There are many different conditions that are recognized as mental health disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, also known as the DSM-IV. Examples of common mental health conditions include post-traumatic stress disorder (PTSD), depression, generalized anxiety disorder, bipolar disorder, and schizophrenia. The VA utilizes the DSM-IV when rating mental disabilities.
We receive many calls from veterans who have multiple mental health conditions, and they are unhappy because they feel the VA has not taken all of their conditions into account when assigning a disability rating. For example, a veteran may suffer from PTSD and depression based on the DSM IV criteria; however, the VA has only assigned a total rating of 30% for both conditions.
Although assigning only one rating may seem odd because the veteran is suffering from two distinctly separate conditions, the VA regulations pertaining to mental health generally mandate that the veteran be assigned only one disability rating for all mental conditions, even if there is more than one. So in the above example, even though the veteran has PTSD and depression, only one rating will be assigned. Of course, it may logically follow that a veteran with more conditions may be more seriously impaired than a veteran with only one condition; however, that is not necessarily always the case.
The VA uses the General Rating Formula for Mental Disorders to rate mental disabilities. This is found in 38 C.F.R. § 4.130. The Rating Formula assigns ratings ranging from 0% all the way to 100%. A 0% rating means that “a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.” A 100% rating is warranted when there is “total occupational and social impairment” due to certain symptoms. Most veterans fall somewhere in the middle. Their mental conditions warrant more than a 0% rating; however, they are not ratable at the 100% level.
The real issue when rating claims involving mental disabilities is determining the appropriate rating to be assigned, which really has nothing to do with the total number of conditions because the VA is using only one rating scale. When determining the appropriate rating, the VA considers the effect of the mental conditions on occupational and social impairment. Symptoms that are considered include but are not limited to: impairment in thought processes or communication; grossly inappropriate behavior; persistent danger of hurting self or others; suicidal ideation; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); memory loss; panic or depression affecting the ability to function; impaired impulse control; chronic sleep impairment; and decreased work efficiency.
Since the VA is rating these claims based on subjective symptoms there is often room for error in the ratings. Oftentimes, veterans will attend compensation and pension examinations at the VA, and the result is a rating decision that underrates the severity of the mental condition(s). This happens despite the VA regulations which state that the VA is to assign a rating based on all evidence of record, and not just “solely on the examiner’s assessment of the level of disability at the moment of the examination.” 38 C.F.R. § 4.126(a).
The VA has stated that its goal on rating veterans is to determine how much the service connected disability affects the veteran’s ability to work. The first question I ask a veteran when discussing a claim is whether or not they are working. If the veteran is not working I then ask whether the mental illness is contributing to the unemployment. If the answer is yes it is then the veteran should be receiving a rating of 100% or Total Disability due to Individual Unemployability (commonly called TDIU or IU). If the veteran is working then we discuss how much the disability affects the veteran’s employment.
If the degree of disability has been underrated, it is important that the veteran file a timely appeal of the rating decision contesting the rating assigned. An experienced veterans’ law attorney can assist you with filing any necessary appeals and developing the record to properly document the severity of the mental conditions.