Automatic 50% PTSD Rating
Post-traumatic Stress Disorder (PTSD) Explained
Typically, one does not hear of automatic 50 percent VA ratings, but the concept does exist in VA law. First, let’s understand PTSD and how VA rates it.
According to the American Psychiatric Association (APA), post-traumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape, or who have been threatened with death, sexual violence, or serious injury.
PTSD has been referred to by many names throughout history, including “shell shock” during the years of World War I and “combat fatigue” after World War II. Nonetheless, the symptoms of PTSD have remained consistent over the years. PTSD symptoms are divided into the following four categories and can range greatly with regard to severity:
- Intrusion – intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
- Avoidance – avoiding reminders of the traumatic event may include avoiding people, places, activities, objects, and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
- Alterations in cognition and mood – inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming oneself or others; ongoing fear, horror, anger, guilt or shame; decreased interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (i.e., a void of happiness or satisfaction).
- Alterations in arousal and reactivity – arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive manner; being overly watchful of one’s surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.
PTSD can be either short-term or chronic depending on the individual and the circumstances. Regardless, the main treatments for people with PTSD are medications (e.g., antidepressants), psychotherapy (i.e., talk therapy), or both.
Service Connection for PTSD
To prove PTSD to VA and establish direct service connection, veterans must satisfy the following elements:
A Current Diagnosis of PTSD
It is important to note that veterans will not be eligible to receive VA disability benefits if they are not currently diagnosed with PTSD. For service connection purposes, VA requires a formal diagnosis from a qualified healthcare professional, whether it be a therapist, psychiatrist, or general practitioner, made using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
In-Service Stressor
The traumatic event or incident that caused the veteran’s PTSD is known as a “stressor.” Generally speaking, the occurrence of the stressor should be consistent with the circumstances of the veteran’s service. In some cases, veterans will have to provide VA with evidence to corroborate the reported stressor. Corroborating evidence involves evidence from a source other than the veteran which supports the fact that the claimed in-service stressor occurred. Such evidence can include buddy statements, military records, newspaper articles, police reports, and more. However, there are also circumstances in which veterans do not have to provide stressor corroboration, including combat exposure, fear of hostile military or terrorist activity, prisoner of war, and military sexual trauma.
Medical Nexus
The last step in proving PTSD to VA involves establishing a medical nexus (i.e., link) between your PTSD and the in-service stressor. Importantly, a medical nexus is not required in cases where PTSD is presumed to be connected to your service as described above. However, when a medical nexus is necessary, it must demonstrate that your PTSD is at least as likely as not related to your in-service stressor. VA will likely obtain a medical opinion regarding this nexus, but it is important to note that you are able to seek an outside opinion from a psychological expert as well.
How VA Rates PTSD
Once service-connected for PTSD, VA will assign a disability rating. In doing so, VA will consider the frequency, duration, and severity of your symptoms along with the resulting level of social and occupational impairment. In other words, your disability rating reflects how you are affected in both your personal life and your work life. Generally, the more severe your symptoms are, the higher your disability rating.
To determine your disability rating for PTSD, VA uses the General Rating Formula for Mental Disorders. This rating scale ranges from 0 percent to 100 percent with in-between ratings of 10, 30, 50, and 70 percent. Each rating under the General Rating Formula for Mental Disorders has specific criteria that a veteran must meet in order to receive that evaluation.
What is an Automatic 50 Percent PTSD Rating?
Many veterans are under the impression that they can receive an automatic PTSD rating of 50 percent. Unfortunately, this notion is not entirely accurate as there are specific circumstances under which the automatic 50% rating applies.
According to VA regulation titled 38 CFR § 4.129, “when a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran’s release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran’s discharge to determine whether a change in evaluation is warranted.” In other words, an automatic 50% disability rating will only be granted to veterans with PTSD if they were discharged from military service as a result of their PTSD.
Furthermore, this automatic 50 % disability rating only lasts for six months at which point the condition will be re-evaluated. While it is possible that the Veteran’s automatic 50% disability rating will continue, it is also possible that the rating will be reduced. To establish a 50 percent rating for PTSD outside of the automatic qualifier, veterans must demonstrate the following:
- 50% – “Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circulatory, 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.
If a veteran receives a 50 percent PTSD rating under typical circumstances, it is likely that they are beginning to display more noticeable cognitive deficits such as difficulty following instructions or making decisions that depart from past behavior.
Additionally, some of the mood-associated symptomology including depression and anxiety may begin to manifest in physiological ways, such as a flattened affect. In other words, due to feelings of depression, you might speak in a monotonous tone and lack facial expressions. Again, the level of occupational and social impairment also increases as part of the 50 percent PTSD rating. Here, the symptoms mentioned above cause a decrease in your ability to efficiently complete work-related tasks.
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