C&P Exam for Major depressive disorder (DC 9434)

Diagnostic code: 9434Condition: Major depressive disorderRegulation: 38 CFR § 4.130DBQ: DBQ PSYCH Mental Disorders

Which form the examiner uses

For major depressive disorder (DC 9434), the C&P examiner completes the following Disability Benefits Questionnaire (DBQ):

DBQs are Department of Veterans Affairs Form 21-0960 series documents. Public DBQs are hosted on benefits.va.gov. A handful are examiner-only and are not posted publicly.

What the examiner records

The fields below are reproduced from the DBQ form the examiner completes for this diagnostic code. This is the structural map of the form, showing what the examiner is asked to measure, observe, and record. It is a factual reproduction of the public DBQ, not advice on how to answer.

This DBQ evaluates mental disorders (other than PTSD and eating disorders) for VA disability rating, documenting diagnosis, clinical findings, symptoms, behavioral observations, and competency.

How DC 9434 maps to this DBQ: for this diagnostic code specifically, the examiner typically completes sections I-VII of this form. Section I is the condition-specific section for this code.

DIAGNOSIS (Section I)
  • A1. Does the Veteran now have or has he or she ever been diagnosed with a mental disorder(s)?
  • Mental Disorder Diagnosis #1:
  • ICD Code: (Diagnosis #1)
  • Comments, if any: (Diagnosis #1)
  • Mental Disorder Diagnosis #2:
  • ICD Code: (Diagnosis #2)
  • Comments, if any: (Diagnosis #2)
  • Mental Disorder Diagnosis #3:
  • ICD Code: (Diagnosis #3)
  • Comments, if any: (Diagnosis #3)
  • If additional diagnoses, list using the above format:
  • A2. Medical diagnosis relevant to the understanding or management of the mental health disorder (to include TBI):
  • ICD Code (A2)
  • Comments, if any: (A2)
CLINICAL FINDINGS (Section II)
    SYMPTOMS (Section III)
    • 3A. For VA rating purposes, check all symptoms that apply to the Veteran's diagnoses
    • Depressed Mood
    • Anxiety
    • Suspiciousness
    • Panic attacks that occur weekly or less often
    • Panic attacks more than once a week
    • Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively
    • Chronic sleep impairment
    • Mild memory loss, such as forgetting names, directions or recent events
    • Impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks
    • Memory loss for names of close relatives, own occupation, or own name
    • Flattened affect
    • Circumstantial, circumlocutory or stereotyped speech
    • Speech intermittently illogical, obscure, or irrelevant
    • Difficulty in understanding complex commands
    • Impaired judgment
    • Impaired abstract thinking
    • Gross impairment in thought processes or communication
    • Disturbances of motivation and mood
    • Difficulty in 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
    • Obsessional rituals which interfere with routine activities
    • Impaired impulse control, such as unprovoked irritability with periods of violence
    • Spatial disorientation
    • Persistent delusions or hallucinations
    • Grossly inappropriate behavior
    • Persistent danger of hurting self or others
    • Neglect of personal appearance and hygiene
    • Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene
    • Disorientation to time or place
    BEHAVIORAL OBSERVATIONS (Section IV)
    • 4A. Behavioral Observations
    OTHER SYMPTOMS (Section V)
    • 5A. Does the Veteran have any other symptoms attributable to mental disorders that are not listed above?
    • If 'Yes,' describe
    COMPETENCY (Section VI)
    • 6A. Is the Veteran capable of managing his or her financial affairs?
    • If 'No,' specify each injury or disease resulting in incompetency and provide a rationale to support this finding:
    REMARKS (Section VII)
    • 7A. Remarks (Including any testing results), if any:

    Rating Levels for DC 9434

    The following tiers are reproduced from 38 CFR Part 4, the VA Schedule for Rating Disabilities. Toggle between the official VA criteria and a Plain English explanation.

    Plain-English summaries are AI-generated to explain the official criteria. The official 38 CFR language is the binding legal standard. When in doubt, ask a VSO.

    Evidence cited in published BVA decisions for DC 9434

    The counts below are aggregated from published Board of Veterans Appeals decisions for this diagnostic code. Each row reports how often a given evidence type was discussed in the decision text, broken down by outcome. This is a factual aggregate of the public record, not a prediction or recommendation about any specific claim.

    • VA examination: appeared in 242 granted decisions (178 denied, 234 remanded; 654 total)
    • Private medical opinion: appeared in 219 granted decisions (38 denied, 70 remanded; 327 total)
    • Medical literature: appeared in 97 granted decisions (2 denied, 22 remanded; 121 total)
    • Buddy / lay statements: appeared in 84 granted decisions (26 denied, 53 remanded; 163 total)
    • Nexus letter: appeared in 70 granted decisions (5 denied, 25 remanded; 100 total)
    • Service treatment records: appeared in 22 granted decisions (43 denied, 57 remanded; 122 total)

    Standardized screening instruments at the C&P exam

    The following standardized screens are administered at the C&P exam for this diagnostic code. Questions and scoring are reproduced verbatim from VA's General Medical Separation Health Assessment DBQ (the same instruments are used at compensation and pension exams).

    Patient Health Questionnaire-2 (PHQ-2) Depression Screen

    Two-item depression screen. Each item scored 0-3 (0 = Not at all, 1 = Several days, 2 = More than half the days, 3 = Nearly every day). Total range 0-6.

    1. Over the past two weeks, how often have you been bothered by little interest or pleasure in doing things?
    2. Over the past two weeks, how often have you been bothered by feeling down, depressed, or hopeless?

    Scoring: Positive screen if total score is 3 or greater.

    Suicide Risk Secondary Screen (Columbia-style)

    Eight-item secondary screen administered when the primary suicide-risk question elicits any response above 'Not at all'. Positive screen = 'yes' to questions 3, 4, 5, or 8.

    1. Over the past month, have you wished you were dead or wished you could go to sleep and not wake up?
    2. Have you actually had any thoughts of killing yourself?
    3. Over the past month, have you been thinking about how you might do this?
    4. Over the past month, have you had these thoughts and had some intention of acting on them?
    5. Over the past month, have you started to work out or worked out the details of how to kill yourself?
    6. If yes to question 5: At any time in the past month, did you intend to carry out this plan?
    7. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life?
    8. If yes to question 7: Was this within the past three months?

    Scoring: Positive screen if 'yes' to question 3, 4, 5, or 8. Immediate emergency response procedures apply when there is concern about an immediate threat.

    Alcohol Use Disorders Identification Test - Consumption (AUDIT-C)

    Three-item alcohol-use screen. Items scored 0-4 each. Mental-health screening commonly includes AUDIT-C because substance use frequently co-occurs with PTSD, depression, and anxiety.

    1. How often did you have a drink containing alcohol? (Never / Monthly or less / 2-4 times per month / 2-3 times per week / 4 or more times per week)
    2. How many drinks containing alcohol did you have on a typical day when you were drinking? (1 or 2 / 3 or 4 / 5 or 6 / 7 to 9 / 10 or more)
    3. How often did you have six or more drinks on one occasion in the past year? (Never / Less than monthly / Monthly / Weekly / Daily, or almost daily)

    Scoring: Positive screen if total score is 5 or more (men). Women's threshold uses a four-or-more-drinks variant of question 3.

    What the Board discussed in granted decisions for DC 9434

    The themes below were extracted by clustering 500 grant-factor sentences from published Board of Veterans Appeals decisions for this diagnostic code. Frequencies indicate how often each theme appeared in the sample. This is a factual aggregate of the public record, not advice or strategy for any specific claim.

    1. 29% Benefit of the doubt doctrine cited as legal standard
      The Board or decision cited the statutory or regulatory benefit-of-the-doubt rule as the governing standard, noting that approximate balance of positive and negative evidence entitles the claimant to prevail.
      143 of 500 sample sentences
    2. 18% VA examiner nexus opinion cited at least as likely as not
      A VA examiner's opinion recorded that a current disability was at least as likely as not incurred in, caused by, or related to the veteran's active military service.
      89 of 500 sample sentences
    3. 16% Evidence found in equipoise warranting benefit of the doubt
      The Board found the positive and negative evidence in relative or approximate equipoise on a material issue and resolved that balance in the veteran's favor.
      82 of 500 sample sentences
    4. 8% Private or non-VA examiner nexus opinion cited
      A private or non-VA clinician's opinion was noted in the record concluding that the veteran's disability was at least as likely as not related to service or a service-connected condition.
      38 of 500 sample sentences
    5. 7% Benefit of the doubt applied to disability rating level
      The Board resolved the benefit of the doubt in the veteran's favor to assign or confirm a specific disability rating percentage when the evidence was in approximate balance as to the applicable rating criteria.
      36 of 500 sample sentences
    6. 7% Preponderance against claim, benefit of the doubt inapplicable
      The Board found the preponderance of the evidence weighed against the claim, making the benefit-of-the-doubt doctrine inapplicable and requiring denial.
      35 of 500 sample sentences
    7. 5% MDD secondary to service-connected disability, nexus found
      A medical opinion or Board finding recorded that the veteran's major depressive disorder was at least as likely as not caused or aggravated by an existing service-connected physical or mental disability.
      25 of 500 sample sentences
    8. 4% Benefit of the doubt applied to TDIU or unemployability finding
      The Board resolved reasonable doubt in the veteran's favor in finding that service-connected disabilities, including or primarily major depressive disorder, rendered the veteran unable to secure or follow substantially gainful employment.
      20 of 500 sample sentences
    9. 4% Direct service connection for MDD established on equipoise
      The Board found the evidence at least in equipoise that major depressive disorder or a depressive condition had its onset during service or is etiologically linked to in-service events, and granted service connection accordingly.
      18 of 500 sample sentences
    10. 3% Benefit of the doubt inapplicable; evidence not in balance
      The Board noted that the benefit-of-the-doubt doctrine was considered but found the evidence was not in approximate balance, so the doctrine was not triggered and the specific claim was not granted.
      14 of 500 sample sentences
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    Disclaimer: This page reproduces public Department of Veterans Affairs forms (DBQs) and verbatim text from 38 CFR Part 4 (the VA Schedule for Rating Disabilities). It is informational only and is not legal or medical advice. For guidance on a specific claim, contact a VA-accredited representative.