxious or nervous and got easily overwhelmed.  He lost focus easily when he felt anxious or overwhelmed.  The examiner concluded that the Veteran experienced occupational and social impairment with reduced reliability and productivity. 

At the Veteran's November 2024 Board hearing, the Veteran testified that he tried to take his own life in December 2023, and was subsequently hospitalized.  He also testified to having problems with memory, concentration, depressed mood, anxiety, and panic attacks.  The Veteran described his last panic attack when he spoke to his ex-girlfriend's son, and indicated that the non-stop talking overwhelmed him and caused him to pass out.  The Veteran described angry outbursts when he used to work, two of which caused him to lose his jobs.  At another job, his anxiety would increase due to being in an enclosed storage room and this was also during COVID.  He reported that he does not leave his apartment except to get food and take a half mile walk each day.  Once in a while he plays a round of golf.  The Veteran testified that he had a suicidal ideation three days prior to the hearing when thinking about his ex-girlfriend. 

With respect to social impairment, the evidence of record shows the Veteran reported that he lives alone but maintains a relationship with his ex-girlfriend, albeit strained.  He has never been married and does not have children.  The Veteran keeps in touch with his two sisters and his ex-girlfriend's brother.  As previously detailed, he is reclusive with few exceptions and has had periods of significant social anxiety causing him to pass out from a panic attack even when talking to people that he knows, or having suicidal ideation when thinking about his ex-girlfriend.  

As for occupational impairment, the Veteran separated from the military in 1996.  His post-military employment includes landscaping and maintenance, washing dishes, computer networking, managing a campground for a summer, and more recently working as a computer technician at two retail stores.  He reported he was terminated from both retail stores due to his angry outbursts.  His last position ended in 2020 when he was a hotel lobby attendant, and he left that job due to his anxiety surrounding COVID.  

The Board must consider the totality of the nature, frequency, severity, and duration of the Veteran's psychiatric symptomatology, as well as both the occupational and social impairment resulting therefrom.  In this regard, the Board affords the medical evidence of record, and the VA examiners' findings significant probative value as such were based on evaluation of the Veteran and consideration of his own lay reports of his symptoms in light of the rating criteria.  

Upon review, the Board finds an initial rating of 100 percent is warranted for the period prior to November 24, 2024.  The Board acknowledges that the RO granted a 100 percent rating as of November 24, 2024, based on a claim for increase filed by the Veteran shortly after the November 2024 Board hearing in this appeal.  However, the Board finds that the overall evidence of record reveals that the impairment caused by the Veteran's psychiatric disorder has been of the same severity since prior to November 2024.  Indeed, the medical and lay evidence shows that prior to November 24, 2024, the Veteran was a persistent danger of hurting himself, as he had made several suicide attempts, some of which required inpatient hospitalization, and engaged in years of suicidal ideations.  The Veteran was totally occupationally impaired, as his anger issues caused him to be fired from two jobs, and his severe anxiety prevented him from continuing in another job.  Furthermore, the Veteran had gross impairment in thought processes or communication, as hallucinations and delusions have been reported by the Veteran and a concerned citizen.  The Veteran also lived alone and kept mostly to himself, and even the couple relationships he maintained were strained, as they have been known to cause panic attacks or trigger suicidal ideation.     

In sum, the Board resolves all doubt in the Veteran's favor and finds that his anxiety disorder with MDD has been characterized by symptomatology consistent with a 100 percent disability rating.  Therefore, the Board finds that an initial rating of 100 percent under DC 9440 is warranted for the entire period on appeal prior to November 24, 2024.  38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

2. Entitlement to TDIU.

The Veteran contends that he has been unable to work due to his service-connected disabilities.  

The Veteran filed his claim for TDIU on November 24, 2024.  However, the Board finds that the claim for entitlement to a
's favor and finds that his anxiety disorder with MDD has been characterized by symptomatology consistent with a 100 percent disability rating.  Therefore, the Board finds that an initial rating of 100 percent under DC 9440 is warranted for the entire period on appeal prior to November 24, 2024.  38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

2. Entitlement to TDIU.

The Veteran contends that he has been unable to work due to his service-connected disabilities.  

The Veteran filed his claim for TDIU on November 24, 2024.  However, the Board finds that the claim for entitlement to a TDIU was also part and parcel with the appeal for an initial increased rating for anxiety disorder with MDD.  Rice v. Shinseki, 22 Vet. App. 447 (2009).  The Veteran has been granted a 100 percent rating for anxiety disorder with MDD during the entire period on appeal for TDIU.

The Court has recognized that a 100 percent disability rating under the Schedule for Rating Disabilities means that a veteran is totally disabled.  Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990).  Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis.  See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period).

However, a 100 percent disability rating does not always render the issue of a TDIU moot.  See Bradley v. Peake,?22?Vet. App.?280, 291-92?(2008).  VA's duty to maximize a claimant's benefits includes consideration of whether his disabilities establish entitlement to SMC pursuant to 38 C.F.R. § 1114(s).  SMC?may be warranted if the Veteran has a?100?percent?disability?rating?for a single disability, and VA finds that TDIU is warranted based solely on a disability other than the disability that is rated at 100 percent.  38?U.S.C. §?1114?(s); Id.

In the present case, in addition to the Veteran's psychiatric disorder that has been rated at 100 percent, he is also service-connected for fibromyalgia, tinnitus, and left ear hearing loss.  However, the evidence does not show, and the Veteran has not claimed, that he is unable to work due solely to any single service-connected disability other than his psychiatric disorder.  

Therefore, the Board finds there is no legal basis to award?SMC?related to a claim of TDIU.  Due to there being no allegation of error of fact or law remaining for appellate consideration, the Board has no jurisdiction to review the appeal for the issue of entitlement to a TDIU?rating, and it is dismissed as moot.  38?U.S.C. §?7105?(d)(5);?38?C.F.R. §?20.202. 

 

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scherba, Heather L.

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.