Citation Nr: A25035242 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 240624-450717 DATE: April 16, 2025 ORDER A disability rating in excess of 50 percent for major depressive disorder (MDD), recurrent, moderate, is denied. FINDING OF FACT The Veteran's depressive symptoms manifested as occupational and social impairment with reduced reliability and productivity throughout the appeal period. CONCLUSION OF LAW The criteria for a disability rating in excess of 50 percent for MDD, recurrent, moderate, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.1-4.14, 4.130 Diagnostic Code (DC) 9434. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2011 to April 2015. This decision has been written under the guidelines of the Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA). In March 2024, the agency of original jurisdiction (AOJ) granted service connection for MDD, recurrent, moderate with an assigned evaluation of 50 percent from October 27, 2023. In March 2024, the Veteran requested Higher-Level Review (HLR) of that rating decision. In a March 2024 rating decision, the AOJ denied an increased evaluation in excess of 50 percent for MDD and an earlier effective date prior to October 27, 2023. In June 2024, the Veteran appealed the evaluation of his service-connected MDD to the Board via a Form 10182 and elected the Direct Review docket. 38 C.F.R. § 20.301. The Veteran's MDD has been evaluated as 50 percent disabling from October 27, 2023, under DC 9434. Under the General Rating Formula for Mental Disorders, a 50 percent rating is warranted under the General Rating Formula for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks occurring more than once a week, difficulty in understanding complex commands, impairment of short-term memory (i.e., retention of only highly learned material or forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing effective work and social relationships. A 70 percent rating is warranted under the General Rating Formula for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 an 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 an inability to establish and maintain effective relationships. A 100 percent rating is warranted under the General Rating Formula 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 the ability to maintain minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. The symptoms listed under the rating criteria are meant to be examples of symptoms that would warrant the rating, but they are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). If the evidence shows that a veteran experiences symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Furthermore, the rating code requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment at a level consistent with the assigned rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Turning to the evidence of record, VA treatment records in 2021 and 2022 demonstrate psychiatric treatments for depression, insomnia, fatigue, lack of appetite, loss of weight, and inability to upkeep personal hygiene. Additionally, treatment records show an isolated hospitalization in 2012 following suicide attempt by overdose, prior to the current appeal period. Other treatment records in 2022 demonstrate normal behavioral observations. VA mental health notes in 2023 evidence more persistent symptoms of depression and anxiety, to include little interest or pleasure; feeling down; trouble sleeping; tired/low energy; poor appetite; feelings of failure; trouble concentrating; and motor retardation. The evidence does not demonstrate that the Veteran endorsed suicidal/homicidal ideation. In fact, an August 2023 treatment note shows the Veteran presented with concerns for depressed mood, anxiety, insomnia, and nightmares. The medical professional notes a history of chronic posttraumatic stress disorder (PTSD) and routine psychiatric care up until February 2023. The Veteran reports increased symptoms of anxiety, panic attacks, and nightmares/flashbacks have negatively impacted her relationships. There are no reports of suicidal/homicidal ideations. VA mental health notes in 2024 continue to show treatments for anxiety and depression. The Veteran reports an occupation as a legal assistant with aspirations to start her own business, a healthy relationship with her husband and daughter, and enjoyment with watching television, going out to eat, and attending social events. Behavioral observations were unremarkable, and the Veteran denied any suicidal/homicidal ideations. A February 2024 VA examination demonstrated a diagnosis for MDD, recurrent, moderate. The Veteran reported that she previously participated in a 12-week therapy program and was prescribed medication, but it made her more depressed. She endorsed symptoms of depression; changes in sleep pattern; loss of interest; guilt; lack of energy and concentration; and loss of appetite but she denied suicidal ideations. Objective symptoms associated with the Veteran's psychiatric disability were documented as depressed mood; anxiety; suspiciousness; chronic sleep impairment; disturbance of motivation and mood; difficulty in establishing and maintaining effective relationships; and difficulty adapting to stressful circumstances. Upon behavioral observations, the Veteran was casually dressed, appropriately groomed, and oriented, and she displayed a stable mood, appropriate eye contact, normal speech, and linear thought process. While the Veteran's history of a suicide attempt in 2012 was noted, no current suicidal or homicidal ideation was reported. The clinician found the Veteran's symptoms resulted in social and occupational impairment with reduced reliability and productivity. After a careful review of the evidence, and consideration of arguments presented by the Veteran, the Board finds that a disability rating in excess of 50 percent is not warranted for MDD. The Board has based this conclusion on the frequency and duration of the Veteran's challenges consistent with anxiety and depression. The Board finds the Veteran competent to relay her personal experiences and finds her statements are credible. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). However, the weight of the evidence demonstrates a finding that the Veteran's consistent reports of depression, anxiety, sleep disturbance, and occasional isolative nature demonstrates occupational and social impairment with reduced reliability and productivity. The Veteran's reported symptoms, taken in context with the totality of the evidence, reflects symptoms of disturbance of mood and motivation, as contemplated by a 50 percent rating. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). Although the Veteran had one documented incident of a suicide attempt in 2012, suicidal ideation has not been reported during the appeal period; rather, when asked, the Veteran has denied suicidal ideation. Furthermore, VA treatment records demonstrated that the Veteran's mental health observations were relatively normal. Notably, VA treatment records variously demonstrate the Veteran reported periods of downward emotional spirals but also periods of positive emotions and no difficulty with anger. Hence, a rating in excess of 50 percent is not warranted because the weight of the evidence is against a finding that the Veteran's symptoms resulted in occupational and social impairment with deficiencies in most, areas, as contemplated by a 70 percent rating. While the Veteran reported having increased irritability and panic attacks, the symptoms did not rise to the level of such as unprovoked irritability with periods of violence and there was no evidence suggesting the presence of hallucinations or delusions, obsessional rituals, or neglect of personal appearance or hygiene. In fact, the Veteran reported stable relationships with her husband and daughter as well as interest in social activities. Moreover, none of the symptoms for a 100 percent rating have been shown. As such, entitlement to a disability rating in excess of 50 percent for MDD is not warranted, and the claim is denied. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y.Asfaw, 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.