Citation Nr: 18148236 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 07-27 691 DATE: November 8, 2018 ORDER Entitlement to a 70 percent rating, but no higher, from January 21, 2014 to October 22, 2015, for major depressive disorder (MDD) is granted. Entitlement to a rating higher than 50 percent for MDD prior to January 21, 2014 and after October 22, 2015 is denied. FINDINGS OF FACT 1. Prior to January 21, 2014, the Veteran’s major depressive disorder was manifested by symptoms which caused occupational and social impairment with reduced reliability and productivity; the symptoms did not cause deficiencies in most areas, or total occupational and social impairment. 2. From January 21, 2014 to October 22, 2015, the Veteran’s major depressive disorder was manifested by symptoms which caused deficiencies in most areas but not total occupational and social impairment. 3. As of October 22, 2015, the Veteran’s major depressive disorder has been manifested by symptoms which cause occupational and social impairment with reduced reliability and productivity; the symptoms have not caused deficiencies in most areas, or total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 for major depressive disorder prior to January 21, 2014 have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 3.321, 4.130, Diagnostic Code 9434 (2017). 2. The criteria for a 70 percent rating, but no higher, from January 21, 2014 to October 22, 2015 for major depressive disorder have been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 3.321, 4.130, Diagnostic Code 9434 (2017). 3. The criteria for a rating in excess of 50 for major depressive disorder as of October 22, 2015 have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 3.321, 4.130, Diagnostic Code 9434 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from July 1985 to October 1993 and from February 2003 to December 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) located in St. Petersburg, Florida, which confirmed and continued a previously assigned 50 percent rating for MDD. Jurisdiction of this appeal has been transferred to the RO in Detroit, Michigan. This matter was before the Board in July 2015 at which time it was remanded for additional evidentiary development. Most recently, this matter was remanded in May 2016 to obtain outstanding medical records. A review of the record shows that the RO has complied with the remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). In a December 2015 rating decision, the RO granted entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) effective from January 14, 2013. In April 2016, the RO received the Veteran’s Notice of Disagreement with the effective date assigned for the TDIU. In a May 2016 decision, the Board remanded the issue of entitlement to an effective date earlier than January 14, 2013 for the award of a TDIU for the issuance of a statement of the case. In correspondence received in December 2017, the Veteran’s attorney argued that the TDIU claim is part of the Veteran’s increased rating claim. While an increased rating claim can include a TDIU claim as part of the increased rating claim, here, the Veteran was awarded a TDIU, with the same effective date as the date of the Veteran’s increased rating claim. Accordingly, the grant of a TDIU in the context of the Veteran’s increased rating claim is granted in full, and therefore is no longer part of the increased rating claim. Moreover, with respect to the Veteran’s claim for an earlier effective date for the award of TDIU, the RO has not issued the statement of the case in this regard as requested in the Board’s remand directives. As such, the earlier effective date claim will not be addressed at this time. The Board observes that in correspondence received in June 2017, the issue of entitlement to special monthly compensation was raised by the Veteran’s attorney. The matter is referred to the RO for appropriate action. Additionally, the Veteran and his representative are advised that, effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form prescribed by the Secretary. 38 C.F.R. §§ 3.1 (p), 3.155, 3.160 (2017). Entitlement to a rating in excess of 50 percent for major depressive disorder The Veteran’s major depressive disorder has been rated under the criteria contained in the General Rating Formula for Mental Disorders. Under those criteria, a 50 percent rating is warranted 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; difficulty in establishing effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9434. A 70 percent rating is assigned when there is objective evidence demonstrating 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, or 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. Id. 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 and place, memory loss for names of close relatives, own occupation, or own name. Id. In Mauerhan v. Principi, 16 Vet. App. 436 (2002), the U.S. Court of Appeals for Veterans Claims (Court) held that 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. Accordingly, the evidence considered in determining the level of impairment under section 4.130 is not restricted to the symptoms provided in the diagnostic code. Rather, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. More recently, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that “a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 (Fed.Cir 2013). The Federal Circuit explained that in the context of a 70 percent rating, section 4.130 “requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” Id. at 118. The Federal Circuit indicated that “[a]lthough the veteran’s symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran’s level of impairment in most areas.’” Id. According to the Fourth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, a Global Assessment of Functioning (GAF) score is a scale reflecting the “psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness.” Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266 (1996) (citing the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994) (DSM-IV)). The Board notes that effective August 4, 2014, VA implemented rules replacing references to the DSM-IV with the DSM-5. The DSM-5 applies to claims certified to the Board on and after August 4, 2014. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). The Veteran’s appeal was certified to the Board in June 2015. Consequently, the DSM-5 is for application. The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (2014); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Factual Background Turning to the evidence of record, VA treatment records reveal psychiatric treatment. Notably, in a February 2012 VA treatment record, the Veteran reported that he was upset with the VA. The physician noted that the appellant was hypervigilant during the evaluation. On mental status evaluation, the appellant was dressed appropriately; his motor activity was calm, and interpersonal was cooperative. The appellant’s speech was normal in rate and rhythm, his mood was depressed and his affect was restricted. Additionally, attention was normal and concentration was brief. Remote memory was normal and recent memory was described as forgetful at times. Thought process was normal, linear, and goal directed, and thought content was negative for auditory or visual hallucinations or delusional thoughts. Judgment and insight were fair and the appellant was oriented in all four spheres. The appellant denied suicidal thoughts or plans. The Veteran underwent a VA examination in January 2014. The examiner determined that the Veteran’s level of occupational and social impairment with regards to his mental diagnosis was best summarized as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or symptoms controlled by medication. It was noted that the appellant denied taking any medication. Occupationally, it was noted that the Veteran was unemployed and spent most of his days at home. Socially, the appellant reported that he briefly watched television, but generally kept it on for back ground noise since he does not like silence. He denied having hobbies and indicted that he has no interest in doing anything and does not help around the house because “there is not much to do.” He reported that he does not have friends with whom he exchanges visits on a regular basis and had not made many social contacts since he migrated to the states in 2007. The Veteran stated that he had been married to his current wife for thirteen years and indicated that he marriage was not going well. He reported that he would probably be moving out of the house in week because he does not want to be around anyone. He has one child with his current wife. He indicated that he did not have a close relationship with his siblings. On mental status evaluation, it was noted that the Veteran was aware of the reason of the examination and was adequately capable of comprehending the purpose, nature, and scope of the examination. The Veteran walked into the examination unassisted with a normal gait. He was casually dressed but unshaved wearing dark glasses. He was initially short with his responses, but did not appear to be uncomfortable. There was no inappropriate or peculiar behavior present. The Veteran communicated with good eye contact and was fully oriented in time, place and person. He was also fully conscious, alert, attentive and involved in the session. The Veteran was found to be cooperative during the interview. His speech was of normal rate, tone, and rhythm and his language skills were intact and appropriate. His mood was irritable and affect was congruent with mood. The appellant’s thought processes were normal, coherent, and goal directed without loose associations or tangential thinking. There were no delusions or obsessive thinking present or suicidal, homicidal, or violent thoughts expressed or detected. Insight, judgment, and memory were good, and fund of knowledge was average. The examiner indicated that the Veteran was not in significant risk of self-harm. In so finding, he noted that the appellant denied current suicidal/homicidal ideation, intent, or plan. He also denied past suicide attempts or hospitalization for psychiatric reasons. The examiner noted that the Veteran’s psychiatric symptoms included depressed mood and disturbances in motivation and mood. The examiner opined that the frequency, severity, and intensity of the appellant’s symptoms had not worsened. He noted that the validity of the appellant’s report of his symptoms was highly questionable in view of the results of the SIMS screening measure, which suggested gross exaggeration of symptoms, and the fact that the Veteran had not followed up with appointment or taken medications for his condition. In a subsequent January 2014 private treatment record, it was noted that the appellant was admitted on a voluntary status due to increasing anxiety and depression. The Veteran reported that he had been struggling with hopelessness, worthlessness, death wishes, and suicidal thoughts with no plans. He did not endorse psychosis, delusions, or hallucinations. Additionally, there was no evidence of any fearfulness, suspiciousness, or hallucinatory behavior. The Veteran’s cognition and memory were intact, he was alert and oriented. He acknowledged that he had not been compliant with any of his psychotropics. In a March 2014 posttraumatic stress (PTSD) disability benefits questionnaire, it was noted that the appellant’s current diagnoses included PTSD and major depression. The examiner determined that the Veteran’s level of occupational and social impairment with regards to his mental diagnoses was best summarized as occupational and social impairment with reduced reliability and productivity. He indicated that both diagnosed psychiatric disabilities contributed to the Veteran’s social and occupational impairment. It was noted that the appellant’s psychiatric disability was treated with medication. Socially, the Veteran was married and lived with his wife. He had little or no social activity. Occupationally, he had not been employed since leaving the military in 2004. Symptoms associated with the Veteran’s psychiatric condition included; depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; disturbances of motivation and mood; difficulty establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control such as unprovoked irritability with periods of violence. It was also noted that the Veteran had intense suspiciousness verging on paranoia and agoraphobia making shopping difficult. The examiner noted that hypervigilance and agoraphobia were due to the appellant’s PTSD and the remainder of the symptoms were due to both diagnosed psychiatric disorders. VA clinical records following the examination reveal psychiatric treatment. Symptoms included avoidance, irritability, depression, and isolation. Notably, in a May 2014 note, the Veteran reported that he did not go out much because he gets anxious and does not want to be around people. He said that what helps him is volunteering at the Moose Lodge with a bike run that raises money for charity. In a July 2014 VA mental hearing nursing outpatient note, the appellant reported that he was going out a little bit more. In January 2015 mental health records, the Veteran reported that over the last month, he had increased anxiety, and irritability. He reported that he was more worrisome, had paranoia, and auditory hallucination. However, the Veteran denied suicidal ideation. Private treatment records dated in March 2015 demonstrate that the Veteran presented with an accidental overdose. It was noted that the appellant took an extra dose of night time medication. In an August 2015 VA mental health note, it was noted that the appellant had an overdose. The physician indicated that it was difficult to determine the nature of the overdose. However, he concluded that it was clearly not intentional and that the Veteran was not suicidal. He stated that the Veteran may have taken extra mirtazapine without knowing. The Veteran was provided a VA social and industrial assessment in September 2015. At that time, it was noted that the Veteran was tearful and dysphoric, but had good eye contact. He was described as finding the interview stressful and threatening and was guarded and withdrawn. However, he was cooperative and friendly. Occupationally, the Veteran reported that he had not worked since discharge from the National Guard. With regards to emotional difficulties, it was noted that the Veteran had been hospitalized on one occasion due to fleeting suicidal ideation and depression. The Veteran had one accidental overdose. Socially, it was noted that the appellant had been married to his second wife since 2001. He has one biological child with his wife, who is 14 years old. He also has a 24-year-old son from a previous relationship and two step children. The Veteran stated that he and his wife have no social life. They only do things together. They have no club memberships or church affiliations. Occasionally, his wife will have her brother over for a visit. The appellant reported that he has trouble sleeping, has no hobbies or interests, and spends most of his time watching television. With regards to appearance, the Veteran was dressed appropriately for the weather and occasion. His speech was of a normal rate and rhythm. He became tearful throughout the interview as he described his life. On metal status evaluation, the Veteran was found to be alert and oriented and showed no evidence of a thought disorder. His mood was depressed and his affect was labile. Cognitively, he was intact and his judgment and insight were fair. The examiner indicated that the Veteran’s is irritable due, in part, to his depression. He has no interest in spending time with people, and this includes his family. It was noted that the Veteran’s relationship with his wife and been difficult at times. In the report of an October 2015 VA mental health examination, it was noted that the appellant had a diagnosis of persistent depressive disorder. It was documented that the appellant was briefly hospitalized approximately 3 months prior to the examination when he discontinued his psychotropic medication except for Xanax and Ambien and “unintentionally overdosed.” The examiner determined that the Veteran’s level of occupational and social impairment with regards to his mental diagnosis was best summarized as occupational and social with reduced reliability and productivity. Socially, the Veteran reported that he lived with his wife and 14-year-old son. He also reported that he has a 24-year-old son from a previous relationship who lives out of state. However, he reported that he maintained contact with him. He also has two step-daughters. The Veteran described himself as “housebound” and reported having no social life. However, he attended church occasionally and went to family events. He reported doing chores around his household. Occupationally, the Veteran had not worked since leaving the miliary in 2004. Symptoms associated with the Veteran’s psychiatric disorder included depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Additional symptoms included irritability, resentment, and limited social interaction. On behavioral observation, it was noted that the Veteran was appropriately dressed for the evaluation and behaved in a cooperative manner. Eye contact was consistent and speech was understandable. The Veteran provided information in a detailed and organized manner and there were no significant deficits in memory. He maintained adequate emotional control throughout the assessment process. No psychotic symptoms were displayed. An average level of intelligence was estimated. The examiner reported that psychological testing produced results of questionable validity due to the Veteran’s overreporting of symptoms. He indicated that the testing data warranted consideration with determining disability/impairment in the Veteran’s case. Regarding the Veteran’s competency to manage financial affairs, he suggested during the examination that he had previously been found “incompetent” and that his wife manages the finances and makes financial decisions for the household. However, throughout the examination, the Veteran presented himself coherently and provided information in a detailed and organized manner. He was quite familiar with the VA claims process and did not display any cognitive deficits which might suggest incompetency. In addition, a review of the Veteran’s VA medical records noted consistently good insight and judgment. In a November 2015 report of general information, the Veteran expressed anxiety at leaving his house and stated that he was traumatized from the social and industrial assessment during which he had to revisit/relive traumatic memories and emotions. Subsequent VA clinical records note psychiatric treatment. Reported symptoms included nightmares, memory loss, and difficulty sleeping. In a November 2015 record, the appellant reported a low mood, but was not suicidal. In an April 2016 treatment record, the appellant reported that he was doing fine regarding depression and sleep. It was noted that his wife was present and was very supportive. In June 2017 note, it was noted that the appellant returned for treatment after more than a year hiatus. A final VA examination was provided in September 2017 at which time major depressive disorder, recurrent, with anxious distress was assessed. It was noted that the appellant felt depressed most of the day, every, day. Additionally, he had loss of interest in most activities, fatigue, and difficulty maintaining concentration for short-term tasks. He also reported passive thoughts of deaths but no active suicidal intern or plans. He stated that he felt “keyed up/tense,” restless, worried constantly, and feared that something awful may happen. However, he was able to control his emotions during the interview and there were no psychotic behaviors. The examiner determined that the Veteran’s level of occupational and social impairment with regards to his mental diagnosis was best summarized as occupational and social with reduced reliability and productivity. The examiner noted that the appellant’s wife of 16 years accompanied him during the interview. The Veteran consulted her for the accuracy of his responses. She explained that she handles the bills because she is the one earning the money. The examiner opined that it does not appear to relate to any perception of his ability. With regards to psychosocial and marital functioning, the Veteran lived with his wife of 16 years and children ages 16 and 19. He has two older children and talks to them regularly. The Veteran indicated that he had no friends, but stated that he “never believed in friends.” However, he has acquaintances. He relies strictly on his wife and children for companionship. Additionally, he maintained contact on social media with two friends from the military. He stated that they had been friends since 1985. Occupationally, the Veteran had not worked since discharge from military service. Symptoms associated with the Veteran’s psychiatric disability were depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. On behavioral observation, the Veteran was casually attired and sported a 3 days beard growth (the Veteran stated that he is mad at the VA so he doesn’t shave). Content of speech was lucid and coherent with no sign of formal thought disorder. Rate and volume of speech was within normal limits. Irritability was noted at the end of the evaluation, but the Veteran became cooperative after a few minutes. The appellant was ble to relate his history of issues with the VA in a coherent, detailed, and sequential manner. Good recall of memory was noted. Subsequent VA clinical records note psychiatric treatment. An October 2017 treatment record revealed major depressive disorder in partial remission. Analysis After a review of the evidence, and resolving doubt in favor of the Veteran, the Board finds that a 70 percent rating for the Veteran’s service-connected psychiatric disability is warranted from January 21, 2014 to October 22, 2015. However, the preponderance of the evidence is against a rating in excess of 50 percent prior to January 21, 2014 and from October 22, 2015. Prior to January 21, 2014 During this period of the appeal, the Veteran’s psychiatric symptoms were shown to include hypervigilance, depressed mood, and disturbances in motivation and mood. Such symptoms are contemplated by the current 50 percent evaluation and were determined to cause occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress; or symptoms controlled by medication. See 38 C.F.R. § 4.130, Diagnostic Code 9434. The Board finds, however, that the preponderance of the evidence is against the assignment of a rating in excess of 50 percent. In this case, the medical evidence has shown that the Veteran’s overall disability picture is not more consistent with nor does it more nearly approximate the criteria required for 70 percent evaluation during this period of the appeal. In this regard, the Veteran’s psychiatric symptoms have not caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Mauerhan, supra, Vazquez-Claudio, supra. Specifically, as set forth in more detail above, the evidence shows that the Veteran did not exhibit suicidal ideation, obsessional rituals, illogical or irrelevant speech; near continuous panic attacks; spatial delusions; impaired impulse control; spatial disorientation; or an inability to establish and maintain effective relationships. Further, there was no indication of neglect of personal appearance and hygiene. Socially, the Veteran reported that he did not have a close relationship with his siblings. While the appellant indicated that did not have friends with whom he visited and had not made many social contacts since he migrated to the states, the evidence does not suggest that he has no social relationships. Although the Veteran reported marital difficulties, he had been married to his current wife for 13 years. In view of the record in its entirety, the Board finds that the Veteran’s major depressive disorder symptoms do not indicate a disability picture commensurate with the next-higher 70 percent rating. In summary, the Board has considered the Veteran’s psychiatric disorder symptoms that affect his level of occupational and social impairment. After so doing, the Board concludes that the preponderance of the evidence is against a rating in excess of 50 percent during this period of the appeal. Gilbert v. Derwinski,1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2017). From January 21, 2014 to October 22, 2015 During this stage of the appeal, the Veteran’s psychiatric symptoms included depressed mood; anxiety; suspiciousness; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; chronic sleep impairment; disturbances of motivation and mood; difficulty establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; inability to establish and maintain effective relationships; suicidal ideation; and impaired impulse control such as unprovoked irritability with periods of violence. The Board observes that the March 2014 examiner determined that the Veteran’s level of occupational and social impairment with regards to his mental diagnosis was best summarized as occupational and social impairment with reduced reliability and productivity. However, the Veteran reported suicidal ideations during this period of the appeal. In Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017), the Court held that the language of the general rating formula “indicates that the presence of suicidal ideation alone... may cause occupational and social impairment with deficiencies in most areas.” The Court also held that “insofar as the Board required evidence of more than thought or thoughts to establish the symptom of suicidal ideation, it erred.” Id. Based on the Court’s holding and reasoning in Bankhead, the Board finds that the Veteran’s major depressive disorder is more nearly approximated by the criteria for a 70 percent rating. The Board finds that the Veteran’s major depressive disorder is more nearly approximated by the criteria for a 70 percent rating. See 38 C.F.R. § 4.130, Diagnostic Code 9434; Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). However, the Veteran’s major depressive disorder symptoms have not more nearly approximated the criteria for a 100 percent rating. 38 C.F.R. § 4.7 (2017). In so finding, symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; disorientation to time and place; memory loss for names of close relatives, own occupation or name, have not been shown. Critically, the evidence does not show total occupational and social impairment due to the Veteran’s service-connected psychiatric disability. In so finding, the Board notes that the Veteran is shown to maintain a relationship with his wife and children. Further, in a May 2014 VA clinical record, the Veteran reported that he volunteered at the Moose Lodge. Thus, neither the symptoms nor overall level of impairment meet the criteria for a 100 percent schedular rating under the Rating Schedule, and a rating in excess of the 70 percent assigned herein is therefore not warranted for the Veteran’s major depressive disorder. In summary, the Board has considered the Veteran’s psychiatric disorder symptoms that affect his level of occupational and social impairment. After so doing, the Board concludes that, resolving all doubt in favor of the Veteran, a 70 percent rating is warranted from January 21, 2014 to October 22, 2015. However, the preponderance of the evidence is against a higher rating. As of October 22, 2015 As of October 22, 2015, symptoms associated with the Veteran’s psychiatric disorder included depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Such symptoms are contemplated by the current 50 percent evaluation and have been determined to cause occupational and social impairment with reduced reliability and productivity. See 38 C.F.R. § 4.130, Diagnostic Code 9434. The Board finds, however, that the preponderance of the evidence is against the assignment of a rating in excess of 50 percent. In this case, the medical evidence has shown that the Veteran’s overall disability picture is not more consistent with nor does it more nearly approximate the criteria required for 70 percent evaluation during this period of the appeal. In this regard, the Veteran’s psychiatric symptoms have not caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Mauerhan, supra, Vazquez-Claudio, supra. Specifically, as set forth above, the evidence shows that the Veteran did not exhibit illogical or irrelevant speech; near continuous panic attacks; spatial delusions; impaired impulse control; spatial disorientation; or an inability to establish and maintain effective relationships. Further, there was no indication of neglect of personal appearance and hygiene. The Board acknowledges that at the time of the September 2017 VA examination, the appellant reported passive thoughts of death, but no active suicidal intent or plan. However, such symptom has not been shown to have an impact on the Veteran’s overall ability to function socially or occupationally. With regard to the report of suicidal ideation, in Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the Court suggested that the Board must consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating. Even considering such symptom, there was no finding that the overall disability picture caused occupational and social impairment with deficiencies in most areas. In this regard, the Board observes that in post-service medical records during this period of the appeal, the appellant specifically denied suicidal ideation, plan, or intent. Socially, the Veteran reported that he had been married to his wife for 16 years and indicated that he talked to his children regularly. Although the Veteran consistently reported that he did not have any friends, he reported that he had friends whom he kept in contact with on social medical. They had been friends since 1985. He also indicated that he occasionally attended church. In view of the record during this period of the appeal, the Board finds that the symptom does not indicate a disability picture commensurate with the next-higher 70 percent rating. In summary, the Board has considered the Veteran’s psychiatric disorder symptoms that affect his level of occupational and social impairment. After so doing, the Board concludes that the preponderance of the evidence is against of a rating in excess 50 percent from October 22, 2015. Gilbert v. Derwinski,1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (2014); 38 C.F.R. § 3.102 (2017). L. B. CRYAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel