Are you seeking service connection and a VA disability rating for PTSD? An increase in your VA disability rating for PTSD? Or, did you just receive a ratings decision that left you wondering if you received the correct VA disability rating for PTSD based on the symptoms you have?
No matter which situation you find yourself in, it is important to understand how VA rates PTSD and what evidence is required to move to the higher levels.
What You Must Have Before You Are Entitled to a VA Disability Rating for PTSD
It may seem obvious, but you must have a current diagnosis of PTSD if you are to be rated by VA. Some veterans think they have PTSD but don’t formally meet the diagnostic criteria for this mental condition. Sometimes, it may not actually be PTSD.
Depression, anxiety, and certain obsessive compulsive disorders can present symptoms similar to PTSD. It is important that you are evaluated by a qualified psychiatrist, psychologist, or other mental health professional qualified to diagnose your particular condition.
General Principles of Your VA Disability Rating for PTSD
If you have PTSD related to your military service, you may be rated at one of six different ratings levels. 38 C.F.R. §4.126 sets forth how to look at your symptoms when evaluating the extent of your PTSD disability.
The rating criteria are primarily focused on how you are affected in your personal life and work life. Generally, the more symptoms you have the higher up the scale you should be rated. Also, the more severe your symptoms are the higher your rating should be.
As you know if you have PTSD or know someone who does, not all PTSD symptoms are constant. They can come and go. They can be triggered by certain events or stimuli. The VA rating should take into account the frequency of your symptoms as well.
If you have a current diagnosis of PTSD but don’t have any current symptoms, you will be assigned a noncompensable rating of 0%. At the other end of the scale, you will be assigned a 100% VA disability rating for PTSD if you have total occupational and social impairment, meaning you are totally disabled.
In between those two extremes are four other ratings levels: 10%, 30%, 50%, and 70%. Many of the criteria are similar at each level but vary in degree. As I have discussed before, the amount of your rating greatly affects the type of benefits you receive from VA. Below are the criteria VA uses for each rating level.
General Rating Formula for Post-Traumatic Stress Disorder
|Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.||100|
|Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; 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 worklike setting); inability to establish and maintain effective relationships.||70|
|Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.||50|
|Occupational and social impairment with occasional decrease in work efficiency 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|
|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 symptoms controlled by continuous medication.||10|
|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.||0|
If you are concerned about your rating, we will discuss a couple of things to keep in mind as you go through your claim to make sure you get the most benefits you deserve on account of your VA disability for PTSD.
Contrary to what the VA may have said in your Ratings Decision, you do not have to exhibit ALL of the PTSD symptoms of a particular rating level to receive that rating. For certain disabilities, you must have each and every symptom at the specified severity or frequency. That is not the case with PTSD.
The PTSD rating criteria are a guide for VA raters when assessing your particular disability. Because PTSD is a complex and unique disorder, your PTSD may not neatly fit into one level of the ratings tables.
Luckily, VA law realizes that many veterans find themselves in that situation. Because of this, when deciding between two rating levels, the VA should rate you at the one that most closely describes your level of disability.
We say “should” because we have seen decision in the past where the VA did not grant the higher rating level because the veteran did not meet each and every part of the higher rating criteria. So, how does this work in reality?
Let’s say you have applied for VA disability for PTSD and have some symptoms that fall in the 50% rating level and some other symptoms in the 70% rating level. Although your symptoms may be somewhere in between these two levels, it is not possible to “split the difference. There is no 60% rating for PTSD, so the VA will have to decide which one is appropriate.
If VA assigned you the lower of two possible ratings for VA disability for PTSD, you will want to look closely to see which level better describes your particular situation. You will need to consider the severity of your symptoms – how greatly they impair your social and work relationships.
You will also need to look at how frequently you have those impairments. The more frequently you experience problems related to your PTSD, the more difficult it is to maintain personal relationships and employment. You will need to make sure that your doctor understands, either through psychological testing or the information you provide, the extent of your disability.
It is probably best to provide your doctor with a copy of the ratings criteria so they can address your symptoms in a way that will allow you to receive the highest and most appropriate rating.
Let Us Know If We Can Help
The VA disability rating table for PTSD is difficult. Many VA ratings focus on certain measurements like range of motion or testing results. The PTSD rating table is more general. You may find that VA rates you at a lower level even though your symptoms justify a higher rating.
Post-traumatic stress disorder presents enough struggles to the diagnosed veteran and the veteran’s loved ones. It can often be frustrating or difficult to deal with the VA disability claims process.