This article explains how VA mental health ratings work, what PTSD requires that other psychiatric conditions do not, and why the condition a veteran pursues can change the outcome of a claim.
Veterans struggling with mental health disorders often file a claim for Post-Traumatic Stress Disorder (PTSD) with the Department of Veterans Affairs even if they have been diagnosed with other mental health disorders, because they mistakenly believe that if their psychiatric disability was caused by service, it must be PTSD.
What PTSD requires under the DSM-5
There are significant clinical differences between PTSD and other mental health disorders. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists the required criteria for PTSD as follows:
- Stressor. Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence through direct exposure, witnessing the trauma, learning that the trauma happened to a close relative or close friend, or indirect exposure to details of the trauma, usually in the course of professional duties.
- Traumatic events are persistently re-experienced in the following way: unwanted upsetting memories; or nightmares; or flashbacks; or emotional distress after exposure to traumatic reminders; or physical reactivity after exposure to traumatic reminders.
- Avoidance of trauma-related stimuli after the trauma: trauma-related thoughts or feelings; or trauma-related reminders.
- Negative thoughts or feelings that began or worsened after the trauma (2 required): inability to recall key features of the trauma; overall negative thoughts and assumptions about oneself or the world; exaggerated blame of self or others for causing the trauma; negative affect; decreased interest in activities; feeling isolated; difficulty experiencing positive affect.
- Trauma-related arousal and reactivity that began or worsened after the trauma (2 required): irritability or aggression; risky or destructive behavior; hypervigilance; heightened startle reaction; difficulty concentrating; difficulty sleeping.
- Symptoms last for more than one month.
- Symptoms create distress or functional impairment.
- Symptoms are not due to medication, substance use or other illness.
If a veteran does not meet all eight criteria, VA will likely deny service connection for PTSD because the veteran’s diagnosis does not meet the criteria for PTSD.
Why the stressor usually has to be corroborated
In addition to demonstrating a current diagnosis, service connection for PTSD also requires, with few exceptions, the stressor to be corroborated. VA can corroborate a stressor by looking at service records or other external evidence to confirm that an event occurred that would qualify as a stressor, meaning exposure or threat of death and similar events. For example, motor vehicle accidents, accidental grenade explosions, and friendly fire all need to be corroborated by VA. If VA cannot corroborate the stressor that led to PTSD, service connection will be denied.
The exceptions are set out at 38 CFR §3.304(f). Corroboration of the stressor is not required where the stressor occurred during combat service; where the stressor relates to fear of hostile military or terrorist activity; where the veteran was a prisoner of war; or where a diagnosis of PTSD occurred while still on active duty. In each of those situations, the veteran’s own testimony can establish the stressor, absent clear and convincing evidence to the contrary, provided it is consistent with the circumstances of service.
There is a fifth situation worth knowing about. Where the claimed stressor is a personal assault, including military sexual trauma, the regulation permits evidence from sources other than service records to corroborate the account. That can include law enforcement or medical records, statements from family or fellow service members, or documented changes in behavior following the assault. Claims involving military sexual trauma frequently turn on that evidence rather than on the service file.
When another mental health condition is the better claim
Because PTSD has additional requirements, it may not always be possible to obtain service connection. In cases where a veteran has been diagnosed with PTSD and another mental health disorder, it may be easier and faster to establish service connection for another mental health disorder and not PTSD.
Unlike PTSD, other mental health disorders do not require the corroboration of a stressor. Other mental health disorders can be service connected if there is evidence of:
- a current disability;
- that the disability was incurred in service, meaning symptoms of the mental health disability began in service, or an in-service event happened that caused the mental health disorder to develop; and
- a medical opinion linking the current mental health disorder to the in-service symptoms or event.
For example, a veteran diagnosed with major depressive disorder can be service connected if he submits medical evidence diagnosing major depressive disorder; medical or lay evidence or a witness statement that he began suffering from depressive symptoms in service; and a medical opinion that links the current diagnosis to the in-service symptoms.
The same three elements apply to generalized anxiety disorder, adjustment disorder, and other acquired psychiatric conditions. Where the evidence of an in-service stressor is thin but the treatment history is strong, that difference can decide whether a claim succeeds.
How VA mental health ratings are assigned
Whether a veteran is service-connected for PTSD or another mental health disorder, VA will assign a disability rating using the same functional criteria, found in VA’s Schedule for Rating Disabilities at 38 CFR §4.130. The rating schedule measures the level of social and occupational impairment caused by the service-connected mental health disability. The disability ratings provided in the rating schedule range from 0 to 100 percent.
Because the same criteria apply to every psychiatric diagnosis, a rating for anxiety and a rating for depression are decided the same way. The diagnosis does not set the percentage. The documented level of occupational and social impairment does.
Why you cannot be paid twice for the same symptoms
Because VA rates all mental health disabilities using the same functional criteria, a veteran cannot be compensated for more than one psychiatric disability, because it would violate VA’s no pyramiding rule at 38 CFR §4.14. This means that a veteran cannot be compensated twice for the same symptomatology. VA will combine all the mental health disabilities into one single disability rating and base the rate on the most disabling condition.
This is worth understanding before filing. Adding a second psychiatric diagnosis to a claim does not add a second rating. What can raise a rating is evidence that the level of occupational and social impairment is greater than VA found it to be.
Conditions that are medically distinct from the psychiatric disability are treated differently. Those may be claimed as secondary service-connected disabilities and rated separately, provided the medical evidence supports the connection.
Frequently Asked Questions
Does VA rate PTSD differently from depression or anxiety?
No. VA rates every service-connected mental health condition under the same criteria at 38 CFR §4.130, based on the level of social and occupational impairment. The difference between PTSD and other conditions is in what has to be proven to establish service connection, not in how the condition is rated afterward.
Is anxiety a disability VA will compensate?
Yes, where it is service connected. VA disability for anxiety is established the same way as any other acquired psychiatric condition: a current diagnosis, evidence that symptoms began in service or that an in-service event caused the condition, and a medical opinion linking the two. Generalized anxiety disorder and adjustment disorder are then rated under the same schedule as every other psychiatric condition.
Where are the VA mental health rating criteria written down?
In 38 CFR §4.130, the section of VA’s Schedule for Rating Disabilities covering mental disorders. It contains the General Rating Formula that sets the 0, 10, 30, 50, 70 and 100 percent levels, and it applies to every psychiatric diagnosis VA rates.
Can I receive separate ratings for PTSD and depression?
No. Under 38 CFR §4.14, VA combines mental health disabilities into a single rating based on the most disabling condition, because paying twice for the same symptoms is not permitted.
What happens if I do not meet all the PTSD criteria?
VA will likely deny service connection for PTSD, because the diagnosis does not meet the criteria. That denial does not necessarily end the matter if another psychiatric diagnosis is present in the record, since other conditions do not carry the stressor corroboration requirement.
Does a stressor always have to be corroborated?
Not always. Under 38 CFR §3.304(f), corroboration is not required where the stressor occurred in combat, relates to fear of hostile military or terrorist activity, arose during captivity as a prisoner of war, or where PTSD was diagnosed in service. Personal assault claims have their own rule allowing corroboration from sources outside the service records.
My rating feels too low. What can be done?
A rating reflects the impairment VA found documented, which is not always the impairment a veteran actually has. Where the record does not describe the full level of occupational and social impairment, that is what an appeal or a supplemental claim has to address. The C&P exam report is usually the document that decided the percentage, and it is worth reading before deciding what to do next.
Where to start if your VA mental health rating is too low
Formulating a plan on how best to pursue service connection for psychiatric disabilities, or the highest disability rating possible, can be overwhelming.
Goodman Allen Donnelly is a Virginia-based law firm representing veterans and their dependents in VA disability appeals, with more than 25 years of veterans benefits experience across the team. The firm handles appeals and supplemental claims for veterans and their dependents only.
If you have been denied service connection for one or more psychiatric disabilities, or have not been rated appropriately, Goodman Allen Donnelly offers a free consultation for veterans and their families.
About The Author
This article was contributed by Nancy Foti, Managing Partner of Goodman Allen Donnelly. With over 20 years of experience, Nancy has represented disabled veterans and their families before the Department of Veterans Affairs, the U.S. Court of Appeals for Veterans Claims, and the U.S. Court of Appeals for the Federal Circuit. She clerked for the Honorable Ronald Holdaway of the U.S. Court of Appeals for Veterans Claims and previously served as a staff attorney with the National Veterans Legal Services Program.