GENERALIZED ANXIETY DISORDER

Summary

The veteran, who served in the U.S. Air Force from September 1956 to February 1960, appealed the denial of an increased disability rating for generalized anxiety disorder (GAD) with persistent depressive disorder (PDD). The veteran's claim was remanded by the Court of Appeals for Veterans Claims (CAVC) for further review of the Board's assessment of the evidence, specifically regarding suicidal ideation and the Veteran's symptoms in relation to the 70 percent rating criteria. The Board reviewed a January 2023 private psychological evaluation which noted occupational and social impairment with deficiencies in most areas, including suicidal ideation and difficulty adapting to stressful circumstances. The Board also considered VA treatment notes and a February 2024 VA examination, which diagnosed adjustment disorder with mixed anxiety and depressed mood, and later generalized anxiety disorder and persistent depressive disorder, respectively. The Board found the private evaluation's symptoms, particularly suicidal ideation and difficulty adapting to stress, aligned with the 70 percent rating criteria. While the Board acknowledged the evidence was approximately balanced regarding the level of impairment for a 70 percent rating, it applied the benefit of the doubt doctrine to grant an initial rating of 70 percent. The Board found the evidence did not support a rating higher than 70 percent, citing the absence of gross impairment in thought processes, persistent delusions or hallucinations, or intermittent inability to perform daily living activities.

Rationale

Suicidal ideation and difficulty adapting to stress noted in private evaluation; Symptoms approximated criteria for 70% rating; Benefit of the doubt applied for 70% rating

Full Decision Text

Citation Nr: A26040495
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 240326-429225
DATE: April 30, 2026

ORDER

Entitlement to an initial rating of 70 percent, but no higher, for generalized anxiety disorder (GAD) with persistent depressive disorder (PDD) is granted.

FINDING OF FACT

The Veteran's GAD with PDD manifested with symptoms approximating occupational and social impairment with deficiencies in most areas, but not total social and occupational impairment.

CONCLUSION OF LAW

The criteria for an initial rating of 70 percent, but no higher, for GAD with PDD have been met.  38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§, 4.130, General Rating Formula for Mental Disorders.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the U.S. Air Force from September 1956 to February 1960.

The rating decision on appeal was issued in February 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In his March 26, 2024, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.  

Therefore, the Board may only consider the evidence of record at the time of the February 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182.  38 C.F.R. § 20.303.  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.303, 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.

In July 2024, the Board issued a decision that denied the claim on appeal.  The Veteran subsequently appealed the July 2024 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In a May 2024 Memorandum Decision, the Court vacated the Board's decision and remanded this matter back to the Board for action consistent with the Memorandum Decision.

Increased Rating

Disability ratings are assigned under a schedule for rating disabilities and based on a comparison of the veteran's symptoms to the criteria in the rating schedule.  38 U.S.C. § 1155; 38 C.F.R. Part 4.  Disability ratings are determined by assessing the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the ratings schedule. Individual disabilities are assigned separate Diagnostic Codes, and ratings are based on the average impairment of earning capacity.  See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2.  If there is a question as to which evaluation should be applied to the veteran's disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7. 

The primary focus in a claim for increased rating is the present level of disability.  Although the overall history of the veteran's disability shall be considered, the regulations do not give past medical reports precedence over current findings.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Additionally, a staged rating is warranted if the evidence demonstrates distinct periods of time in which a service- connected disability exhibited diverse symptoms meeting the criteria for different ratings throughout the course of the appeal.  Fenderson v. West, 12 Vet. App. 119,
imates the criteria for that rating. Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7. 

The primary focus in a claim for increased rating is the present level of disability.  Although the overall history of the veteran's disability shall be considered, the regulations do not give past medical reports precedence over current findings.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  Additionally, a staged rating is warranted if the evidence demonstrates distinct periods of time in which a service- connected disability exhibited diverse symptoms meeting the criteria for different ratings throughout the course of the appeal.  Fenderson v. West, 12 Vet. App. 119, 125-126 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

Entitlement to an initial rating in excess of 50 percent for GAD with PDD.

The Veteran's service-connected GAD with PPD is evaluated as 50 percent disabling under the General Rating Formula for Mental Disorders, 38 C.F.R. § 4.130, Diagnostic Code 9400.

Under the provisions for rating psychiatric disorders, 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 a work like setting; 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 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.  38 C.F.R. § 4.130, Diagnostic Code 9400.

Ratings are assigned according to the degree of occupational and social impairment resulting from manifestations of the disability at issue.  However, the use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.  Mauerhan v. Principi, 16 Vet. App. 436 (2002).

When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission.  The rating agency shall assign a rating 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.  When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign a rating solely on the basis of social impairment.  38 C.F.R. § 4.126.

Under the general rating 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 occupational and social impairment required for a higher disability rating.  Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

A March
" 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 occupational and social impairment required for a higher disability rating.  Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

A March 2022 VA mental health treatment note shows that the Veteran reported feeling depressed and chronic anxiety.  He lived alone and had close relationships with his ex-wife and son.  He had a few close friends.  He retired at age 62 and still occasionally worked in catering with a local restaurant owner.  On mental status examination, he presented alert and oriented to person, time, and place.  His dress and hygiene were good.  He was cooperative and had good eye contact.  There was no evidence of psychomotor agitation or retardation.  His speech was normal.  There was no evidence of thought disorder.  He denied any hallucinations, delusions, or paranoia.  His cognition and memory appeared grossly intact.  The diagnosis was adjustment disorder with mixed anxiety and depressed mood.

An April 2022 VA psychotherapy note reflects that the Veteran reported ongoing mild distress around his lack of a sense of purpose or finding his niche in life.  He had some mild anxiety and depressive affect on examination. Additional records from April 2022 indicate he felt good emotionally, and was interested in reconnecting with his interests.  He felt his treatment goals had been met and elected to discontinue psychotherapy.  On mental status examination, he had good grooming and hygiene.  He was cooperative.  His mood was euthymic and his affect was congruent with ideational content.   He was fully oriented and there were no overt signs of psychosis.  His thought process was coherent and rational.

In March 2023, the Veteran submitted a January 2023 private psychological evaluation report and a disability benefits questionnaire (DBQ) prepared by a licensed clinical social worker.  The DBQ indicates that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, and/or mood.  It was noted he had anxiety in public and crowds, trouble relaxing, and did not feel safe in public and his depression limited his motivation and outings-his energy was low.  The Veteran had anxiety problems with posttraumatic stress disorder (PTSD) features including intrusive ideation, nightmares, and panic.  He likely worried excessively and ruminated, engaged in compulsive behavior such as repeated checking, experiences obsessions, and was rigid and perfectionistic.  He reported feeling sad and unhappy, complained of feeling depressed, experienced sadness and despair, and had a lack of interest and presented with anhedonia.

He had been married three times but none of the marriages lasted for the most part due to his need for rules and structure and his anxiety and depressive symptoms.  He remained amicable with his last ex-wife, but they could not live together.  He had one son from this marriage, and he had a good relationship with his son.  Over the years, he worked in various positions, but the position that he kept more consistently typically involved working alone most of the time.  The examiner noted current symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, flattened affect, impaired judgment, disturbances of motivation and mood, difficulty adapting to stressful circumstances, including work or work-like setting, and suicidal ideation.  The examiner also remarked how the Veteran likely engaged in compulsive behavior and experienced obsessions.  He had significant persecutory ideation, was socially withdrawn, and had difficulty forming relationships.  He was capable of managing his financial affairs.

On psychological testing, the Veteran was attentive and fully oriented.  He had good insight into the nature of the evaluation.  He communicated in a fairly open, straightforward manner, sharing his observations, thoughts, and impressions with some apparent anxiety and worry about the process.  His concentration, memory, and motivation appeared to be within normal limits.  His speech was clear.  

Testing revealed difficulties with attention and concentration, emotional distress, lack of interest, persecutory ideation such as believing that others seek to harm him, and interpersonal difficulties.  He endorsed significant symptoms of depression on the testing and in the evaluation. He indicated that he felt depressed more days than not and
 and had difficulty forming relationships.  He was capable of managing his financial affairs.

On psychological testing, the Veteran was attentive and fully oriented.  He had good insight into the nature of the evaluation.  He communicated in a fairly open, straightforward manner, sharing his observations, thoughts, and impressions with some apparent anxiety and worry about the process.  His concentration, memory, and motivation appeared to be within normal limits.  His speech was clear.  

Testing revealed difficulties with attention and concentration, emotional distress, lack of interest, persecutory ideation such as believing that others seek to harm him, and interpersonal difficulties.  He endorsed significant symptoms of depression on the testing and in the evaluation. He indicated that he felt depressed more days than not and his most common feeling was depression, followed by anxiety.  He was exhausted in part due to chronic hypervigilance and worried about his future.  He lacked energy and had lost interest in things he used to enjoy.  He endorsed symptoms of irritability, feelings of helplessness to change how he felt, and fatigue.  He had continued to evidence symptoms of anxiety. He endorsed feeling nervous and irritable, frequent hypervigilance, trouble falling and staying asleep, intrusive thoughts at bedtime, and racing thoughts during the day when he was worried about something happening that could lead to injury.  

The Veteran's ex-wife submitted an April 2023 statement in support of his claim.  She reported symptoms of his trouble sleeping and problems with concentration. 

A February 2024 VA examiner found the Veteran's mental diagnosis resulted in occupational and social impairment with reduced reliability and productivity.  The Veteran reported being close to his third wife, having a few close friends, and having additional acquaintances.  He had retired but occasionally helped a friend with catering jobs.  He acknowledged occasional panic attacks and low-grade background depression.  The examiner noted current symptoms of depressed mood, anxiety, suspiciousness, panic attacks weekly or less often, sleep impairment, mild memory loss, and difficulty establishing and maintaining effective relationships.  The diagnoses were generalized anxiety disorder and persistent depressive disorder.  The Veteran described moderate social and occupational impairment of a moderate level arising from these disorders.

In a May 2024 written statement, the Veteran reported some level of anxiety every day, fatigue, lack of concentration, anger, frustration, distrust, worry, and self-esteem issues.

Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran's GAD with PDD more nearly approximated the criteria for a rating of 70 percent, but no higher, during the entire rating period on appeal.

In the September 2025 Memorandum Decision, the Court determined that the Board, by overlooking the evidence of suicidal ideation-a symptom indicative of a 70 percent rating, failed to assess whether the January 2023 private evaluation report reflects symptoms more consistent with a 70 percent rating.

The Memorandum Decision stated that although the Board found that the level of the Veteran's symptoms did not match the severity of symptomatology in the January 2023 private examination report, the Board failed to explain why symptoms reported in January 2023 were not of sufficient frequency or duration to warrant a 70 percent rating.

In the January 2023 private evaluation report, the examiner found that the Veteran had "occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking and/or mood."  It was also noted that the Veteran had suicidal ideation and difficulty adapting to stressful circumstances, including work or work-like setting, which are symptoms listed in the criteria for a 70 percent rating.  See 38 C.F.R. § 4.130.  Additionally, suicidal ideation, no matter how fleeting or passive, is a symptom listed in the criteria for a 70 percent rating.  See Bankhead v. Shulkin, 29 Vet. App. 10, 21-22 (2017).

As such, on further review, the Board finds that the evidence establishes that the Veteran's psychiatric manifestations resulted in occupational and social impairment with deficiencies in most areas such as work, family relations, judgment, and mood, due to such symptoms as suicidal ideation and difficulty in adapting to stressful circumstances.  Accordingly, the Board awards an initial rating of 70 percent.

However, the evidence is neither evenly balanced nor approximately so with regard to whether a rating in excess of 70 percent rating is warranted.  Rather, the evidence persuasively weighs against so finding.  There are no indications of gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name.  The record does not show intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene).  He was
 such symptoms as suicidal ideation and difficulty in adapting to stressful circumstances.  Accordingly, the Board awards an initial rating of 70 percent.

However, the evidence is neither evenly balanced nor approximately so with regard to whether a rating in excess of 70 percent rating is warranted.  Rather, the evidence persuasively weighs against so finding.  There are no indications of gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name.  The record does not show intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene).  He was deemed capable of handling his own affairs as he lived alone.  He was described as being alert and fully oriented, maintaining good eye contact, and deemed capable of managing his financial affairs.  He had also been observed as being adequately groomed and appropriately attired.  He was cooperative and made good eye contact.  His speech was clear and thought processes were coherent.  His memory and cognition functions were also grossly intact.

Based on the evidence of record, including that highlighted above, the Board finds that the evidence is approximately balanced regarding whether the Veteran's service-connected GAD with PDD has been productive of occupational and social impairment with deficiencies in most areas.  The Memorandum Decision noted that the Board should have addressed whether the Veteran was entitled to staged ratings.  However, applying the benefit of the doubt doctrine, the Board grants an initial rating of 70 percent throughout the appeal period.  38 U.S.C. § 5107(b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

 

 

L. CHU

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. J. In

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.