ADJUSTMENT DISORDER

Summary

The veteran, who served from February 1985 to January 1989, December 1990 to May 1991, and April 1995 to December 2000, appeals the January 2025 rating decisions concerning his service-connected psychiatric disability and several musculoskeletal conditions. The veteran sought an increased rating for his adjustment disorder with mixed anxiety and depressed mood, and for his right shoulder impingement syndrome, bilateral knee tenosynovitis, bilateral ankle tenosynovitis, and Crohn's disease with GERD. The Board granted an increased rating for the psychiatric condition to 70 percent, finding that the veteran's symptoms, including suicidal ideation, near-continuous depression, chronic sleep disturbance, impaired concentration, social withdrawal, and difficulty maintaining relationships, met the criteria for this level of impairment. This finding was supported by a private psychological evaluation and a statement from the veteran's niece, which corroborated his significant functional limitations. However, the Board remanded the claims for the right shoulder, bilateral knees, bilateral ankles, and Crohn's disease with GERD. The existing VA examinations for these conditions were over six years old and did not adequately reflect current symptom severity, as indicated by updated treatment records showing increased pain, need for more supportive bracing, and worsening GERD symptoms. The Board deferred adjudication on the TDIU claim, as it is premised on the severity of the remanded conditions.

Rationale

Private psychological evaluation found 70% impairment; Niece's statement corroborates functional impairment and social isolation; Symptoms include suicidal ideation, depression, sleep disturbance, impaired concentration, social withdrawal

Full Decision Text

Citation Nr: A26040337
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 251110-599029
DATE: April 29, 2026

ORDER

Entitlement to an increased rating of 70 percent, but no higher, for service-connected adjustment disorder with mixed anxiety and depressed mood is granted.

REMANDED

Entitlement to a disability evaluation in excess of 20 percent for right shoulder impingement syndrome and rotator cuff tendonitis is remanded.

Entitlement to a disability evaluation in excess of 30 percent for Crohn's disease with gastroesophageal reflux disease (GERD) status post resection of the small intestine is remanded.

Entitlement to a disability evaluation in excess of 10 percent for right knee tenosynovitis is remanded.

Entitlement to a disability evaluation in excess of 10 percent for left knee tenosynovitis is remanded.

Entitlement to a disability evaluation in excess of 10 percent for right ankle tenosynovitis is remanded.

Entitlement to a disability evaluation in excess of 20 percent for left ankle tenosynovitis is remanded.

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

FINDING OF FACT

For the entire period on appeal, the Veteran's adjustment disorder with mixed anxiety and depressed mood was manifested by social and occupational impairment with deficiencies in most areas; it was not manifested by total social impairment.

CONCLUSION OF LAW

The criteria for a disability rating of 70 percent, but no higher, for adjustment disorder with mixed anxiety and depressed mood are met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 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 from February 1985 to January 1989, December 1990 to May 1991, and from April 1995 to December 2000.

He appeals January 2025, July 2025, and October 2025 rating decisions by the Agency of Original Jurisdiction (AOJ).  In his November 2025 notice of disagreement (NOD), the Veteran appealed the decisions directly to the Board of Veterans' Appeals (Board) and chose the Direct Review docket.  See November 2025 VA Form 10182.  Therefore, the Board may only consider the evidence of record at the time of the AOJ decisions on appeal.  38 C.F.R. § 20.301.

As noted, the Veteran selected the Direct Review Docket.  Pursuant to 38 C.F.R. § 20.202(c)(2), a Veteran may modify a NOD to change the Board docket being requested.  The time limit for such modification is "within one year from the date that the [AOJ] mails notice of the decision on appeal, or within 60 days of the date that the Board receives the [NOD], whichever is later."  See 38 C.F.R. § 20.202(c)(2).  "[T]he Board ordinarily may not decide an appeal before this time period is up."  See Williams v. McDonough, 37 Vet. App. 305 (2024).  However, in a November 10, 2025 correspondence, the Veteran waived any remaining time; thus, the Board will adjudicate the claim now.  See November 2025 Waiver of Time to Select a Different Board Review Option.

1. Acquired Psychiatric Disorder

The Veteran maintains that his service-connected psychiatric disability is more severe than reflected by the currently assigned 30 percent evaluation.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern.  Francisco v. Brown, 7 Vet. App. 55 (1994).

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities based on average impairment of earning capacity.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Each disability must be viewed in relation to its history.  38 C.F.R. § 4.1.

Psychiatric disabilities are evaluated under 38 C.F.R. § 4.130.  A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood, due to symptoms such as
 primary concern.  Francisco v. Brown, 7 Vet. App. 55 (1994).

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities based on average impairment of earning capacity.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Each disability must be viewed in relation to its history.  38 C.F.R. § 4.1.

Psychiatric disabilities are evaluated under 38 C.F.R. § 4.130.  A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood, due to symptoms such as suicidal ideation, near-continuous depression affecting the ability to function independently, difficulty adapting to stressful circumstances, and inability to establish and maintain effective relationships.  A 100 percent rating is warranted for total occupational and social impairment.  38 C.F.R. § 4.130, Diagnostic Code 9440.

When evaluating mental disorders, VA must consider the frequency, severity, and duration of symptoms and their resulting level of occupational and social impairment.  Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); 38 C.F.R. § 4.126.

After review of the record, the Board finds that the Veteran's psychiatric symptoms more nearly approximate the criteria for a 70 percent rating for the entire period on appeal.

The Veteran submitted a private psychological evaluation from Dr. K.F.B., dated December 1, 2019 and first received by VA in January 2020.  Dr. K.F.B. found that the Veteran's psychiatric disability results in occupational and social impairment with deficiencies in most areas, consistent with a 70 percent level of impairment.  She identified symptoms including depressed mood, anxiety, near-continuous panic or depression affecting the ability to function independently, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, inability to establish and maintain effective relationships, and suicidal ideation.  See December 2019 Dr. K.F.B. examination report.

The attachment to Dr. K.F.B.'s report noted the Veteran lived alone and experienced significant impairment in activities of daily living.  He reported persistent depression, chronic sleep disturbance alternating between insomnia and hypersomnia, severe irritability, social withdrawal, impaired concentration and memory, and inability to sustain attention for basic tasks.  The Veteran further endorsed feelings of worthlessness, loss of interest in activities, and a prior suicide attempt in 2007.  He reported significant difficulty tolerating others, stating he is only able to be around people for short periods before becoming irritable, which has contributed to his isolation and withdrawal from social relationships.  Id.

A statement from the Veteran's niece, B.F., further corroborates significant functional impairment.  She reported that the Veteran has isolated from family since service, rarely maintains contact, and has become increasingly withdrawn and socially detached.  She described persistent depression, anxiety, and stress intolerance, noting that the Veteran frequently expresses hopelessness, diminished self-worth, and statements suggesting he "doesn't know how much more he can take."  She also reported concern for possible self-harm and described the Veteran as socially isolated with minimal meaningful relationships.  See November 2019 B.F. statement.

The Board finds this evidence highly probative as it reflects consistent and sustained impairment across occupational, social, and cognitive domains.  The Veteran's symptoms include suicidal ideation, near-continuous depression, chronic sleep impairment, impaired concentration and memory, severe social withdrawal, and inability to maintain effective relationships.  The Veteran's functioning is further impaired by difficulty adapting to stress, irritability, and significant occupational impairment, including inability to sustain employment.

Taken together, the Veteran's disability picture reflects deficiencies in most areas, including work, family relations, thinking, and mood.  The severity of his social isolation, impaired interpersonal functioning, and occupational limitations is consistent with a high level of impairment contemplated by a 70 percent rating.

While the Veteran has endorsed symptoms contemplated by higher evaluations, the evidence does not demonstrate total occupational and social impairment.  The Veteran remains able to perform activities of daily living, maintains some limited contact with family, and is not shown to have gross impairment in thought processes, persistent delusions or hallucinations, disorientation, or similar symptoms consistent with a 100 percent rating.  Accordingly, the criteria for a 100 percent rating are not met.

The Board has considered whether staged ratings are warranted; however, the evidence demonstrates a relatively consistent level of impairment throughout the period on appeal.  Therefore, staged ratings are not appropriate.

Accordingly, resolving reasonable doubt in favor of the Veteran, the criteria for an increased
 contemplated by a 70 percent rating.

While the Veteran has endorsed symptoms contemplated by higher evaluations, the evidence does not demonstrate total occupational and social impairment.  The Veteran remains able to perform activities of daily living, maintains some limited contact with family, and is not shown to have gross impairment in thought processes, persistent delusions or hallucinations, disorientation, or similar symptoms consistent with a 100 percent rating.  Accordingly, the criteria for a 100 percent rating are not met.

The Board has considered whether staged ratings are warranted; however, the evidence demonstrates a relatively consistent level of impairment throughout the period on appeal.  Therefore, staged ratings are not appropriate.

Accordingly, resolving reasonable doubt in favor of the Veteran, the criteria for an increased rating of 70 percent, but no higher, for the entire period on appeal are met.  38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

REASONS FOR REMAND

1. Crohn's Disease with GERD

2. Right Shoulder

3. Right Knee

4. Left Knee

5. Right Ankle

6. Left Ankle

The Veteran contends that his service-connected right shoulder, bilateral knee, and bilateral ankle disabilities, as well as Crohn's disease with GERD, are more severe than the ratings currently assigned.

The Veteran last underwent VA examinations addressing his musculoskeletal conditions in October 2019 (right shoulder, bilateral knees, and bilateral ankles) and for Crohn's disease with GERD in January 2020.  See October 2019 and January 2020 VA examination reports.  As these examinations are now more than six years old, they do not adequately reflect the current severity of the Veteran's disabilities.  Subsequent VA treatment records suggest a potential worsening of symptoms across the Veteran's multiple service-connected conditions.

With respect to Crohn's disease with GERD, VA treatment records reflect increasing symptom severity.  A May 2024 VA treatment note documents the Veteran's report of increased gastroesophageal reflux occurring on a daily basis.  See May 15, 2024 VA treatment note.  Thereafter, a separate VA treatment note reflects a refill request for pantoprazole due to worsening GERD symptoms.  See November 4, 2024 VA treatment note.  These records suggest a progression in severity since the last VA examination in January 2020.

Regarding the Veteran's knees, VA treatment records reflect escalation in treatment modalities following the October 2019 VA examination.  A December 2020 VA treatment note documents issuance of new bilateral knee orthoses, including knee sleeves with patella donuts and side stays.  Shortly thereafter, treatment records further reflect issuance of Corflex hinged knee braces.  See VA treatment notes.  The prescription of more supportive orthotic devices suggests a potential increase in functional impairment since the prior examination.

Similarly, with respect to the bilateral ankles, a December 30, 2020 VA treatment note indicates the Veteran requested new ankle braces, with issuance of ankle orthoses and ankle stabilizing canvas gauntlets.  See VA treatment notes.  This represents additional and updated bracing not documented at the time of the October 2019 examination and suggests possible worsening symptomatology.

As to his right shoulder, a November 2020 treatment note documents worsening shoulder pain over the preceding three months without intervening injury. Additionally, records reflect that the Veteran received steroid injections in approximately October 2020, suggesting ongoing escalation in treatment for pain management.  See VA treatment notes.

Ultimately, the Board finds that the above evidence indicates an increase in severity of the Veteran's service-connected disabilities since the time of his last VA examinations.  Where the record suggests a worsening of symptoms and the available evidence is too remote to adequately evaluate the current disability picture, VA's duty to assist requires provision of a contemporaneous examination.  See Snuffer v. Gober, 10 Vet. App. 400 (1997); see also Barr v. Nicholson, 21 Vet. App. 302 (2007).

Accordingly, remand is warranted to obtain updated VA examinations assessing the current severity of the Veteran's service-connected Crohn's disease with GERD, right shoulder, bilateral knee, and bilateral ankle disabilities.  As the foregoing evidence was of record prior to the January 2025 rating decision on appeal, the failure to obtain contemporaneous examinations constitutes a predecisional duty to assist error and remand is appropriate.  38 C.F.R. § 20.802(a).

7. TDIU

As the Veteran's TDIU claim is premised on the severity of his service-connected disabilities subject to remand herein, the issue of TDIU is inextricably intertwined.  Accordingly, the Board will defer adjudication on the matter.  See Harris
 to obtain updated VA examinations assessing the current severity of the Veteran's service-connected Crohn's disease with GERD, right shoulder, bilateral knee, and bilateral ankle disabilities.  As the foregoing evidence was of record prior to the January 2025 rating decision on appeal, the failure to obtain contemporaneous examinations constitutes a predecisional duty to assist error and remand is appropriate.  38 C.F.R. § 20.802(a).

7. TDIU

As the Veteran's TDIU claim is premised on the severity of his service-connected disabilities subject to remand herein, the issue of TDIU is inextricably intertwined.  Accordingly, the Board will defer adjudication on the matter.  See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).  The duty to assist errors identified above regarding the Veteran's increased rating claims extend to this intertwined claim as well and remand is appropriate.  38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral knee, bilateral ankle, and right shoulder disabilities.  The examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing.  The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups.

If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected Crohn's disease with GERD.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.

 

 

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Poe, 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.