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While many veterans experience physical injuries and ailments following active duty, mental health is a concern as well. Depression is one of the most common mental health issues that former service members face along with PTSD. Much like post-traumatic stress disorder, this illness is often invisible and can be tricky to characterize. However, depression can have life-long effects on a veteran’s well-being and daily life.
Fortunately, veterans suffering from depression may be eligible for service-connected disability benefits through the U.S. Department of Veterans Affairs. This guide will break down the VA rating for depression, as well as PTSD. If you’d like to learn more about the comorbidity of PTSD and depression, click here. Below is our video on everything you need to know about Depression and the VA!
Understanding VA Mental Health Ratings For Depression
Some symptoms of major depressive disorder include lack of interest in activities, feeling depressed most of the day, feeling fatigued, and more
Before diving into VA depression ratings, it’s important to understand how this mental health condition is characterized. The VA lists depression under the category of “Mood Disorders”. The VA used to rate depression using GAF Scores but have since switched to WHODAS 2.0. You can read more about the change here from GAF Psychology to WHODAS 2.0. There are two types of depression that the VA recognizes under this category: major depressive disorder and dysthymic disorder.
A diagnosis of major depressive disorder requires at least two major episodes of depression lasting at least two weeks. The symptoms of major depression need to significantly impair daily functioning. Some of these symptoms of depression include:
- A lack of interest in most activities
- Feeling depressed most of the day
- Inability to sleep or excessive sleeping
- Feeling very fatigued and /or low energy
- recurrent thoughts of death or suicide
The VA also recognizes dysthymic disorder as a type of depression, which is characterized by a mildly depressed or irritable mood. It requires feeling depressed for two years or more with symptoms that greatly prevent everyday functioning. An individual with dysthymic disorder may also have low self-esteem, feelings of hopelessness, difficulty in decision making, and concentration challenges.
VA Disability Depression: Eligibility for VA Compensation
There are three ways to receive disability compensation for depression: direct service connection, secondary service connection, and service connection by aggravation.
Direct Service Connection for Depression
Direct service connection means that an in-service incident directly caused a veteran’s depression. It’s important for a veteran looking to file a VA disability claim for depression to know the eligibility requirements. Specifically, the veteran would need to show:
- A current diagnosis of depression
- Evidence of an incident in service that caused depression
- Medical evidence of a link or nexus between the current diagnosis of depression and the incident in service
Secondary Service Connection Depression
It’s also possible for veterans to receive disability benefits based on secondary service connection. This could be that their depression stems from another service-connected medical condition thus it is compensable. Depression could also be considered the primary service-connected condition that leads to another disability that can be secondarily connected. Below, let’s get into common secondary conditions with depression.
For example, a veteran may have back pain that impairs their ability to work, socialize with friends and family members, and complete daily activities. These limitations may lead to depression.
In order to receive benefits based on secondary service connection, a veteran must receive a diagnosis from a medical professional. A medical professional must also provide evidence of the link between the veteran’s service-connected injury or illness and the depression.
Depression and Lifestyle Changes
First, some of the well-known symptoms of depression are inactivity, loss of interest, low self-esteem, melancholia, difficulties with decision-making, feelings of worthlessness. Major Depressive Disorder makes it nearly impossible to get ANYTHING done, and physical activity, while it can help with depression, is much more difficult when you lack the energy or willpower to get it done. Those with depression are much more likely to have a sedentary lifestyle and are much more likely to become overweight. In addition, those with depression (and nearly every mental health illness or mental disorder) are more likely to smoke tobacco, drink alcohol, and suffer from drug abuse | substance abuse. All of these lifestyle factors GREATLY increase the risk of developing cardiovascular problems as well as diabetes, which causes cardiovascular problems on its own and can lead to comorbidity of these issues.
Depressive episodes also cause a great deal of stress. Additionally, social and occupational problems are related to depression and can be a form of depression. These factors often end up causing problems with life events leading to poor social relationships and employment. In turn, these problems often lead to unemployment and divorce, which lead to even MORE psychiatric disorders such as mood disorders, anxiety disorders, depressed moods, stress, and more. Both social isolation and stress increase your chances of dying by a sudden cardiac event.
Diabetes and Secondary Depression
In those who suffer from different types of depression, the risk factor of developing diabetes increases by about 20%, even after adjusting for other factors like exercise and diet when compared to the general population. To make matters worse, those with diabetes actually have an increased risk of developing depression and similar symptom patterns of depression. The two disabilities seem inextricably linked, with depression making existing diabetes worse, and diabetes worsening depression as well.
Antidepressants and Cardiovascular Dysfunction
Several antidepressants used for psychiatric treatment can cause problems with your heart. Many older tricyclic antidepressants used to treat this psychiatric illness have been shown to cause fatal arrhythmias, or irregular heartbeats. While newer SSRI antidepressants like fluoxetine, citalopram and escitalopram do seem to cause less symptoms, studies show SSRIS also cause arrhythmias, which can increase the likelihood of a cardiac event.
Depression and Heart Conditions (cardiovascular issues)
As I’ve written above, stress, seasonal affective disorder, substance use disorders, bipolar disorder, social isolation, and diabetes secondary to primary depression can lead to cardiovascular problems. However, depression alone is the biggest culprit. Depression alone predicts the development of coronary heart disease in initially healthy people. In fact, those with clinical depression, even after accounting for other factors are nearly THREE times more likely to develop coronary heart disease. Researchers also have discovered that the relationship is “dose-dependent” as defined in arch gen psychiatry. In other words, the worse your depression, the more likely you are to develop heart problems.
As if all this wasn’t bad enough, when those who suffer from depression DO have a heart attack, they are more than three times more likely to die within 18 months than those without depression.
Depression Aggravated by Service
There are some cases where a veteran who has been diagnosed with depression before service may have an event in service that causes their mental illness to worsen, or be aggravated. Service connection is still possible.
There are some cases where a veteran may have been living with depression before their time in service. This individual may have had an experience during military service that caused their mental illness to worsen. This is called aggravated service connection – an event in service that made a pre-existing condition worse.
Aggravated service connection for a pre-existing diagnosis of depression requires:
- A current diagnosis of depression by a VA doctor, psychiatrist, or psychologist
- Evidence of an incident in service that worsened the depression
- Medical evidence of a link between the worsening of the depression and the incident in service.
What Is Posttraumatic Stress Disorder?
Posttraumatic stress disorder (PTSD) is a mental condition that develops after experiencing a shocking, terrifying, or dangerous event. These events are often referred to as “stressors” or “traumas”. Unfortunately, this condition is becoming more and more common among our military service members.
During a traumatic event, the body responds by going into a “flight or fight” mode. Fight or flight mode is when the body is determining whether to run from a threat or fight against it.
These incidents cause the body to release stress hormones, such as norepinephrine and adrenaline, which trigger a quick burst of energy, along with feelings of anxiety or panic. During this stress response, the heart rate increases, and memory may be negatively affected.
Essentially, PTSD causes the brain to get trapped in a “danger mode.” Even after someone is no longer in danger, the body remains on alert. Stress signals and warning signs are continuously sent throughout your body, which leads to PTSD symptoms.
PTSD is more than an anxiety disorder. The symptoms of this mental illness are often severe, affecting the individual’s daily life and relationships. Some common symptoms include:
- Flashbacks: re-experiencing of the traumatic experience that caused the PTSD
- Avoidance: any action intended to stop the occurrence of an uncomfortable emotion such as sadness, shame, or fear
- Nightmares: recurrent bad dreams related to the trauma
- Hypervigilance: being constantly on guard to detect any danger that may be present
- Hyperarousal: when a person’s body suddenly kicks into high alert as a result of thinking about their trauma
- Distress or Irritability: easily frustrated or angered; often feeling negative emotions
- Panic Attacks: sudden episodes of intense fear or apprehension
Trauma survivors can work with a mental health professional to receive a diagnosis and get the PTSD treatment they need. The National Center for PTSD had a database of health care providers who are available to help. There are available support groups and promising results with therapy such as cognitive behavioral therapy.
How is Major Depressive Disorder different from PTSD?
Depression is a mood disorder that causes frequent feelings of sadness and a loss of interest in activities that were once enjoyed. This disorder is more than feeling down or a “case of the blues”. It is not something that someone can just “snap out of”. This is a very real mood disorder that may require different forms of treatment, such as therapy or medications.
The symptoms of major depression can vary, but individuals with this mental health condition often experience:
- Depressed mood most of the day, nearly every day
- Diminished interest or pleasure in activities once enjoyed
- Weight loss or weight gain
- Sleeping more or less than usual
- Increased restlessness and pacing, or slowing movements and speech
- Fatigue and loss of energy
- Difficulty with concentration, focus, and memory
- Negative thoughts. Thoughts of death and/or suicide
It’s important to remember that veterans who are experiencing this should get help from a mental health professional. The National Suicide Prevention Lifeline and Veterans Crisis Line are two resources that are available for veterans in crisis. If you are a loved one are struggling with mental illness, these resources can provide assistance.
Understanding VA Disability Rating For PTSD and Depression
Based on the VA’s General Rating Formula for Mental Disorders, compensation will be based on the symptoms from which the veteran suffers rather than a diagnosis of PTSD or other diagnosis assigned to the veteran’s disorder.
The VA is concerned with how much occupational and social impairment is caused by the veteran’s symptoms, not with the diagnosis. The rater will look at factors such as how often the veteran suffers from ptsd and depression, PTSD symptoms and or panic attacks, whether the veteran suffers from suicidal or homicidal thoughts, whether the veteran has problems with memory loss, or whether the veteran has problems with irritability, anger, delusions or hallucinations.
In addition, the rater will consider how the veteran deals with stressful situations and whether the veteran is able to make and keep relationships with loved ones such as friends, family members, or co-workers. They will also consider other symptoms such as difficulty sleeping, flashbacks, substance abuse, and more.
In other words, a veteran who experiences social and employment impairment because of symptoms such as suicidal thoughts, near-constant depression, a violent temper, or an inability to get along with co-workers or deal with stress, will be entitled to a 70% disability rating, whether he is diagnosed with PTSD or with a Major Depressive Disorder.
A veteran who cannot work and cannot function in society due to persistent hallucinations is entitled to a 100% rating, whether he is diagnosed with schizophrenia or PTSD. Ensure that you are receiving the proper treatment from your treating doctors and the proper compensation for the symptoms from which you suffer, but do not be concerned if the VA service-connects you for something other than PTSD.
VA Ratings For PTSD, Depression, and Mental Conditions
The ratings for depression, PTSD, and mental conditions are broken down as follows:
- 0% Rating: A mental condition has been formally diagnosed, but symptoms are not severe enough to either interfere with occupational and social functioning or to require continuous medication. The VA considers this a non-compensable rating.
- 10% Rating: The veteran has occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or the veteran is taking medications continuously to control the symptoms.
- 30% Rating: The veteran has occupational and social impairment with an occasional decrease in work tasks due to symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (at least once per week), chronic sleep impairment, and mild memory loss.
- 50% Rating: The veteran has occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect, circumstantial, circumlocutory, or stereotyped speech; panic attacks that occur more than once a week, difficulty understanding complex commands, impairment of short and long term memory, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships.
- 70% Rating: The veteran experiences occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation, obsessive rituals that interfere with day to day activities, illogical speech, near-continuous panic attacks, depression that affects the ability to function independently, impaired impulse control, neglect of personal hygiene and appearance, difficulty adapting to stressful situations (including work or work-like settings), and inability to establish and maintain effective relationships.
- 100% Rating: The veteran has total occupational and social impairment due to symptoms such as gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting yourself or others, intermittent inability to perform day to day activities, disorientation of time and place, and memory loss of names of close relatives, own occupation, or name.
If you have a service-connected mood disorder and you cannot work, then you can apply for individual unemployability (IU). Unemployability can be awarded for one disability or for several different ones. PTSD by itself can cause unemployability due to PTSD symptoms of angry outbursts, isolation, and inability to get along with others.
C&P Exam for Mental Health Conditions
When determining a rating for a mental illness, the VA will normally send veterans to Compensation and Pension Exams, for a doctor to review all the veteran’s symptoms and give a medical opinion. Since there is variability in this process, it can be extremely difficult to predict the exact rating a veteran will receive.
Keep in mind that the VA may give out a low disability rating or deny the claim to start out. However, this should not dissuade a veteran from applying for disability compensation. If a veteran has a mental condition that is linked to the military, the veteran should always pursue the claim. If the claim is denied or if the rating given is too low, the veteran can always appeal.
Understanding the way that the VA rates a mental health condition like depression is a crucial aspect when filing a claim for VA disability compensation. Veterans who understand the initial claims process will have the insight and knowledge that is needed, with one foot already in the door.
Can you be depressed and have PTSD at the same time?
Both PTSD and Depression tend to coexist with other medical conditions. Some of these other conditions include chronic pain, headaches, substance abuse disorders, and anxiety disorders.
These two conditions often exist together within the veteran population. It has also been shown that PTSD can lead to Depression, and Depression can have symptoms similar to those of PTSD. So, you might be experiencing both PTSD and depression symptoms together.
Anyone who has experienced or witnessed a life-threatening event can suffer from PTSD. Military combat veterans, accident victims, people who have survived a natural disaster, sexual assault victims, and children who have been abused can all be subject to PTSD.
According to the VA, other factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. These factors include your military duties, the politics around the war, where the war is fought, and the type of enemy you face.
Risk factors for depression include negative life events, such as divorce, loss of a loved one, or loss of employment. Research shows that chronic stressors (such as illness, lack of social support, and numerous “daily hassles”) are also linked to a higher risk for depression. In fact, stress from adjusting to military life has also been known to cause depression.
Getting Help With Your Claim
If you or a family member have had a disability claim denied and are unable to work due to mental illness, the team at Hill & Ponton is here to help. Our experienced veterans’ disability lawyers can asses your case and help with your appeal. Contact us today to get started.
