Table of Contents
- How VA Evaluates PTSD for Disability Compensation
- GAF Scores No Longer Used
- Presumption of Direct Service Connection – PTSD
- Compensation and Pension (C&P) Exams for PTSD
- Overview of DSM-5 Diagnostic Criteria for Veterans’ PTSD VA Ratings
- PTSD New Category: Trauma- and Stressor-Related Disorders.
- Two specifications:
- PTSD VA Rating Schedule
- General Rating Formula for Mental Disorders (38 CFR § 4.130)
- What Does VA Pay in Disability Benefits for PTSD?
- Traumatic Brain Injury (TBI) and PTSD
- Send a Strong PTSD Claim to the VA
There is a widespread misconception that post-traumatic stress disorder (PTSD) is rated at a level that does not accurately reflect the severity of your impairment. It is very difficult for you to assess your PTSD VA rating due to these factors. There is no easy answer to the PTSD claims filed by US service members. The fight for fair ratings is hard-fought to cover veterans' traumatic symptoms every day.
It is your right to receive swift and just compensation if you have PTSD. According to the VA disability ratings, injury, illness, or disability associated with the military affects veterans' quality of life after leaving the armed forces. A different percentage is assigned to each disabling condition. By combining multiple disability ratings, VA creates an overall disability rating.
It is also the case for PTSD claims, but these evaluations are somewhat more complex for the following reasons.
How VA Evaluates PTSD for Disability Compensation
First: When the VA assesses a PTSD claim, two sources are utilized: an outside source and an internal source.
- DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) specifies the criteria for diagnosing PTSD in Veterans Affairs. The American Psychiatric Association publishes this authoritative resource on psychiatric diagnosis and research. Online access to the manual requires a subscription.
- VA’s official rating schedule in the Code of Federal Regulations: The schedule of ratings for mental disorders can be accessed online by searching 38 CFR § 4.130.
Second: PTSD has been added to the Trauma- and Stressor-Related Disorders section of DSM-5 as of 2013. It was previously included in the category of Anxiety Disorders.
PTSD's diagnosis criteria have been progressively updated in the DSM manual. PTSD was first diagnosed in 1980 using the DSM-III with clear diagnostic criteria. PTSD diagnostic criteria were updated to reflect the latest research in successive editions. The most recent of these is DSM-5, which was released in 2013. August 2014 marked the official adoption of DSM-5 by the VA.
GAF Scores No Longer Used
Veterans' mental health disabilities such as PTSD or other mental disabilities were rated by the VA using the Global Assessment of Functioning (GAF) Score before August 2014. VA adopted the DSM-5 in August 2014, which eliminated GAF scores.
Therefore, all VA PTSD disability claims received after August 4, 2014, or those pending VA review on or after that date will be evaluated according to DSM-5 diagnostic criteria and rated using CFR 38 § 4.130.
Presumption of Direct Service Connection – PTSD
When the following conditions are met, you are presumed to be suffering from post-traumatic stress disorder:
- PTSD diagnosis supported by medical evidence;
- Based on medical evidence, a link (nexus) exists between current symptoms and a current stressor; and
- The existence of an in-service stressor that is supported by credible evidence.
Proving an event's nexus is extremely difficult, especially when the event is undocumented and seems to be impossible to establish. As a result, the VA has provisions where, in certain circumstances, you may not be required to prove a specific military event using written records but instead by other means, such as lay testimony.
Compensation and Pension (C&P) Exams for PTSD
The above background information is important because the veteran will need a C&P medical evaluation to determine whether PTSD is a valid diagnosis.
A VA-recognized health professional who is specially trained to diagnose PTSD in veterans must make the diagnosis. Examinations will be conducted by psychiatrists or psychologists who are board-certified or board-eligible and by other credentialed or qualified mental health professionals acting under the close supervision of a psychiatrist or psychologist who is a licensed doctorate-level practitioner.
You will likely have to undergo the PTSD C&P exam if you file for disability due to PTSD - even if you already have a diagnosis from a doctor outside the VA. DSM-5 diagnostic requirements for PTSD and evaluation methods for PTSD will be familiar to the examiner.
Let's explore the DSM-5 guidelines for PTSD.
Overview of DSM-5 Diagnostic Criteria for Veterans’ PTSD VA Ratings
As a diagnostic requirement, all conditions listed under the new Trauma- and Stressor-Related Disorders section of DSM-5 must have been exposed to trauma or stress.
However the disturbance arises, it causes the veteran clinically significant distress or impairment in their ability to interact with others, work, or other important areas of functioning. The condition is not caused by medication, drugs, alcohol, or another medical condition.
Post-traumatic Stress Disorder is defined in the DSM-5 by the following summary. All of the criteria must be met to diagnose PTSD.
PTSD Criterion A (one required) – Stressor
They may have been exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence as a result of:
- Direct exposure
- Being a witness to the trauma
- Knowing a family member or close friend was exposed to a traumatic event
- The aversive details of trauma are often indirectly exposed, usually since such exposure is part of one's job description (e.g., first responders, medics)
PTSD Criterion B (one required) – Intrusion Symptoms
Survivors persistently re-experience traumatic events in the following way(s):
- Memories that upset you
- Having nightmares
- Exposure to traumatic memories can lead to emotional distress
- Reactions to traumatic memories on the physical level
PTSD Criterion C (one required) – Avoidance
Trauma-related stimuli should be avoided following trauma, in the following ways:
- Feelings or thoughts related to trauma
- Reminders related to trauma
PTSD Criterion D (two required) – Negative alterations in cognitions and mood
After the trauma, negative thoughts or feelings develop or worsen in the following way(s):
- Traumatic experiences are difficult to recall
- A negative mindset or overly negative assumptions about the world or oneself
- Blaming yourself or others for causing trauma in an exaggerated way
- Having a negative attitude
- Become less interested in activities
- Sense of isolation
- An inability to experience positive emotions
PTSD Criterion E (two required) – Alterations in arousal and reactivity
After a trauma, there is arousal and reactivity related to that trauma, in one or more of the following ways:
- Aggression or irritability
- Behavior that can be dangerous or destructive
- A hypervigilant attitude
- Increased startle response
- Having trouble concentrating
- Not being able to sleep
PTSD Criterion F (required) – Duration of Symptoms
Symptoms persist for more than one month.
PTSD Criterion G (required) – Functional significance
Stress causes distress or functional impairments (social, occupational).
PTSD Criterion H (required) – Exclusion
Other illnesses or medications do not cause the symptoms.
- Dissociative Specification
The individual must also experience high levels of either of the following symptoms in reaction to trauma-related stimuli to be diagnosed:
- Depersonalization: Feeling detached or as if one is watching or observing oneself from an outside perspective (e.g., feeling as if one were in a dream).
- Derealization: Experiences of unreality, distortion, or distance (e.g., “Things do not exist”).
- Delayed Specification
It usually takes at least six months after the trauma(s) before full diagnostic criteria are met, although symptoms may start immediately after the trauma.
PTSD VA Rating Schedule
Aside from using the DSM-5 as a reference tool (summarized above), VA also applies its PTSD VA rating schedule, published in 38 CFR § 4.130 – Schedule of ratings - Mental disorders (and reproduced below).
VA mental health claims are rated on a CFR scale by the severity of post-traumatic stress disorder: 0, 10, 30, 50, 70, or 100 percent. VA mental health claims are rated on a CFR scale by the severity of post-traumatic stress disorder: 0, 10, 30, 50, 70, or 100 percent.
General Rating Formula for Mental Disorders (38 CFR § 4.130)
|An exhaustive list of symptoms that result in total occupational and social impairment, such as gross impairment of thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of harming oneself or another; intermittent inability to perform tasks of daily living (including maintaining minimal personal hygiene); and complete disorientation to time or place.||100%|
|Occupational and social impairment, with deficiencies in most areas, such as work, family relations, thinking, judgment, school, or mood, due to such symptoms as obsessional rituals which interfere with routine activities; suicidal ideation; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships.||70%|
|Various symptoms lead to reduced reliability and productivity in the workplace, such as flattened affect, circumstantial, circumlocutory, or stereotyped speech, panic attacks more than once per week, difficulties understanding complex commands, impaired short- and long-term memory (e.g., remembering only highly learned material and forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and so on.||50%|
|Occupational disability with occasional decreased performance and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal) due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).||30%|
|Incapacity to perform occupational tasks due to mild, transient symptoms during times of excessive stress or if the symptoms are controlled by continuous medication.||10%|
|A mental disorder has been diagnosed, but it is not severe enough to require continuous medication or interfere with social or occupational functioning.||0%|
Many service-connected impairments qualify for Total Disability Individual Unemployability benefits, including PTSD.
What Does VA Pay in Disability Benefits for PTSD?
Veterans with no dependents who suffer from PTSD will receive the following monthly compensation after obtaining benefits from the VA as of 2019:
- 0% disability rating: $0.00
- 10% disability rating: $140.05
- 30% disability rating: $428.83
- 50% disability rating: $879.36
- 70% disability rating: $1,403.71
- 100 disability rating: $3,057.13
As an individual with a 0 percent rating, the VA recognizes that you have service-connected PTSD, but not to the extent that the condition prevents you from pursuing gainful employment or affecting your daily life activities.
Rather than starting the claim process from scratch if the situation deteriorates, you need to request an increase to your PTSD VA rating for the disability.
Traumatic Brain Injury (TBI) and PTSD
Many veterans with post-traumatic stress disorder have also sustained traumatic brain injuries. Secondary service-connected PTSD often occurs following a TBI, as both conditions result from the same experience and share many of the same symptoms. Veterans who have suffered traumatic brain injuries during the conflicts in Afghanistan and Iraq (OEF/OIF) are on the rise.
Send a Strong PTSD Claim to the VA
The process of determining your PTSD VA rating can be difficult. Several factors must be considered. Veterans attorneys can help you obtain the PTSD evaluation and rating you deserve, whether you are applying for VA compensation for the first time, disputing a denial, or making an appeal.
You have the final say on your case when you have proper representation. Don't hesitate to contact a disability lawyer for consultation if you served in any US military branch and have PTSD claims against the VA. The attorney can assist you in establishing a connection, communicating the extent of your disability to the VA, and ensuring that your claim is properly developed and presented.
Applying for Social Security benefits can be an overwhelming process. If you are interested in seeking SSDI benefits, check out our article on who’s eligible for Social Security disability benefits. To learn more, visit DisabilityHelp.org today!