The DSM-5 and the VA

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“DSM-5”), was published in May of 2013. The DSM-5 replaces the DSM-IV-TR, which was published in the year 2000. Even though the DSM-5 has been released, as of today, the VA is still utilizing the DSM-IV to diagnose, evaluate, and rate veterans’ mental disabilities.  It remains to be seen when the VA will adopt the new guidelines and modify its regulations. Not surprisingly, some experts predict that it may be 3 to 5 years before the VA fully implements the DSM-5.

One of the major changes in the DSM-5, relevant to VA law, is the elimination of the Global Assessment of Functioning (GAF) score. Under the DSM IV, clinicians assign a GAF score to assess the impact of mental conditions on their patients’ social, occupational, and psychological functioning. The GAF score is based on a numerical scale, ranging from 0 to 100, with scores of 50 or less indicating serious to severe impairment in functioning. More often than not, the VA utilizes the GAF score as a part of its determination regarding the impact of the mental illness on social and occupational functioning, and as a tool to assign disability ratings. For example, from our experience, veterans with GAF scores above 50 are very seldom assigned disability ratings higher than 50 percent.

Critics of the GAF score have always indicated that this measure is too subjective, and that more objective standards are needed to assess the impact of mental health on one’s overall functioning. Now that GAF scores will no longer be used under the DSM-5, it will be interesting to see what standards the VA will use to replace that measure when assigning the disability ratings.

Another major change in the DSM-5 is a change in the criteria necessary for a diagnosis of Post-Traumatic Stress Disorder (PTSD). For example, criterion A2 which required fear, helplessness or horror to happen right after the trauma has been eliminated. The qualifying events for a PTSD diagnosis have been narrowed down. The diagnosis now requires at least one ‘avoidance’ symptom to be met. There are also new subtypes of PTSD. There are other changes which I have not discussed, but are worth noting.

The take-away for anyone pursuing VA disability is that knowing some of the key differences between the DSM IV and DSM-5 will be important to future success in these claims and dealing with the VA. Especially with elimination of GAF scores, it will be crucial to make sure that treating practitioners are accurately recording the severity and impact of any mental illnesses in the treatment records. As in the past, the treating practitioners will likely have a better grasp of the veteran’s functioning and the big picture, versus a one-time review by a compensation and pension examiner who is providing an examination on limited time constraints.

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