PTSD Rating Scale Explained
Overview of Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a mental health condition that occurs as a result of experiencing a distressing, shocking, or otherwise traumatic event. Many veterans develop PTSD from events they witnessed or experienced during their military service. PTSD can be diagnosed by a medical professional, whether it be a therapist, psychiatrist, or general practitioner. It is important to note that the symptoms and severity of PTSD can vary from person to person. However, the most common symptoms include:
- Re-experiencing the trauma through intrusive, distressing recollections of the event, flashbacks, and nightmares
- Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma
- Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered
Veterans may be eligible to receive VA disability benefits for PTSD if they experienced a traumatic event during service and now have the above-mentioned symptoms as a result. This traumatic event or incident that caused the veteran’s PTSD is known to VA as a “stressor.” Veterans can have multiple stressors, which can come in various forms.
Direct Service Connection for PTSD
To obtain direct service connection for PTSD, veterans must demonstrate the following to VA:
- 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, 5th Edition (DSM-5).
- A statement from the veteran about the stressor that occurred during service: 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, supporting the claim that the in-service stressor occurred. Such evidence can include buddy statements, military records, newspaper articles, police reports, and more.
- A medical opinion that the stressor was sufficient enough to cause PTSD from a VA psychologist/psychiatrist, or a psychologist/psychiatrist under contract with VA: 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 (i.e., combat exposure, fear of hostile military or terrorist activity, prisoner of war, or military sexual trauma). 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.
Once a veteran’s PTSD is service-connected, VA rates this condition under 38 CFR § 4.130, Diagnostic Code 9411.
How VA Rates PTSD and Other Mental Health Conditions
Aside from eating disorders, VA rates all mental health conditions using the same diagnostic criteria. Mental health conditions are rated at 0, 10, 30, 50, 70, or 100 percent using VA’s General Rating Formula for Mental Disorders. These ratings are based on the level of social and occupational impairment a condition presents. However, each disability rating presents its own diagnostic criteria and requirements.
10% PTSD Disability Rating
A 10 percent on the PTSD rating scale is the lowest compensable rating offered by VA’s rating criteria for mental disorders. As such, the rating criteria reflects very minimal and often well-controlled symptomatology. When assigning a 10 percent PTSD rating, VA will look for:
- “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.”
In this case, a veteran may experience certain PTSD symptoms that are exacerbated during periods of stress, but ultimately do not impair their ability to work in most occupations. Furthermore, the increase in severity of PTSD symptoms during periods of stress implies that the symptoms tend to be episodic otherwise. This means that they are not always present and therefore do not significantly interfere with occupational and social functioning. Moreover, when symptoms are present, it is likely that they can be managed with treatment or medication. Overall, a 10 percent rating on the PTSD rating scale reflects a low level of disability.
30% PTSD Disability Rating
Again, each rating under the General Rating Formula for Mental Disorders has specific criteria that a veteran must meet in order to receive that evaluation. The criteria for a 30 percent rating on the PTSD rating scale are as follows:
- “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).”
The criteria for a 30 percent PTSD rating outlined above are meant to represent mild PTSD symptomatology. In this case, “occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks” might mean that you are starting to periodically miss work due to your lack of motivation associated with PTSD. However, your PTSD does not fully prevent you from performing and succeeding in a work environment.
Furthermore, you may experience symptoms such as depressed mood, anxiety, and panic attacks. This may cause you to occasionally isolate yourself but does not completely prohibit you from maintaining your relationships with others. Overall, a 30 percent PTSD rating is assigned when a veteran demonstrates these symptoms in a mild manner, intermittently over time.
50% PTSD Disability Rating
The criterion for on the PTSD rating scale for a 50 percent disability rating under 38 CFR § 4.130, Diagnostic Code 9411, is as follows:
- “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.”
The 50 percent PTSD rating criteria involve an escalation in the frequency, duration, and severity of PTSD symptoms from lower ratings, and also includes several additional symptoms If you receive a 50 percent PTSD rating, it is likely that you 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. The overall 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.
70% PTSD Disability Rating
A 70 percent PTSD disability rating is one step below the highest schedular rating for the condition. Many veterans receive a 70 percent PTSD rating because their symptoms cause significant levels of impairment, both occupationally and socially. This rating is typically assigned to veterans with PTSD symptoms that are one step below totally disabling. The criteria for a 70 percent on the PTSD rating scale are as follows:
- “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 work-like setting); inability to establish and maintain effective relationships.”
The 70 percent disability rating criteria for PTSD are the most inclusive insofar as they represent a wide array of symptoms. Furthermore, they also reflect a progression of the symptoms included in the lower disability ratings. Namely, a veteran who receives a 70 percent PTSD rating suffers from all the symptoms included in the 50 percent rating, but at a higher frequency, severity, and duration. Here, the veteran is almost always in a state of panic or depression that affects their ability to interact with others.
The veteran may also have trouble controlling their emotions in a way that leads to violent outbursts or conflict with others. The level of occupational and social impairment may be evidenced by the veteran’s inability to hold down a job or complete classes for school. Additionally, a veteran may engage in obsessional rituals such as checking the locks on their doors multiple times throughout the course of a day as a result of being hypervigilant.
100% PTSD Disability Rating
A 100 percent PTSD rating is often difficult to obtain from VA because it requires a veteran’s symptoms to be so severe that they are totally impaired and unable to function in everyday life. While the symptoms listed in the 70 percent rating criteria involve a high level of impairment, the jump to 100 percent remains significant. The criteria for a 100 percent PTSD rating are as follows:
- “Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communications; 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.”
The above-mentioned symptoms represent a substantial decline in cognitive and emotional functioning as compared to the rating criteria for lower percentages. Importantly, this decline results in a total impairment when it comes to a veteran’s work life and personal life. Specifically, a veteran may experience hearing voices or perceiving things that are not actually present. Self-injurious behaviors and suicide attempts are also consistent with a 100 percent rating.
In addition to this suicidality, a 100 percent on the PTSD rating scale also includes homicidal ideation in which a veteran might have thoughts of harming others. An intermittent inability to perform activities of daily living can involve a veteran feeling too depressed to get out of bed, take a shower, or change clothes. All of these symptoms and behaviors are consistent with the highest level of impairment reflected by the rating criterion.
Do Veterans Need to Have All of the Symptoms Listed to Receive a PTSD Rating?
As mentioned above, the General Rating Formula for Mental Disorders includes a large number of symptoms for each disability rating. Importantly, a veteran does not need to exhibit all of these symptoms in order to qualify for a specific rating. For example, a veteran who only experiences suicidal ideation and near-continuous panic or depression still falls under the 70 percent PTSD disability rating according to VA law. Specifically, the Court of Appeals for Veterans Claims case, Mauerhan v. Principi, established that the symptoms listed in Diagnostic Code 9411 (PTSD) are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating. Therefore, a veteran can have any number of the symptoms listed in the rating criteria and still meet that level of evaluation.
What if Your Symptoms Are Consistent with More Than One PTSD Rating?
Since PTSD is a complex condition and many of the symptoms within the rating criteria overlap, you may not fall completely into one percentage category. For example, you may experience mild memory loss in addition to impaired judgment and flattened affect, meaning your symptoms are consistent with both a 30 percent and a 50 percent rating on the PTSD rating scale. Since it is not possible to split the difference between the two ratings, VA must choose one to award. In these cases, VA should award the higher rating based on 38 CFR § 4.7. Specifically, when there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability more clearly meets the criteria required for that rating.
Total Disability Based on Individual Unemployability (TDIU) Based on PTSD
Importantly, if your PTSD significantly impairs your ability to work, you may be eligible for a total disability rating based on individual unemployability (TDIU) – a VA benefit that allows veterans to receive compensation at the 100 percent rate if their service-connected condition(s) prevent them from securing and maintaining substantially gainful employment.
There are two ways veterans can qualify for TDIU based on their PTSD under VA’s regulation 38 CFR § 4.16: schedular and extraschedular. In order to be eligible for schedular TDIU:
- Your PTSD must be rated at 60 percent or higher on its own; or
- You must have a combined rating of 70 percent or higher when your PTSD is taken together with other service-connected conditions and at least one of those conditions is rated at 40 percent or higher on its own
If you do not meet the eligibility requirements listed above, but you are unemployable due to your PTSD, you may qualify for TDIU on an extraschedular basis. In both cases, you must show that your PTSD (along with your other service-connected conditions, if applicable) contribute to your inability to work.
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