ADJUSTMENT DISORDER WITH MIXED ANXIETY AND DEPRESSED MOOD

Summary

The Veteran, an Air Force Veteran who served from January 2013 to April 2025, appeals the denial of an initial disability rating in excess of 50 percent for chronic adjustment disorder with mixed anxiety and depressed mood. The Veteran contends that his symptoms warrant a higher rating. The Board reviewed the evidence of record as of the April 2025 agency of original jurisdiction decision. The September 2024 VA examination indicated symptoms consistent with a 50 percent rating, including flattened affect, disturbances in motivation and mood, and difficulty with social and work relationships, described as 'reduced reliability and productivity.' While the Veteran had a history of suicidal ideation and a prior attempt, the current examination showed intact judgment, insight, and cognition, with no current suicidal ideation. The Board acknowledged the Veteran's subjective belief of greater severity but found the objective evidence, including service treatment records and the VA examination, more closely approximated the criteria for a 50 percent rating. The Board noted that while past suicidal ideation was present, current symptoms did not meet the criteria for a 70 percent rating, which requires more severe impairment like near-continuous panic or depression affecting independent functioning, or inability to establish and maintain effective relationships. The Board found the evidence persuasively weighed against a 70 percent rating. The appeal is denied.

Rationale

Symptoms more closely approximated criteria for 50% rating; Flattened affect, disturbances in motivation and mood, difficulty with social/work relationships noted; Intact judgment, insight, cognition; no current suicidal ideation

Full Decision Text

Citation Nr: A26040062
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250916-588395
DATE: April 29, 2026

ORDER

Entitlement to an initial rating in excess of 50 percent for chronic adjustment disorder with mixed anxiety and depressed mood is denied.

FINDING OF FACT

The severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas.

CONCLUSION OF LAW

The criteria for an initial rating in excess of 50 percent for chronic adjustment disorder with mixed anxiety and depressed mood 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 9440.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Air Force from January 2013 to April 2025.

The rating decision on appeal was issued in April 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In the September 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 April 2025 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 an initial rating in excess of 50 percent for chronic adjustment disorder with mixed anxiety and depressed mood is denied. 

The Veteran contends his service-connected chronic adjustment disorder with mixed anxiety and depressed mood warrants a rating in excess of 50 percent.

The Veteran's chronic adjustment disorder with mixed anxiety and depressed mood is rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9440. Diagnostic Code 9440 is rated under the General Formula for Mental Disorders (General Formula). Under the 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).

Under the General Formula, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation).

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
ness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation).

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.

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.

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.

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the veteran).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt will be resolved in favor of the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

On the September 2024 VA mental disorders examination, the examiner indicated that the Veteran has a diagnosis of chronic adjustment disorder with mixed anxiety and depressed mood. The examiner found the Veteran to experience symptoms of depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. The examiner observed the Veteran to be oriented; logical and linear thought process; no hallucinations, delusions or loss of reality contact; normal speech; normal eye contact; average intelligence quotient (IQ); adequate insight and judgment; memory, focus, attention, and cognition within expected limits; tense affect; congruent mood; and no current homicidal or suicidal ideation. The examiner concluded that the Veteran's psychiatric disorder results in occupational and social impairment with reduced reliability and productivity. 

In a November 2024 and December 2024 service treatment records the Veteran was assessed to have a history of major depressive disorder and a previous suicide attempt in February 2024. The Veteran denied any current suicidal or homicidal ideation. On examination, the medical provider noted that the Veteran has intermittent morbid ideation, denies ideation, and the last attempt was more than six months prior. 

After a review of the evidentiary record, the Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 50 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with
4 and December 2024 service treatment records the Veteran was assessed to have a history of major depressive disorder and a previous suicide attempt in February 2024. The Veteran denied any current suicidal or homicidal ideation. On examination, the medical provider noted that the Veteran has intermittent morbid ideation, denies ideation, and the last attempt was more than six months prior. 

After a review of the evidentiary record, the Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 50 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating.

The Board acknowledges that that the Veteran contends that his symptoms are more severe than the 50 percent rating assigned. However, service treatment records and the September 2024 VA examination show that the Veteran's chronic adjustment disorder with mixed anxiety and depressed mood was manifested by symptoms associated with a 50 percent rating including flattened affect, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. Although his psychiatric disorder was, in the past, also manifested by a symptom associated with a 70 percent rating (suicidal ideation), the Board finds the current level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 50 percent rating.

The September 2024 VA examiner summarized the Veteran's overall level of occupational and social impairment as 'reduced reliability and productivity,' which is consistent with a 50 percent rating. The Board affords the examiner's assessment in this regard significant probative weight as the examiner, a psychologist, is competent to make such an assessment.  The September 2024 VA examination report indicates that the Veteran had intact speech, judgment, insight, and cognition. The Veteran also denied suicidal ideation during the VA examination.

Moreover, the evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 50 percent rating. Indeed, the evidence demonstrates that the Veteran's chronic adjustment disorder with mixed anxiety and depressed mood to include depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; orientation; logical and linear thought process; normal speech; normal eye contact; adequate insight and judgment; memory, focus, attention, and cognition within expected limits; tense affect; and, congruent mood.

The evidence of record does not demonstrate obsessional rituals that interfere with routine activities; illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; and/or inability to establish and maintain effective relationships. The Veteran has denied perceptual problems, delusions, paranoia, and auditory or visual hallucinations. The evidence also does not demonstrate symptoms more nearly approximating such criteria. For instance, while the Veteran had a prior history of suicidal ideation and attempt, the record does not indicate that the Veteran has gross impairment in thought processes or communication, grossly inappropriate behavior, or a persistent danger of hurting self or others.

The Board acknowledges the Veteran's contentions that his psychiatric disorder is more severe than currently shown on examination and observes that he is competent to report his observable symptoms. However, he is not competent to report that his mental health symptoms were of sufficient severity to warrant a higher rating under VA's tables for rating such disabilities because such an opinion requires medical expertise that he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

The Board has only considered the evidence of record at the time of the April 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. In doing so, the Board considered whether staged ratings are appropriate; however, the Veteran's overall level of impairment has been stable throughout the period on appeal. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Therefore, assigning additional staged ratings is not warranted.

Accordingly, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating. The criteria for a 70 percent rating or higher are not met, and the appeal must be denied. 38 U.S.C.