MAJOR DEPRESSIVE DISORDER

Summary

The veteran, who served in the U.S. Army from March 1990 to January 1992, appeals the denial of service connection for major depressive disorder (MDD) and an increased rating for posttraumatic stress disorder (PTSD). The veteran claimed MDD was secondary to PTSD, citing symptoms of depressed mood, detachment from loved ones, and decreased pleasure. The Board reviewed evidence from July 2024, noting that the Veteran's PTSD was already service-connected and rated at 30 percent. The Board found no current diagnosis of MDD, and the evidence indicated that while the Veteran experienced depressed mood, it was responsive to therapy and coping skills, allowing her to maintain employment and social relationships. The VA examiner concluded that the Veteran's PTSD caused occasional decreases in work efficiency and intermittent inability to perform tasks, but generally allowed satisfactory functioning. The Board found this level of impairment did not warrant a rating higher than 30 percent for PTSD. Service connection for MDD was denied due to lack of a current diagnosis, and the increased rating for PTSD was denied as the evidence did not support impairment beyond the current 30 percent level.

Rationale

No current diagnosis of Major Depressive Disorder (MDD) found.; Evidence shows depressed mood, but not MDD.; Symptoms responsive to therapy and coping skills.

Full Decision Text

Citation Nr: A26038647
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 250412-537612
DATE: April 24, 2026

ORDER

Entitlement to service connection for major depressive disorder is denied.

Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder is denied.

FINDINGS OF FACT

1. The Veteran has already been granted service connection for posttraumatic stress disorder.

2. There is no evidence showing that the Veteran has been diagnosed with major depressive disorder.

3. The Veteran's posttraumatic stress disorder does not cause occupational and social impairment with reduced reliability and productivity, nor any higher degree of occupational and social impairment.

CONCLUSIONS OF LAW

1. The criteria for service connection for major depressive disorder are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for a disability rating in excess of 30 percent for posttraumatic stress disorder have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from March 1990 to January 1992. 

This matter comes to the Board of Veterans' Appeals (Board) from an October 2024 rating decision. Before this appeal, the October 2024 rating decision was subject to higher-level review. See December 2024 VA Form 20-0996; April 2025 rating decision.

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (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 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 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. 

Entitlement to service connection for major depressive disorder is denied.

A Veteran is entitled to service connection for a disability resulting from a disease or injury incurred or aggravated during active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To substantiate a claim of service connection, there must be evidence of (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal connection between the disease or injury in service and the current disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310 (a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

The matter currently before the Board stems from a claim filed on a July 2024 copy of VA Form 21-526EZ in which the Veteran contended that her PTSD had "caused [her
3.310 (a). To establish secondary service connection there must be evidence: (1) of a current disability (for which secondary service connection is sought); (2) of an already service-connected disability; and (3) that the current disability for which service connection is sought was either (a) caused or (b) aggravated by the service-connected disability. 38 C.F.R. § 3.310 (a); see Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).

The matter currently before the Board stems from a claim filed on a July 2024 copy of VA Form 21-526EZ in which the Veteran contended that her PTSD had "caused [her] to develop depression." She seeks service connection for "depression" secondary to her service-connected posttraumatic stress disorder (PTSD). See, e.g., April 2025 VA Form 10182. This term is sometimes used as a colloquialism for the DSM-5 diagnosis of Major Depressive Disorder (MDD). The Board understands the Veteran's claim to seek service connection for the same. The sole piece of evidence showing a diagnosis of MDD dates from July 2022, two years before the date on which she filed the claim currently at issue. Those records describe a "single episode" of MDD. The evidence from the period beginning in July 2024 persuasively shows that the Veteran no longer meets the diagnostic criteria for MDD. See, e.g., VA medical records dated October 16, 2024 ("patient reported some symptoms of depression, symptoms are not consistent with a major depressive episode."); August 2024 VA Review PTSD DBQ ("Veteran currently meets DSM-5 criteria for Posttraumatic Stress Disorder. They do not currently meet DSM-5 criteria or any other mental disorder").

The diagnosis of MDD is not the same thing as "depressed mood," a common symptom of many DSM-5 diagnoses, including PTSD. The evidence persuasively shows that while the Veteran has not been diagnosed with MDD, she does suffer from depressed mood as a symptom of her PTSD. VA has taken the Veteran's depressed mood symptom into account in rating the Veteran's PTSD. See rating decisions dated December 2022; October 2024 (assigning ratings based in part on symptoms of depressed mood). As discussed further below, the Board has interpreted the Veteran's appeal to include an appeal for an increased rating for her PTSD.

Entitlement to service connection for MDD is denied.

Entitlement to an increased rating for PTSD

The matter currently before the Board stems from a claim filed on a July 2024 copy of VA Form 21-526EZ in which the Veteran contended that her PTSD had "caused [her] to develop depression." She described related symptoms, and stated on the form that she sought both an increased rating for PTSD and service connection for MDD. See July 2024 VA Form 21-526EZ. VA adjudicated both theories of entitlement in an October 2024 rating decision. The Veteran sought higher-level review and, afterward, appealed to the Board, explicitly addressing only depression during both requests.

However, during both requests the Veteran stated that she was satisfied with both "service connection" and "disability evaluation." Further, the Veteran's initial statements regarding her theory of entitlement clearly describe an exacerbation of mental health symptoms, whether formally phrased as a claim for service connection or one for an increased rating. Therefore, the Board has interpreted the Veteran's April 2025 VA Form 10182 to also encompass an appeal of the October 2024 rating decision's denial of an increased rating for PTSD. See Clemens v. Shinseki, 23 Vet. App. 1 (2009) (VA must not restrict its focus to the specific words used by a layperson in describing a claim for disability compensation).

The Veteran's PTSD is rated under the General Rating Formula for Mental Disorders (General Formula), found at 38 C.F.R. § 4.130. Ratings are assigned based on all the evidence of record that bears on occupational and social impairment rather than solely on an examiner's assessment of the level of disability at the moment of an examination. 38 C.F.R. § 4.126(a). 

The General Formula lists specific symptoms that are typically associated with each rating, sometimes distinguishing between different ratings by the level of frequency, severity, and duration of those symptoms. Rating decisions are made in close reference to those symptoms, because the General Formula constitutes VA's conclusion that in a typical case, those symptoms cause the associated degree of occupational and social impairment. However, the symptoms listed in the General Formula are merely examples of symptoms that warrant particular ratings. Ratings are ultimately awarded by the degree of occupational and social impairment caused by the symptoms, not merely by the presence or absence of
 social impairment rather than solely on an examiner's assessment of the level of disability at the moment of an examination. 38 C.F.R. § 4.126(a). 

The General Formula lists specific symptoms that are typically associated with each rating, sometimes distinguishing between different ratings by the level of frequency, severity, and duration of those symptoms. Rating decisions are made in close reference to those symptoms, because the General Formula constitutes VA's conclusion that in a typical case, those symptoms cause the associated degree of occupational and social impairment. However, the symptoms listed in the General Formula are merely examples of symptoms that warrant particular ratings. Ratings are ultimately awarded by the degree of occupational and social impairment caused by the symptoms, not merely by the presence or absence of the listed symptoms. See 38 C.F.R. § 4.126; Bankhead v. Shulkin, 29 Vet. App. 10, 18 (2017) ("the list of symptoms [associated with each rating] is non-exhaustive, meaning that VA is not required to find the presence of all, most, or even some of the enumerated symptoms to assign a particular evaluation."); Vasquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013) (discussing the regulatory history and application of the General Formula); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002) (discussing the application of the General Formula).

In addition to lower ratings, the General Formula authorizes a 30 percent rating for cases that manifest in 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). The Veteran currently holds a 30 percent rating.

The General Formula authorizes a 50 percent rating for cases that manifest in 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.

The General Formula authorizes a 70 percent rating for cases that manifest in 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.

The Board notes that "the presence of suicidal ideation alone... may cause occupational and social impairment with deficiencies in most areas" sufficiently to warrant a 70 percent rating. Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017).

The General Formula authorizes a 100 percent rating 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.

In July 2024 the Veteran reported to VA that her symptoms of depression had gotten significantly worse. She reported feeling detachment from friends and family, decreased pleasure from activities she used to enjoy and difficulty experiencing positive emotions. See July 2024 VA Form 21-526EZ.

The Veteran's treatment records from this period corroborate complaints of depressed mood. She reported that her depressive symptoms make it somewhat difficult to work, take care of things at home, or get along with others. However, she also reported that she noticed an improvement in her depressive symptoms after attending an event at the American Legion and after she visited family living in another state, and that she planned to prioritize spending time with loved ones as part of a strategy to manage her symptoms. Working with a therapist, the Veteran developed healthy copying skills, and noticed improvement in her overall depressive symptoms as she began to use those coping skills. She was
 from activities she used to enjoy and difficulty experiencing positive emotions. See July 2024 VA Form 21-526EZ.

The Veteran's treatment records from this period corroborate complaints of depressed mood. She reported that her depressive symptoms make it somewhat difficult to work, take care of things at home, or get along with others. However, she also reported that she noticed an improvement in her depressive symptoms after attending an event at the American Legion and after she visited family living in another state, and that she planned to prioritize spending time with loved ones as part of a strategy to manage her symptoms. Working with a therapist, the Veteran developed healthy copying skills, and noticed improvement in her overall depressive symptoms as she began to use those coping skills. She was specifically able to use these coping skills at work to support an employee during an emotionally charged event. As part of her coping skills strategy, the Veteran created a plan to build stronger community ties in the state where she lives. See VA treatment records dated March 26, 2024; April 30, 2024; September 17, 2024; October 15, 2024. 

At an August 2024 VA examination, the Veteran reported maintaining close relationships with approximately a dozen family members and a close friend in her hometown. She reported approximately 17 years of employment in a supervisory role at a federal government agency. She reported symptoms of depression, anxiety, suspiciousness, chronic sleep impairment, and disturbance of motivation and mood, each of which the examiner endorsed. Based on the Veteran's reports, the examiner concluded that her PTSD causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation normal.

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The Board finds that the Veteran's symptoms fall short of the degree of occupational and social impairment that would justify a rating higher than thirty percent. Her treatment records show that her disability, and particularly her depressive symptoms, are responsive to therapeutic interventions. During the period on appeal, she has been increasingly able to regulate her symptoms with healthy coping mechanisms. Despite her disability, she has been able to maintain employment in a supervisory capacity, as well as to maintain social relationships with family members and friends. Her treatment records indicate that at the time of the decision on appeal, she had created an action plan with specific steps to develop closer relationships in the state where she had recently moved. This evidence is not consistent with occupational and social impairment with reduced reliability, or any higher degree of occupational and social impairment.  Therefore, entitlement to a rating in excess of 30 percent is denied for PTSD.

 

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Sparks, Robert S.

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.