What tools does VA use to rate mental health claims?
The VA recognizes and grants service connection for a number of mental health disorders. Some of the most common ratings are post-traumatic stress disorder (PTSD), major depressive disorder (MDD), general anxiety disorder, and bi-polar. Each of these mental health disorders are described by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, more commonly referred to as the DSM-V. Let’s look how PTSD is rated with the DSM.
- How Does VA rate PTSD?
Prior to the DSM-V, the VA used the DSM-IV-TR for rating mental disorders. The DSM-IV uses the global assessment of functioning (or GAF) score to rate the severity of a mental disability that a veteran suffers. GAF scores reflect the impact of a veteran’s disability on his social, occupational, and psychological functioning. GAF scores range from 0 – 100. A score of 0 represents total impairment, and a score of 100 would represent normal functioning. A GAF score below 50 represents serious to severe social impairment. The VA has used GAF scores in their determination of the impact that mental illness has on the affected individual.
- Does VA still use GAF to rate PTSD?
Critics complained that GAF scores were too subjective to be reliable in reporting the disorder’s actual impairment. Generally, a rater’s training and performance are essential to a GAF score’s reliability. GAF scores often correlate more with the severity of the symptoms that an individual is experiencing. The scores do not usually reflect the functional impact those symptoms have on an individual in day to day situations. For these reasons and others, the authors of the DSM-V decided to exclude GAF scores in rating PTSD and other mental disorders. In the place of GAF, the DSM-V uses the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0).
- What is WHODAS 2.0?
The DSM-V writers recommend using WHODAS 2.0 to assess PTSD for clinical uses. The first difference between GAF and WHODAS is how it rates mental disorders and the resulting disability. Rather than assigning one numerical score, WHODAS separates the medical and psychiatric disorder from the disabilities that those disorders cause. In effect, the WHODAS score assesses the disability first. Then lays out what kind of impairments that disability causes in daily functioning of the affected individual.
How does WHODAS 2.0 affect my VA PTSD rating?
So, what does the WHODAS look like? In WHODAS classifications, PTSD results in particular impairments to functioning. The PTSD classification covers activity limitations, participation restrictions, and the impact on a person’s interaction with his environment. The new test takes into account personal factors of a person rather than trying to fit everyone into broad categories. The WHODAS uses the International Classification of Functioning to assess social factors related to the individual’s functioning. This includes personal circumstances (age, education and motivation) as well as the individual’s environment. The individual’s environment is not limited to just the physical aspects, but also takes note of accommodations and support available.
Does WHODAS 2.0 look at my problems or some objective standard for my VA PTSD rating?
WHODAS, unlike GAF, recognizes two individuals can have PTSD and its functional impairments. But those individuals could have different degrees of disability due to personal and environmental factors. WHODAS is based on the model of diseases where the assessment of impairment and disability is separate from the diagnosis of the disease. The actual test for WHODAS 2.0 is a self-report of assessment by the patient which evaluates six domains and the patient’s ability to perform in each of those domains over the last 30 days. They are as follows:
- Understanding and Communicating
- Getting Around (mobility)
- Getting along with people (social and interpersonal functioning)
- Life activities (home, academic, and occupational functioning)
- Participation in society (participation in family, social, and community activities).
The WHODAS 2.0 comes in two versions a 36- and a 12- question format. Each format is available in three versions: a self-administered, proxy-administered, and a rater-administered. (Proxy versions are meant for a third party, such as a caregiver to take, if the veteran is unable to complete the test himself.)
After completing the test, there are two scoring methods available, a simple scoring method and a complex scoring method. The simple scoring is done by hand and gives no weight to individual items, nor does it convert to a standardized scale. The complex method requires a computer to score and is based on an item-response theory. For rating purposes, this will likely be the version implemented by the VA to standardize scores.
Why has VA replaced GAF for WHODAS?
The WHODAS test is more reliable and responsive to change across different communities and geographic regions than GAF. WHODAS has demonstrated a good facial reliability across countries, populations and diagnostic groups including both ages and genders. For these reasons, the DSM-V has decided to remove GAF from its diagnostic toolbox and add the WHODAS 2.0.
For VA PTSD ratings, the GAF score is not now meaningless for VA ratings. In fact, many VA PTSD decisions still consider GAF scores, but there is a change coming. The change should mean more reliable and consistent ratings for veteran’s seeking help for their mental disorders. The change also means that there is going to be errors as raters adjust to the new criteria. As a result, make sure examiners are recording your PTSD symptoms and not just checking boxes on a sheet.
Look for further posts regarding how this change affects disability ratings as well as more explanation of how this new test works.
Thank you for your service.