Once a veteran’s PTSD has been service-connected, a disability rating will be assigned by the VA. A disability rating is the average impairment in earning capacity resulting from diseases, injuries, or their residual conditions. It is important to note that C&P examiners do not rate claims; exam results go to a VA adjudicator to apply the rating formula and provide a rating for the veteran’s PTSD.
When the VA is evaluating a claim for PTSD, it will look to both the rating formula and the DSM-V. This is one of the only times that the VA is authorized to look to factors outside of the rating criteria that are listed in the Code of Federal Regulations (see below). However, the symptoms in the DSM-V are not meant to replace, but rather supplement, the criteria listed in the rating formula for PTSD. In addition, the factors listed in the rating formula for PTSD are examples of conditions and are not meant to be an exhaustive list.
The VA rating formula goes from zero percent to 100 percent, in increments of 10, but not every disability includes each rating percentage. For example, a veteran’s PTSD can be rated at 0, 10, 30, 50, 70, or 100 percent debilitating. A zero percent 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 percent rating is warranted when there is “total occupational and social impairment” due to specified symptoms. Most veterans fall somewhere in the middle.
Note that VA regulations state that “where there is a question as to which of two evaluations shall be applied; the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned.” This means that if a veteran fits in both the 50 percent and 70 percent box, the argument should be made that the 70 percent rating more accurately encompasses his or her symptoms.
As you can see in the chart above, symptoms that the VA considers when rating PTSD 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.
During its evaluation, the rating activity must consider the frequency, severity, and duration of psychiatric symptoms; the length of remissions; and the veteran’s capacity for adjustment during periods of remission. The rating should be assigned based on all evidence in the record which relates to a veteran’s occupational and social impairment, but a rating cannot be assigned based solely on social impairment. Remember that the purpose of VA disability benefits is to compensate veterans for impairment in earning capacity. Therefore, it is important to emphasize how a veteran’s PTSD symptoms have impaired his or her ability work and maintain gainful employment. If a veteran is unable to work due to his or her PTSD, he or she may be eligible for total disability based on individual unemployability (TDIU). TDIU is another way to get to a 100 percent disability rating if a veteran’s PTSD does not warrant a 100 percent schedular rating but he or she is still unable to obtain and maintain substantially gainful employment.
Continue to Part Five to learn about how to receive a 100 percent rating for total disability based on individual unemployability (TDIU).