The VA Rating Formula for Mental Disorders and Disabilities Like PTSD, Depression, and More


Today we’re going to talk about how mental
health conditions are rated by the V.A. My name is Zack Evans. I’m a veterans disability benefits attorney
with Woods and Woods Attorneys in Evansville, Indiana. The book that I have in front in me is the
Code of Federal Regulations. This is the CFR. Specifically 38 CFR, Section 4.130 is the
section we’re looking at today. That’s 38 CFR 4.130. This is the V.A.’s rule book on mental health
disorders. I use this every day in my job. Anyone that is familiar with the claims process
has probably seen it before. The first thing you’ll see under this section
of the CFR is a listing of diagnoses which fit into this mental health category. We have everything from schizophrenia, major
depressive disorder, posttraumatic stress disorder, somatic symptom disorder. That’s a really important nuance because if
you’re having problems sleeping and insomnia is your chief complaint outside of any anxiety
or depression, anything like that, those are actually going to be considered as mental
health claims. We can get into sort of those procedural wrinkles
in another video, but we’re going to stick to the rating formula itself for the purposes
of this video. After you have this listing of example diagnoses,
which is not exhaustive, you’ll see the general rating formula for mental disorders. You have several ratings tiers, zero, 10,
30, 50, 70, all the way to 100, so those are in increasing severity. Zero means essentially you have a diagnosis,
but you have few if any symptoms that will impact work. This is somewhat of a rare rating to see. It’s certainly more common out of regional
offices than it is after a case has gone to the Board of Veterans Appeals. This is generally because if a veteran has
a complaint of some sort of mental health condition, it’s generally affecting them above
a level of zero. Another one to consider here is the other
end of the spectrum. We just talked about a zero. What does 100 mean? Well, 100 means total occupational and social
impairment. They’re somewhat rare, but we do see them. I work with them relatively regularly. It requires very compelling evidence, so these
are your really standout cases where you read the records, you read the file, and you just
think how is this person not already awarded a total impairment? They really bark at you. A good example of symptoms that you’ll see
in the 100 tier is someone with advanced schizophrenia and you’re seeing persistent delusions and
hallucinations that aren’t controlled with medication. Most of the mental health cases that we see
fall somewhere between 30 to 70. You have three ratings tiers in there, 30,
50, and 70, the 70 rating itself qualifying a veteran for total disability and individual
unemployability, TDIU, IU benefits, so the 70 itself will qualify you. The lower ratings of 50 or 30, you can make
an extra scheduler argument to win your IU case, or what we commonly do is we look for
holistic consideration of everything that the veteran is dealing with. If they have a back problem plus this moderate
mental health condition and bad ankles, the total picture renders that veteran unemployable. You can get to your unemployability benefits
through either just your mental health rating alone or in concert with everything else that’s
going on with you physically. I want to talk about what these different
levels mean, the 30, 50, and 70. A 30 essentially means you have an occasional
decrease in efficiency and intermittent ability to perform occupational tasks. A good way to think about this is if you sometimes
have a bad day where, and it sounds like I’m oversimplifying it, but if it’s less often
than not I guess, you are having the kind of day where you can’t really keep up, you
can’t stay focused on your tasks, if sometimes you have attendance problems at work, those
suggest, again outside of seeing the medical evidence itself, those are indicative of a
30 rating. A 50 rating is reduced reliability and productivity. The way that I think about this is we’re looking
at moderate effects across the board with relative frequency. So if John in the previous example has 30
and he’s doing okay for most of the month, and then on the last week, he’s got a run
of two or three really bad days there and then he’s back to normal, and he’s feeling
himself again at the beginning of the next month, he comes back on Monday and things
are back to normal, he may have a 30 rating. A 50 rating is someone who is consistently
suffering from the effects of their mental health disorder. This is someone who just about every aspect
of their life is affected in some way, especially social and occupational functioning. Now a 70 rating suggest deficiencies in most
areas. This includes work, school, family relations,
judgment, thinking and/or mood. Just by the way the rating is described in
the CFR, you can tell this is a much more serious situation. Not only is it affecting all aspects of a
veteran’s life, but we’re seeing a drastic impact in all of these areas of functioning. These are typically veterans who have a very
limited social network, a very limited support system. We see a lack of access to mental health services
as an ongoing problem. Maybe there’s been a missed diagnosis or an
undiagnosed condition for a long period of time that allowed a veteran to decompensate
while not under the care of a physician or psychiatrist/psychologist. There are various symptoms that appear at
these different ratings, so I’ll give you a couple of examples here straight from the
CFR. We have a 30 rating here, depressed mood,
some anxiety, suspiciousness, panic attacks either weekly or less often. Higher frequencies can get you into higher
ratings. Chronic sleep impairment, mild memory loss,
names, directions, recent events. Some examples of your 50 symptoms, we’re looking
at circumlocutory or stereotype speech, panic attacks more than once a week, difficulty
in understanding complex tasks, impaired judgment, impaired abstract thinking, disturbances of
motivation and mood. Then moving up to the 70 rating, there again
getting a little bit more severe every time, we’re looking at illogical, obscure or irrelevant
thoughts and near-continuous panic or depression affecting the ability to function independently,
appropriately, and effectively. This is also where we start to see impaired
impulse control and unprovoked irritability with periods of violence. The reason that is important is because when
you start seeing emotional outbursts as a symptom of a mental health condition and that’s
present in the evidence of your claim, there is a significant thing to be said about your
employability. If you’re having trouble maintaining or regulating
your mood and it is affecting you, and you’re having outbursts at work, this is why those
symptoms are present in the 70 rating that automatically qualifies you by the schedule
for a TDIU consideration, so as long as you submitted some evidence that your service-connected
mental health disorder actually does prevent you from working. If you have any questions about your mental
health rating, please go online or give us a call here at Woods and Woods. We’d love to help you.

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