MAJOR DEPRESSIVE DISORDER

Summary

The Veteran, who served from February 1970 to January 1972, appeals the denial of an earlier effective date for a 100 percent disability rating for major depressive disorder with psychotic features. The Regional Office (RO) initially granted service connection for the psychiatric disorder effective October 8, 2019, assigning 50 percent and 100 percent ratings effective October 8, 2019, and September 13, 2021, respectively. The Veteran sought a higher-level review, arguing for a 100 percent rating for the entire appeal period. The RO denied an earlier effective date than September 13, 2021. The Board reviewed evidence from the time of the RO's decision, including VA treatment records and examinations. VA treatment records from November 2019 noted hallucinations, while subsequent records in June 2021 showed no hallucinations. Two VA examinations, in September 2020 and September 2021, both indicated persistent hallucinations and significant occupational and social impairment. The Board found the evidence in equipoise regarding total occupational and social impairment due to persistent hallucinations between October 8, 2019, and September 12, 2021. Applying the benefit of the doubt, the Board granted the 100 percent rating for this period.

Rationale

Evidence in equipoise regarding total occupational and social impairment; Persistent hallucinations noted in VA treatment records and examinations; Benefit of the doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26040460
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 240416-432829
DATE: April 30, 2026

ORDER

Entitlement to an initial 100 percent disability rating for major depressive disorder with psychotic features from October 8, 2019, to September 12, 2021, is granted.

FINDING OF FACT

The evidence is in equipoise as to whether from October 8, 2019, to September 12, 2021, the service-connected major depressive disorder with psychotic features was manifested by a total occupational and social impairment due to persistent hallucinations.

CONCLUSION OF LAW

Resolving all reasonable doubt in the Veteran's favor, the criteria for an initial 100 percent disability rating for major depressive disorder with psychotic features from October 8, 2019, to September 12, 2021, have been met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.130, Diagnostic Code 9434 (2026).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from February 1970 to January 1972.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from  a February 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.  In a December 2023 rating decision, the RO granted service connection for the psychiatric disorder effective October 8, 2019, and assigned 50 percent and 100 percent disability ratings effective October 8, 2019, and September 13, 2021.  The Veteran requested a higher-level review of the assignment of an initial 50 percent disability rating for the psychiatric disorder in the December 2023 rating decision.  In a February 2024 rating decision, the RO denied an effective date earlier than September 13, 2021, for the assigment of the initial 100 percent disability rating.  The Board notes that the higher-level-review informal conference worksheet shows that the Veteran argued for a 100 percent disability rating for the psychiatric disorder for the entire appeal period.  As this appeal is from an assignment of an initial disability rating, the Board will analyze the claim as an initial increased rating claim rather than an earlier effective date claim.  

In the April 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  On December 15, 2025, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the February 2024 agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative within 90 days following receipt of the withdrawal of the hearing request.  38 C.F.R. § 20.302(b) (2026).  If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(b), 20.801 (2026). 

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 (2026).  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. 

Increased Rating

1. Entitlement to an initial disability rating in excess of 50 percent for major depressive disorder with psychotic features  

Governing law and regulations

In Fenderson v. West, 12 Vet. App. 119 (1999), the United States Court of Appeals for Veterans Claims (the Court) discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period.

Major depressive disorder is evaluated under the general rating formula for mental disorders.  Under those criteria, a
 a Supplemental Claim are included with this decision. 

Increased Rating

1. Entitlement to an initial disability rating in excess of 50 percent for major depressive disorder with psychotic features  

Governing law and regulations

In Fenderson v. West, 12 Vet. App. 119 (1999), the United States Court of Appeals for Veterans Claims (the Court) discussed the concept of the "staging" of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period.

Major depressive disorder is evaluated under the general rating formula for mental disorders.  Under those criteria, a 50 percent rating is assigned for 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; and difficulty in establishing effective work and social relationships.  38 C.F.R. § 4.130, Diagnostic Code 9434.  

A 70 percent rating is assigned for 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); and inability to establish and maintain effective relationships.  Id.

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; and memory loss for names of close relatives, own occupation, or own name.  Id.

Analysis

In the December 2023 rating decision, the RO granted service connection for the psychiatric disorder effective October 8, 2019, and assigned 50 percent and 100 percent disability ratings effective October 8, 2019, and September 13, 2021, respectively.

VA treatment records reflect that in November 2019, the Veteran had hallucinations but no delusions.  In December 2019, January 2020, and June 2020, there were no hallucinations or delusions.  

The September 2020 VA examination report reveals that the examiner determined that the Veteran had an occupational and social impairment with reduced reliability and productivity.  The Veteran reported persistent hallucinations.  The examiner noted that the Veteran's symptoms were depressed mood, anxiety, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, and persistent delusions or hallucinations. 

VA treatment record shows that in June 2021 there were no hallucinations.

The September 13, 2021, VA examination report reveals that the examiner determined that the Veteran had an occupational and social impairment with deficiencies in most areas.  The clinician indicated that the Veteran has mild auditory and visual hallucinations and that he takes anti-psychotic medications for his hallucinations.  The examiner noted that the Veteran's symptoms were depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, and persistent delusions or hallucinations.

The Board places great weight on the November 2019 VA treatment record revealing hallucinations and the September 2020 and September 13, 2021, VA examination report revealing persistent hallucinations.  The evidence is in equipoise as to whether from October 8, 2019, to September 12, 2021, the service-connected major depressive disorder with psychotic features was manifested by a total occupational and social impairment due to persistent hallucinations.  An initial 100 percent disability rating for major depressive disorder with psychotic features from October 8, 2019, to September 12, 2021, is warranted.  The benefit sought on appeal is accordingly allowed.

 

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Cherry, David T.

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
, 2019, to September 12, 2021, the service-connected major depressive disorder with psychotic features was manifested by a total occupational and social impairment due to persistent hallucinations.  An initial 100 percent disability rating for major depressive disorder with psychotic features from October 8, 2019, to September 12, 2021, is warranted.  The benefit sought on appeal is accordingly allowed.

 

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Cherry, David T.

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.