Citation Nr: A25035998 Decision Date: 04/18/25 Archive Date: 04/18/25 DOCKET NO. 200804-101624 DATE: April 18, 2025 ORDER Entitlement to a rating in excess of 30 percent for somatic symptom disorder (SSD) with other specified depressive disorder (OSDD) prior to February 12, 2020, is denied. FINDING OF FACT Prior to February 12, 2020, the severity, frequency, and duration of the Veteran's symptoms of SSD with OSDD did not more closely reflect occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.130, Diagnostic Code 9422. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1992 to September 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from November 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The November 2015 rating decision granted service connection for SSD with OSDD and assigned a 30 percent rating effective July 14, 2015, under Diagnostic Code (DC) 9422. The Veteran timely appealed and the relevant procedural documents were issued. After remand by the Board in April 2019 and May 2020, the RO issued a July 2020 rating decision granting a higher rating effective February 12, 2020. The Veteran filed an August 2020 Decision Review Request (10182) opting into the modernized review system, also known as the Appeals Modernization Act (AMA). The Veteran selected Evidence Lane for her review option. In April 2024, the Board denied the claim for a higher rating prior to February 12, 2020. The Veteran appealed to the Court of Appeals for Veterans' Claims (Court). In November 2024, the Court issued a Joint Motion for Partial Remand (Remand). The parties of the Remand agreed the Board erred by failing to provide an adequate statement of reasons or bases to support its finding that the Veteran was not entitled to a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020, because it failed to address favorable evidence of record. First, the Board found the November 2015 VA Mental Disorder Disability Benefits Questionnaire (DBQ) showed "the Veteran denied suicidal plan, intent, or rehearsal." However, the DBQ indicated the "Veteran endorsed thoughts of suicide by then described recurrent thoughts of death; thinking that she would be better off dead, and no one would miss her if she died. She denied any history of suicidal ideation, plan, and intent." The Veteran submitted an affidavit in July 2018 in which she stated she "experience[d] suicidal thoughts once or twice per month" and when those occurred, she felt that "it would be better off if [she] were not alive." The Board did not adequately address whether the Veteran's thoughts of suicide and recurrent thoughts of death may cause occupational and social impairment to a degree to warrant a rating higher than 30 percent. Second, the Veteran wrote in her July 2018 affidavit when "severe bouts of depression occur, I often ignore my personal hygiene and do not shower." The Board did not address whether such evidence would support a finding that the Veteran exhibited neglect of personal appearance and hygiene. On remand, the Board must adequately address such evidence and explain the weight and probative value thereof. Third, the Board did not address an expressly raised argument in the October 2020 Appellate Brief. In the Appellate Brief, the Veteran's representative indicated the Veteran's suicidal thoughts and her belief that "she would be better off not alive" support the assignment of a 70 percent rating. The argument also cited to the Court's holding in Bankhead v. Shulkin, 29 Vet. App. 10 (2017). The argument also noted the Veteran reported that her anxiety "caused her to neglect her personal hygiene." Finally, the JMR indicated that the Board potentially imposed a standard that exceeded the regulation when it found the Veteran was not entitled to higher rating prior to February 12, 2020, for SSD with OSDD. The criteria for a 50 percent rating under 38 C.F.R. § 4.130 cite "difficulty in establishing and maintaining effective work and social relationships" and a type of symptom that may demonstrate occupational and social impairment with reduced reliability and productivity. The Board reasoned that a rating in excess of 30 percent was not warranted, in part, because "the Veteran was able to maintain effective social relationships. The record showed the Veteran's daughter, and niece would check in on her, she was not close to anyone in her family, and that her niece "tolerates" her. The Board did not address whether such evidence supported a finding that the Veteran experienced difficulty maintaining effective social relationships. Entitlement to a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020. The Veteran contends that she is entitled to a higher rating for her SSD with OSDD prior to February 12, 2020, because the severity of her symptoms increased equivalent to a 70 percent rating during that period of time. In the February 2025 Appellate Brief, the Veteran's representative argued the evidence demonstrated the Veteran had occupational and social impairment with deficiencies in most areas since at least July 2015. The representative indicated the Veteran stopped working because she got to the point where she would want to lash out. She reported that her psychiatric symptoms prevented her from working since February 2017. Symptoms of hallucinations, homicidal thoughts, and isolation from others were reported throughout the record. During the November 2015 VA examination, the Veteran reported thoughts of suicide. On her July 2018 affidavit, the Veteran reported that she would neglect her hygiene when she was depressed. An October 2016 VA treatment record indicated the Veteran reported having difficulty maintain relationship and had distrust for others. She also reported that her niece checked in on her, but she tolerated her. See May 2017 VA examination. The Veteran's representative argued that this evidence supports an increased rating in the Veteran's SSD with OSDD prior to February 12, 2020. Regulations Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities found in 38 C.F.R. § 4.1. The Rating Schedule is primarily a guide in the evaluation of disabilities resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. Separate diagnostic codes identify the various disabilities, and each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.10. As such, each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. When there is a question as to which evaluation should be applied to a 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). The current regulations establish a general rating formula for mental disorders. 38 C.F.R. § 4.130. Ratings are assigned according to the manifestation of particular symptoms. 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. See Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Entitlement to a specific disability rating, however, requires "sufficient symptoms of the kind listed in the [relevant rating] requirements, or others of similar severity, frequency [,] or duration." Vazquez-Claudio, 713 F.3d at 118. "Although the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran's level of [occupational and social] impairment in most areas." Id. Pursuant to DC 9422, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted where 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 such as, 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 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; and the inability to establish and maintain effective relationships. Id. A maximum 100 percent evaluation is for application 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; and memory loss for names of close relatives, own occupation, or own name. Id. In rating mental disorders under the General 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 impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). Evidence The November 2015 rating decision granted service connection for SSD with OSDD with a 30 percent rating effective July 14, 2015, under 38 C.F.R. § 4.130, DC 9422. The RO issued a July 2020 rating decision granting a higher rating effective February 12, 2020. The only period on appeal is from July 14, 2015, to February 11, 2020. On the August 24, 2015, VA PTSD consult note, the clinician wrote the Veteran arrived early to complete the intake assessment. During the consult, the Veteran denied suicidal ideation intent, plan, and rehearsal. She also denied homicidal ideation intent, plan, and rehearsal. She denied symptoms of mania/hypomania and psychosis. She was not in acute distress upon leaving the clinic. Her behavior was appropriate, and she was oriented. She did not display short term or long-term memory loss. She was neatly and cleanly dressed. Her affect was appropriate, her mood was dysphoric, and speech was normal. On a September 9, 2015, VA mental health outpatient note, it was recorded that she arrived on time for a 60 minute session. Her behavior was appropriate, and she was oriented. She did not display short term or long-term memory loss. She was neatly and cleanly dressed. Her affect was appropriate, her mood was euthymic, and speech was normal. She did not report hallucinations, delusions, suicidal ideation, or homicidal ideation. She did not display impairment of thought process or communication. It appeared the Veteran was able to maintain personal hygiene and activities of daily living. The Veteran was evaluated in November 2015 during a DBQ exam. The examiner reviewed the Veteran's post-military family and social life. The examiner noted the Veteran had never been married, but she had a 20-year-old daughter. The Veteran reported that she had a good relationship with her daughter, and they talked multiple times a week. The Veteran's father called once a month, but "I never really get a chance to call him back." Her mother died in 2004, and she reported that she was still grieving. She also reported a close relationship with her siblings. She denied any long-term romantic relationships since leaving the military. She reported that she was not confident in her ability to be in a monogamous relationship which she related to being taken advantage of while in the military. She didn't have many friends, but she spent her time with her significant other frequently. She did not have contact with her daughter's father. The Veteran also reported that she did not have many friends because she met too many people who "take advantage of me because I'm nice." She identified as Christian, but she did not attend religious services. She denied membership in any social or professional organizations. She worked as an alarm monitor for a security company since 2005. She described her job as "okay" but said she was drained because of the long hours. She worked 36 hours a week on a night shift. She indicated that she got along with her coworkers. She denied ever being fired from a job. When she was off work, she took her medicine, stayed inside, and tried not to hurt herself. Her sister visited twice a week to help around her house. The Veteran reported that she was arrested one time for pushing a chair on someone's toe at work. The other person threw a cell phone at her. She was arrested and taken to jail. However, the charges were dropped for this incident. She drank alcohol about twice a month and she would have one standard drink. She indicated that she had a problem with alcohol over the last two years. She was "dealing with relationships" and had multiple doctors' appointments at the time. She estimated consuming a pint of liquor a week during that period and would drink with a cousin. The examiner noted the Veteran's active symptoms to be depressed mood, anxiety, suspiciousness, and chronic sleep impairment. The Veteran reported nervousness in a crowd or in a group of men. Her hands would sweat and her heart beat fast. She did not want to leave the house, because she might injure herself. She felt uncomfortable speaking in front of others. She had dreams of someone being under her bed or standing in the doorway. The person did not have face. She had been having this dream for 10 years. The dream occurred about once a week. She also endorsed anxiety. She was always worried about something. She thought others were talking about her because of "the way I carry myself." She indicated that it was hard for her complete any one task. She said her work was not very hard, so she did not have as many problems with concentration on the job. She indicated that she has little to no sexual drive. The Veteran endorsed depression. She said she got down about her pain, her physical limitations, and where she was in her life. She believed she failed to take opportunities in life. She believed she could have been a better mother. She no longer enjoyed going out to restaurants, doing things around the house, and taking walks. She could not engage in these activities because of her knees. She initially endorsed thoughts of suicide but then only described recurrent thoughts of death. She thought "she would be better off death, and no one would miss her if she died." She denied any history of suicidal ideation, plan, and intent. She estimated getting 5 hours of broken sleep in a day. She noted problems falling asleep due to pain. She said she woke up because her knees began hurting. She described increased irritability which she related to her increased pain level in her knees and back. The examiner opined the Veteran's impairment was occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. A May 2016 VA women's health note indicated the Veteran denied depression, anxiety, and suicidal thoughts. On an August 2016 VA mental health consult note, it was recorded the Veteran arrived early for her appointment to reenter the military sexual trauma (MST)/post-traumatic stress disorder (PTSD) program. Her assessment was completed, and her treatment plan was started. During the assessment, the Veteran denied suicidal ideation intent, plan, and rehearsal. She also denied homicidal ideation intent, plan, and rehearsal. She also denied mania/hypomania and psychosis. She was not in acute distress upon leaving the clinic. Her behavior was appropriate, and she was oriented. She did not display short term or long-term memory loss. She was neatly and cleanly dressed. Her affect was appropriate, her mood was dysphoric, and speech was normal. It appeared the Veteran was able to maintain personal hygiene and activities of daily living. On a February 2017 VA rheumatology note, the review of symptoms showed no depression, anxiety, suicidal ideation or homicidal ideation. The Veteran was re-evaluated in May 2017. During the examination, the Veteran stated that she didn't have much of a social life. She stayed at home and disliked crowds. Her niece checks in on her. Her niece didn't like for her to cook because she forgot to turn off the stove. She experienced memory problems. She watched TV for fun. She didn't have a close relationship with anyone including her daughter that stayed out of state. However, her daughter called daily to check on her. The Veteran had not seen her daughter since 2017 because she lived in Virginia. She left her job due to physical pain and working odd hours. She supported herself with VA benefits and financial assistance from her daughter. The Veteran reported symptoms of poor sleep, nightmares, intrusive thoughts, and avoiding crowds. She denied any history of hospitalizations or suicide attempts. The examiner indicated the Veteran had more than one mental disorder. However, the symptoms could not be differentiated. The examiner indicated "Somatic disorders are frequently associated with depression, and it is not possible to differentiate what portion of impairment is attributable to each because of symptom overlap." The examiner indicated the Veteran suffered from symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, mild memory loss, and difficulty adapting to stressful circumstances including work or a work life setting. The examiner opined the Veteran's occupational and social impairment was best summarized as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. A November 2017 VA psychiatry note indicated the Veteran denied suicidal ideation, homicidal ideation, alcohol use, and drug use. She also denied psychotic or manic symptoms. She participated in yoga which helped her pain. The Veteran was observed during the visit. The clinician wrote that the Veteran was alert, calm, neatly groomed and dressed, had good rapport and eye contact, and spoke in a soft tone. She had clear thought process. The Veteran denied audio or visual hallucinations. Memory was grossly intact. On the July 2018 affidavit, the wrote that her disabilities caused her to have difficulty moving around her house. It was difficult for her to cook and clean for herself. Her niece came over four times a week to check on her. Her niece helped her move around the house. She did not want to cook because of her memory impairment. She wrote that there were countless times she would start cooking something and then forget about it until the food started to burn. Her depression caused her to have a lack of motivation. It prevented her from leaving the house or completing tasks. She sometimes had more severe bouts of depression which occurred a few times a month and lasted a few days. When these bouts occurred, she would ignore her personal hygiene and did not shower. In addition, she experienced suicidal thoughts once or twice a month. When these occurred, she felt it would be better off if she were not alive. Since she stopped working, she finished her master's degree in counseling and social work. On a September 2018 VA women's health note, the Veteran reported depression. She believed her depression worsened because of pain. She denied suicidal ideation and homicidal ideation. She denied tobacco use or drug use. She rarely consumed alcohol. On a March 2019 VA mental health consult note, the clinician provided the following observation: alert, oriented self, place, time, and situation, no psychomotor agitation; mood generally euthymic, affect appropriate, speech generally normal; thoughts linear and goal directed, no psychotic symptoms, good insight/judgement; denied present suicidal ideation/homicidal ideation. An April 2019 VA psychology noted indicated the Veteran denied current thoughts of suicidal including intent or plan. A September 2019 VA mental health outpatient note indicated the Veteran reported nearly having a "nervous breakdown" ten days prior. She stated that she was drinking at the time and became agitated and angry with people around her. She reported that at the time she had suicidal ideation but did not have a plan or intent. At the time of the visit, she stated that she was in Virginia with a friend who was recently discharged from the Navy. She stated that she was feeling better, and her medication was helpful. She denied suicidal ideation and homicidal ideation. The Veteran was given the number to the crisis line. The Veteran said her friend was supportive and was aware of the crisis resources. In the October 2020 Appellate Brief, the Veteran's representative argued that the Veteran has demonstrated deficiencies in most areas and should be assigned a 70 percent rating throughout the appeal period. He argued that the Veteran should be assigned a 70 percent rating based on the evidence of suicidal ideation and she had endorsed suicidal ideation since 2016. The Veteran wrote in her July 2018 affidavit that she had thoughts of suicide one or twice a month, often believing that she would be better off if she was not alive. The representative further wrote the Veteran's impairment was further illuminated by her symptoms of depression, anxiousness, hallucinations, sleeping difficulties, and homicidal thoughts. More specifically, the representative indicated the May 2017 VA examination documented memory issues such as forgetting to turn the stove off and the Veteran's report of distrust for others. The Veteran also reported sleep issues, nightmares, night sweats, intrusive memories, and avoidance. Lastly, the representative indicated the Veteran had severe deficiencies with her family relations. The Veteran had difficulty maintaining relationships and had significant distrust in any relationship including the relationship with her sister. Based on these reasons, the representative contended that the evidence supported an increase rating to 70 percent prior to February 12, 2020. Analysis When evaluating the evidence of record, the Board must assess the credibility and probative value of the evidence. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). In determining whether statements submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The Board assigns great probative weight to contemporaneous medical records which show that medical professionals regularly inquired, and the Veteran competently and consistently reported her current symptoms. The Board assigns less probative weight to the Veteran's statements made in conjunction with a claim for benefits. Cartright v. Derwinski, 2 Vet. App. 24 (1991); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Macarubbo v. Gober, 10 Vet. App. 388 (1997). Based on the evidence of record, the Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms contemplated by a 30 percent rating which are less severe, less frequent, and shorter in duration than those contemplated by a 50 percent rating. In response to the November 2024 Remand, the Board finds the evidence of record does not align with the Veteran's testimony regarding the severity, frequency, and duration of her symptoms in relation to personal hygiene/behavior, suicidal ideation, and relationships. Personal Hygiene/Behavior In the July 2018 affidavit, the Veteran reported that she neglected her personally hygiene and did not shower when she experienced severe bouts of depression. In addition, she indicated that she experienced memory impairment. However, the evidence of record consistently indicated that she did not neglect her hygiene when she also experienced depression. During routine medical visits, the clinicians observed her behavior and recorded that she was always "neatly and cleanly" dressed and displayed no signs of memory impairment. For example, on the August 24, 2015, VA PTSD consult note, it was noted that her behavior was appropriate, and she was oriented. She did not display short term or long-term memory loss. She was neatly and cleanly dressed. Her affect was appropriate, her mood was dysphoric, and speech was normal. The Veteran was in a state of unhappiness but maintained her hygiene. On an August 2016 VA mental health consult note, it was recorded the Veteran behavior was appropriate, and she was oriented. She did not display short term or long-term memory loss. She was neatly and cleanly dressed. Her affect was appropriate, her mood was dysphoric, and speech was normal. It appeared the Veteran was able to maintain personal hygiene and activities of daily living. Again, the Veteran was in a state of unhappiness but maintained her hygiene. A November 2017 VA psychiatry note indicated the Veteran was alert, calm, neatly groomed and dressed, had good rapport and eye contact, and spoke in a soft tone. She had clear thought process. The Veteran denied audio or visual hallucinations. Memory was grossly intact. See also October 2017 VA addendum (Veteran was able to maintain personal hygiene). The Board cannot enumerate the numerous notations in the record that reflect the Veteran's ability to maintain her hygiene when experiencing depression. However, as illustrated here, the record does not align with the Veteran's statements. The evidence in the record is given more probative weight because it provides the Board with a better overall disability picture. Other than the Veteran's statements, there is insufficient evidence of memory impairment and neglect of personal hygiene. Moreover, the Veteran's behavior was consistently appropriate, her speech was consistently normal or within normal limits, and her judgement was good. Based on this evidence, a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020, is not warranted. Suicidal Ideation In the July 2018 affidavit, the Veteran wrote she "experience[d] suicidal thoughts once or twice per month" and when those occurred, she felt that "it would be better off if [she] were not alive." In addition, she experienced suicidal thoughts once or twice a month. When these occurred, she felt it would be better off if she were not alive. The Board acknowledges the Veteran's sincerity in describing moments she experienced suicidal ideation. The discussion here does not disregard the seriousness of her disability. However, the Board must review and rely on the evidence of record as well as consider the Veteran's statements in assessing her overall disability picture. In this case, the evidence does not support the Veteran's statement regarding the severity, frequency, and duration of her suicidal ideation. For example, on the August 24, 2015, VA PTSD consult note, the Veteran denied suicidal and homicidal ideation to include intent, plan, and rehearsal. On a September 9, 2015, VA mental health outpatient note, she did not report hallucinations, delusions, suicidal ideation, or homicidal ideation. The Veteran was evaluated in November 2015 during a DBQ. The examiner reviewed the Veteran's post-military family and social life. She endorsed thoughts of suicide but then described recurrent thoughts of death. She thought "she would be better off death, and no one would miss her if she died." She denied any history of suicidal ideation, plan, and intent. A May 2016 VA women's health note indicated the Veteran denied depression, anxiety, and suicidal thoughts. On an August 2016 VA mental health consult note, it was recorded the Veteran denied suicidal ideation intent, plan, and rehearsal. She also denied homicidal ideation intent, plan, and rehearsal. She also denied mania/hypomania and psychosis. She was not in acute distress upon leaving the clinic. On a February 2017 VA rheumatology note, the review of symptoms showed no depression, anxiety, suicidal ideation or homicidal ideation. The Veteran was re-evaluated in May 2017. During the examination, the Veteran reported symptoms of poor sleep, nightmares, intrusive thoughts, and avoiding crowds. She denied any history of hospitalizations or suicide attempt. A November 2017 VA psychiatry note indicated the Veteran denied suicidal ideation, homicidal ideation, alcohol use, and drug use. See also September 2018 VA women's health note; March 2019 VA mental health consult note; April 2019 VA psychology note; September 2019 VA mental health outpatient note. As reflected by the record the Veteran frequently denied experiencing suicidal or homicidal ideation during routine treatment. Consistently from 2015 to 2019, the Veteran denied having intent, plan, or rehearsal of suicidal ideation. When she was evaluated during examinations, she reported she had suicidal thoughts. These statements are given less probative weight than statements provided to medical professionals when regularly inquired. The Veteran's representative contended in the October 2020 Appellate Brief that the Veteran's suicidal thoughts and her belief that "she would be better off not alive" support the assignment of a 70 percent rating. A single report of suicidal thoughts is reflective and overall disability picture. Thus, the assignment of a higher rating should not be based on the occurrence of a single statement of suicidal thoughts. Especially, when that statement is overshadowed by consistently denials of suicidal thoughts throughout the record. Based on this evidence, a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020, is not warranted. Relationships In the November 2024 Remand, the parties agreed the Board potentially imposed a standard that exceeded the regulation when it found the Veteran was not entitled to higher rating prior to February 12, 2020, for SSD with OSDD. The criteria for a 50 percent rating under 38 C.F.R. § 4.130 cite "difficulty in establishing and maintaining effective work and social relationships" and a type of symptom that may demonstrate occupational and social impairment with reduced reliability and productivity. The Board reasoned that a rating in excess of 30 percent was not warranted, in part, because "the Veteran was able to maintain effective social relationships. The record showed the Veteran's daughter, and niece would check in on her, she was not close to anyone in her family, and that her niece "tolerates" her. The Board did not address whether such evidence supported a finding that the Veteran experienced difficulty maintaining effective social relationships. In the October 2020 Appellate Brief, the Veteran's representative argued that the Veteran had severe deficiencies with her family relations. The Veteran had difficulty maintaining relationships and had significant distrust in any relationship including the relationship with her sister. Based on these reasons, the representative contended that the evidence supported an increase rating to 70 percent prior to February 12, 2020. The Board acknowledges the language in the rating criteria as "difficulty in establishing and maintaining effective work and social relationships." The language of the rating criteria is clear that both establishment and maintenance of relationships must occur. Difficulty with establishing relationships does not equate to difficulty with maintaining relationships. In this case, the evidence of record indicates the Veteran has had success with maintaining relationships with coworkers and relatives. For example, the Veteran was evaluated in November 2015 during a DBQ. The examiner reviewed the Veteran's post-military family and social life. The Veteran reported that she had a good relationship with her daughter, and they talked multiple times a week. The Veteran's father called once a month, but "I never really get a chance to call him back." (direct contradiction to her testimony in the affidavit). She also reported a close relationship with her siblings. She denied any long-term romantic relationships since leaving the military. She didn't have many friends, but she spent her time with her significant other frequently. She worked as an alarm monitor for a security company since 2005. She described her job as "okay" but said she was drained because of the long hours. She worked 36 hours a week on a night shift. She indicated that she got along with her coworkers. Her sister visited twice a week to help around her house. The Veteran was re-evaluated in May 2017. During the examination, the Veteran stated that she didn't have much of a social life. She stayed at home and disliked crowds. Her niece checks in on her. Her niece didn't like for her to cook because she forgot to turn off the stove. She didn't have a close relationship with anyone including her daughter that stayed out of state. However, her daughter called daily to check on her. The Veteran had not seen her daughter since 2017 because she lived in Virginia. She supported herself with VA benefits and financial assistance from her daughter. A September 2019 VA mental health outpatient note indicated the Veteran stated that she was in Virginia with a friend who was recently discharged from the Navy. She stated that she was feeling better, and her medication was helpful. She denied suicidal ideation and homicidal ideation. The Veteran was given the number to the crisis line. The Veteran said her friend was supportive and was aware of the crisis resources. The Board is cognizant of the Veteran's statements regarding staying home and not trusting others as well as not having many friends. These statements are sufficient and are observable symptoms to satisfy "difficulty in establishing...relationships." However, these statements do not overshadow the more probative evidence of her ongoing and successful maintenance of effective work and social relationships. Based on this evidence, a rating in excess of 30 percent for SSD with OSDD prior to February 12, 2020, is not warranted. Conclusion The Board does not rely on one piece of evidence to determine the conclusion of the Veteran's occupational and social impairment. Even without noting and discussing every single notation in the record related to her symptoms, the Board has considered the totality of the evidence and the symptoms. Based on the evidence of record, the Board finds the severity, duration, and frequency of the Veteran's SSD with OSDD does not indicate occupational and social impairment with reduced reliability and productivity. Therefore, entitlement to a rating in excess of 30 percent for SSD with OSDD is denied. There is no doubt to resolve. 38?U.S.C. §?5107; Gilbert v. Derwinski, 1?Vet. App.?49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harris 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.