This video and article will talk about how the VA generally rates mental health conditions, whether it’s PTSD (see our PTSD prep video) or any other mental health condition, which are all rated exactly the same with the limited exception of certain eating disorders. But in this article, we’re going to focus on non-eating disorder mental health conditions.
Now let’s talk about how the VA generally rates mental health conditions, whether it’s PTSD or any other mental health condition, which are all rated exactly the same with the limited exception of certain eating disorders. But in this article, we’re going to focus on non-eating disorder mental health conditions.
So let’s talk about the rating schedule. The VA rates your condition based on the severity of your symptoms and how they impact your ability to function in a social and occupational environment.
At a zero percent level, that means you have a formally diagnosed mental health condition but symptoms are not severe enough to interfere with occupational or social functioning, nor do they require continuous medication. For example, the veteran has an anxiety condition that manifests in service but doesn’t intrude or impact their life; that’s a zero percent rating.
At 10 percent, that means a veteran has mild or transient symptoms that cause occupational or social impairment by decreasing work efficiency. That is also the minimum rating for individuals whose symptoms are controlled by continuous medication.
At 30 percent, your symptoms begin to have a more severe impact on your work efficiency and ability to perform occupational tasks. This is where symptomatology begins to get factored into the rating. So at the 30 percent level, the veteran should have several, but not necessarily all, of the following symptoms:
A panic attack is an acute bout of anxiety that interferes with your functioning. It’s often described as feeling tightness in your chest, elevated heart rate, dizziness, shortness of breath, chills, sweating, tingling, or trembling in the extremities.
At the 50 percent level, you will have occupational and social impairment with reduced reliability and productivity. For example, you can’t perform as effectively at work or maintain your social relationships reliably due to symptoms such as circumstantial, circumlocutory, or stereotype speech.
Circumstantial speech means that it’s difficult for you to stay on topic. Circumlocutory speech involves using unnecessarily wordy and indirect language to avoid getting to the point. Stereotype speech means that you repeat yourself a lot.
Panic attacks that happen more than once a week are contemplated at the 50 percent level. This is the difficulty in understanding complex commands.
Impairment of short and long-term memory, meaning you can only remember highly learned material, is also a symptom of the 50 percent level.
Another symptom at the 50 percent level is forgetting to complete tasks. This can include remembering to take the trash out or to make phone calls.
Next, we have impaired judgment, which is risk-taking behavior such as infidelity, gambling, reckless driving, risky investments, risky sexual behavior, etc.
Another symptom is impaired abstract thinking, or how you can use your imagination to think about ideas and principles that are symbolic or hypothetical. It’s your ability to build a mental model in your head and manipulate those models in your mind without external support. If you remember taking the ASVAB, you had to look at a drawing of an object and figure out how it fits together; that’s abstract thinking.
Then we have disturbances of motivation and mood. For example, you’re irritable, you’re angry, or you’re down. Because of that, you struggle with motivation to get up and do things whether that’s going to work, meeting up with friends, or even calling the VA to set up appointments.
And lastly, at the 50 percent level, you have difficulty establishing and maintaining effective work and social relationships. And that means making and keeping friendships and getting along with coworkers, peers, and others at work. Personal relationships take work and effort to maintain, and mental health issues can significantly interfere with our ability to do that work.
At 70 percent, you have occupational and social impairment with deficiencies in most areas like work, school, family relations, judgment, thinking, or mood as a result of symptoms such as suicidal ideation.
Now, suicidal ideations are a spectrum. They range from “I have an active plan and will follow through with it unless there’s an intervention,” to a general feeling that you don’t want to be alive anymore. Anywhere on that spectrum is considered a suicidal ideation for VA purposes.
This is a very important symptom to verbalize if you suffer from it. Case law is clear that suicidal ideations are extremely impairing and may, in and of themselves, justify a 70 percent rating.
The next symptom is obsessional rituals which interfere with routine activities.
This can range from traditional OCD-like behaviors such as excessive hand washing and cleaning but can also include other hyper-vigilant behavior like triple-checking locks, doing perimeter sweeps of your home before bed, or even checking your va.gov portal 800 times a day. Those actions can be considered an obsessional ritual which is interfering with routine activities.
Another major symptom is speech which is intermittently illogical, obscure, or irrelevant. A veteran may also experience near-continuous panic or depression which affects the ability to function independently, appropriately, and effectively.
Impaired impulse control, such as unprovoked irritability with periods of violence is another symptom seen at this rating. It can also mean failing to control your impulses through things such as infidelity, risky sexual affairs, impulsive spending, or more.
Other symptoms you will experience at the 70 percent level include spatial disorientation, the neglect of personal appearance and hygiene, and difficulty adapting to stressful circumstances, including work or a work-like setting. Instead of adapting to a stressful circumstance, you may feel overwhelmed and shut down, experience a panic attack, or become irritable and angry.
And lastly, you are not able to establish and maintain effective relationships. The way we talk to clients about this is simple. How many friends do you have and how often do you see them? Or when was the last time you saw your family? At the 50 percent level, you have difficulty establishing and maintaining those relationships. At 70 percent, you have the inability to do so.
And finally, we have the 100 percent level. Please keep in mind that a 100 percent rating for mental health alone is not necessarily a great thing. Some states may have laws that impact your ability to own firearms.
Most importantly, a 100 percent level of impairment contemplates extremely severe symptomatology that renders total occupational and social impairment. Now, you can still work if you have a scheduler 100 percent rating for mental health. However, the VA considers these symptoms to be totally impairing for both social and occupational purposes.
At the 100 percent level, you have gross impairment in thought processes or communications or significant difficulty communicating and formulating thoughts. You’ll see persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting yourself or others, and intermittent or occasional inability to perform activities of daily living.
You’ll also see disorientation to time and place (i.e., you become confused as to when it is or where you are). And then you’ll also experience memory loss for names of close relatives, your occupation, or your name.
It’s important to remember that a C&P examination is not a therapy session. This is not the time to talk about your childhood trauma or how your parents treated you.
Oftentimes, C&P examiners will try and dig up unrelated nonsense from your childhood and try to pin everything you’re experiencing on that. While that is legally impermissible and easy to overturn on appeal, it’s always better to avoid the need for an appeal if at all possible.
It’s important to keep your examiner on track. There is no need to discuss childhood trauma, abuse, or mental health issues unless they have been formally diagnosed and are actually relevant to the issues at hand.
For example, if you entered service and a mental health condition was noted at the time of entrance or if you provided records of childhood mental health treatment, then the issue of childhood mental health issues is relevant in determining whether your mental health condition was aggravated by service.
But if you were never formally diagnosed, never received treatment, and never provided any treatment records from childhood, it’s best to gently remind the examiner that you’re not there to discuss your childhood and would like to focus on how your mental health condition is caused by service.
We also want to ensure you understand how to verbalize your symptoms accurately. When you go in and the doctor asks, “How do you get along with your coworkers?” you shouldn’t default to normal societal platitudes like, “Oh, fine.” Instead, you understand that that question is extremely pertinent to an accurate rating.
You should not be afraid to verbalize what is actually going on. Being honest is of paramount importance.
It is very easy for an examiner to determine when a veteran is exaggerating their symptoms. If you exaggerate, your credibility can be called into question and it’s harder to obtain an accurate rating.
However, in my years of practice, I’ve almost never had this problem with a client.
Instead, the problem I most often run into is my client not being truthful. By that, I mean they minimize their symptoms either out of embarrassment or fear of collateral consequences. I rarely, if ever, find that a client has exaggerated their symptoms, but all too often they underreport or minimize their symptoms.
Now, a VA C&P examination is not a treatment. You’re not going to end up committed, and they’re almost certainly not going to take away your gun rights or do anything other than assess your current level of functioning and disability.
The VA doesn’t want to discourage veterans from seeking treatment or pursuing their benefits. I’ve never seen a case where a veteran has left a mental health exam and had their firearms rights impacted, or ended up involuntarily committed.
Lastly, when preparing for this exam, don’t get dressed up in your Sunday best. Wear the clothes you would normally wear on a daily basis. Show up the way you show up every other day of the week.
You don’t need to shower and look good for your examiner if you don’t shower and look good every single day. Bring your spouse if you have one so they can accurately convey to the examiner what’s going on.
Now, that’s we’ve explained how each of these symptoms applies to you in lay terms, I hope that you’ll feel more comfortable being honest and forthright with your examiner. This is not the time for general niceties and societal pleasantries.
If they ask how you’re doing and you’re not doing fine, don’t say fine. Be honest. Verbalize your experience and ensure that you get the benefits you deserve as quickly as possible.
If you still have any questions about your upcoming exam, or how the VA evaluates or rates mental health, please don’t hesitate to reach out to the team at Stone Rose Law at (480) 498-8998.
