Mental Disorders

How a Rater Decides

The mental health rating schedule is unique in that it relies upon the a wide array of symptoms and evidence in order to determine the Veteran's rating.

Ultimately, a Veteran's rating is based upon the rating percentage that most closely resembles the totality of their symptoms, which is determined based upon all the evidence submitted.

This includes:

• C&P Examiner's Report

• DBQ

• Nexus Letters

• Buddy Letters VA Form 21-10210

• Personal Statements VA Form 21-4138

• Supporting Statements for Service Connection for PTSD VA Form 21-0781

• Private/VA Treatment Notes

• Vet Center Notes (you MUST give the VBA Written permission to access these notes!)

Do know that just because you may have a few symptoms in areas that are attributed to higher rating percentages, it does NOT mean you will be awarded that higher percentage. Your rating will be based upon the totality of your symptoms and evidence before the rater.

And know... you do NOT need to meet every example in a given percentage to be awarded that percentage! They just serve as examples, NOT requirements.

Generally speaking, there are four areas involved when considering severity:

• Ability to Care for Yourself

• Ability to Work

• Social Relationships

• Symptoms

0%

"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."

Veteran has a current mental health diagnosis.

• Ability to Care for Yourself:

  • No impairment.

• Ability to Work:

  • No impairment.

• Medications:

  • Not required.

• Social Relationships:

  • No impairment.

• Symptoms:

  • None.

10%

"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."

• Ability to Care for Yourself:

  • Always able to take care of themselves.

• Ability to Work:

  • Rarely will have problems.

• Medications:

  • May or may not be needed. If taken they keep all symptoms under control.

• Social Relationships:

  • Occasional issues.

• Symptoms:

  • Mild anxiety, depression, or other mood changes;

  • Rarely has a mild panic attack;

  • Occasional sleep disturbances/difficulty falling asleep (nightmares, anxiety, insomnia, etc).

30%

"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)."

• Ability to Care for Yourself:

  • Can take care of themselves most the time. May occasionally be hospitalized for short

• Ability to Work:

  • Occasionally unable to do their job properly.

• Social Relationships:

  • They exist. However, they will often be strained. Which may result in breakups or divorces.

• Symptoms:

  • Occasional spikes in severity of anxiety, mood, depression;

  • Often suspicious of others - especially strangers;

  • One panic attack a week;

  • Mild memory issues - forgetting names, directions, recent events;

  • Frequent sleep disturbances/difficulty falling asleep (nightmares, anxiety, insomnia, etc).

50%

"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."

• Ability to Care for Yourself:

  • Mostly able to take care of themselves. Hygiene may not always be maintained. Veteran is able to do daily tasks such as driving, shopping, household chores, etc. May occasionally be hospitalized.

• Ability to Work:

  • Can work. However, it may be difficult to stay employed for long periods of time.

• Social Relationships:

  • May be able to form relationships. However, they be may be short lived due to the Veteran's inability to be an active participant.

• Symptoms:

  • Extreme lack of motivation and/or mood swings;

  • Difficulty expressing themselves or showing emotions. May also respond to things with an emotion that is inappropriate for the situation;

  • 2 or more panic attacks a week;

  • Constantly showing signs of severe anxiety;

  • Difficulty understanding complex directions;

  • Difficulty thinking logically and may often make poor judgments. Veteran may require a Fiduciary to handle their money;

  • Regularly drifts into unrelated tangents when communicating with someone;

  • Often forgets to do, how to do, or to complete tasks;

  • Experiences pain that does not have a physical explanation;

  • Nightly sleep disturbances/difficulty falling asleep (nightmares, anxiety, insomnia, etc);

  • Has thoughts of suicide, however there is no thought out plan;

  • Occasionally experiences states of delusions or hallucinations.

SPECIAL RATING NOTE:

• Veterans who were separated from service due to PTSD will receive at minimum a rating of 50%. Which will then be Reevaluated within 6 months. At which point, it may be lowered if appropriate.

70%

"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 idealization; 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 work-like setting); inability to establish and maintain effective relationships."

• Ability to Care for Yourself:

  • Unable to take care of themselves most the time. Often resulting in poor hygiene and appearance. Veteran may often be hospitalized or under the care of someone. Due to them being a danger to themselves or being unable to properly care for themselves most of the time.

• Ability to Work:

  • Can work, but may struggle a lot. Resulting in losing their job due to poor work performance. May only be able to work part time or in a position that is well below their education or intelligence.

• Social Relationships:

  • Most of the time the Veteran cannot participate in social relationships. The Veteran themselves mostly does not invite, seek, participate, or encourage social relationships.

• Symptoms:

  • Regularly poses a risk to themselves or others (includes suicidal tendencies);

  • Often has mood swings - seemingly without warning;

  • Has obsessive compulsive behavior that interfere with the completion of day to day activities;

  • Often suffers from severe depression or panic attacks - further being unable to function at all in stressful situations or environments;

  • Constant severe anxiety;

  • Difficulty controlling their anger - possibly resulting in acts of violence;

  • Often unable differentiate make-believe from reality (psychosis);

  • Often confused about time and location;

  • Often unable to communicate logically.

100%

"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."

• Ability to Care for Yourself:

  • Unable to care for themselves. Requiring constant or near constant hospitalization to due to the Veteran being a threat to themselves or others.

• Ability to Work:

  • No ability to work*

• Social Relationships:

  • If they exist, they are one way - directed toward the Veteran. The Veteran themselves does not invite, seek, participate, or encourage social relationships.

• Symptoms:

  • Constantly poses a risk to themselves or others (includes suicidal tendencies);

  • Significant memory loss, resulting in being unable to recall names of close family, friends, self, and other important information;

  • Constant severe anxiety, fear, and/or paranoia;

  • Inappropriate behavior such as drooling, mumbling to self, shouting, etc;

  • Unable to differentiate make-believe from reality. Having regular or constant delusions or hallucinations;

  • Unable to understand time or location;

  • Unable to communicate, reason, or think logically.

*Exception would be employment in a protected environment such as a family business or sheltered workshop.