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.
It is also important to understand that you can potentially qualify for a service-connected mental health condition even if you do not have PTSD. While many veterans who receive disability compensation benefits from VA have PTSD, other veterans receive disability compensation benefits for service-connected Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD)
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.
|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.
|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.
|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).
|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.
|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.
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 rating and benefit you should 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 types of 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 in the table above are a guide for VA raters when assessing your particular disability. Because PTSD is a complex and unique disorder, your PTSD symptoms probably do not neatly fit into one level of the ratings tables.
For example, many veterans experience symptoms that fit into two or three of the different rating levels. They may have two symptoms from one rating level, two symptoms from a second rating level, and another symptom from a third rating level.
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 many decisions 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 and VA understand, either through psychological testing or the information you provide, the extent of your disability.
One way to do this is to provide your doctor with a copy of the ratings criteria. This allows your doctor to address your symptoms in a way that VA is more likely to process correctly. Hopefully, this will help you to receive the most appropriate rating from.
What if My PTSD Symptoms Worsen While My Disability Benefits Claim Is Pending?
It is not uncommon for PTSD symptoms to change over time. Hopefully, treatment can help symptoms improve. But, VA acknowledges that many veterans experience worsening PTSD symptoms as they age.
If your PTSD symptoms worsen while you are fighting with VA to get your PTSD service-connected or to get an increased rating for your PTSD, you need to make sure VA takes these increased symptoms into account in making its decision on your claim.
But, the importance of getting the correct rating for your PTSD cannot be overstated. The different levels of PTSD ratings all provide different benefits:
- The 30% rating on its own allows you to potentially draw benefits for dependents even if PTSD is your only service-connected condition. Veterans with a total rating below 30% do not receive additional benefits for dependents, so qualifying for a 30% rating can be very important.
- In additional to providing a greater monthly benefit amount, a 50% rating should help you avoid an offset if you are a military retiree. Also, if you are service-connected for more than one condition and cannot work, that rating may be helpful in pursuing TDIU benefits.
- If you cannot work, a 70% PTSD rating can be very helpful in qualifying for a 100% rating through TDIU.
Making sure you follow the best path to present this evidence to VA can be difficult. With changes that VA has made in recent years regarding how it processes claims and appeals, it can sometimes be difficult to know the best way to present new medical evidence to VA.
What if my PTSD Symptoms Have Gotten Worse But I Have Not Filed For Additional VA Disability Benefits?
Sometimes, your PTSD symptoms get worse while you have an ongoing claim with VA. Other times, your PTSD symptoms worsen month or years after you start receiving VA benefits for PTSD.
Fortunately, veterans can pursue an increased rating for PTSD that most appropriately matches their symptoms if they worsen. This often happens with veterans who were rated at the 10 or 30 percent level whose PTSD worsens over time. When this happens, it makes it much more difficult to function socially and occupationally. A severe enough worsening can cause a veteran to become unemployable as a result of the PTSD symptoms.
When this happens, the previous rating that VA is paying is no longer appropriate. Fortunately, veterans can file for increased ratings for their PTSD. But, veterans must take action to get PTSD ratings increased to the appropriate rating that takes into account their worsened PTSD symptoms. Otherwise, VA will just continue to pay at the old rating.
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 much more general.
Many veterans find that VA rates them at a lower level even though their 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.