VA Disability Rating for PTSD: The PTSD Rating Scale Guide
VA Disability Ratings for Post-Traumatic Stress Disorder (PTSD)
If you are living with post-traumatic stress disorder caused by military service, you may be entitled to VA disability compensation for this condition. The process of obtaining service-connected disability benefits, however, can be stressful and take years to navigate. The accredited VA disability attorneys from Chisholm Chisholm & Kilpatrick LTD can help veterans file claims for compensation based on their post-traumatic stress disorder (PTSD).
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 symptoms, like those mentioned above, 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. For example, stressors may include exposure to great peril such as death or injury, the threat of great peril, or sexual trauma or threats of sexual trauma.
How Can I Qualify for VA Benefits for PTSD? Direct Service Connection for PTSD
Navigating the VA disability process can be difficult, and you will need to build a compelling case to have the best chance of obtaining the benefits you need. As your veterans disability advocates, we gather substantial evidence on your behalf to build a strong case that supports the maximum amount of benefits to which you are entitled.
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.
Compensation and Pension (C&P) Examinations for PTSD
As discussed above, veterans must show a link between their PTSD and military service in order to receive disability compensation. When it comes to establishing a medical nexus opinion, VA will likely order a Compensation and Pension examination (C&P exam) to evaluate the veteran’s symptoms and the severity of their condition. The doctor will then determine whether the veteran’s PTSD is “at least as likely as not” related to their military service. During a C&P exam for PTSD, the medical examiner may complete a Disability Benefits Questionnaire (DBQ).
A DBQ uses checkboxes and standardized language so that the disability evaluation can be made quickly and correctly. Specifically, healthcare providers will “check a box” next to a description that most accurately depicts the disability in question – in this case, PTSD. However, it is important to note that a DBQ will not be used if the veteran is undergoing an initial PTSD evaluation.
Diagnosing PTSD during a C&P Exam
VA uses criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) to evaluate whether there is a valid diagnosis of PTSD. This diagnostic criteria section of the DBQ is broken down into six categories (Criteria A-F). The subsequent section lists additional symptoms related to PTSD. Assuming a veteran meets all the criteria from the DSM-V necessary for a PTSD diagnosis, the symptoms section of the DBQ will then help determine an appropriate disability evaluation.
Another important section of the DBQ addresses the veteran’s level of occupational and social impairment. Here, the level of impairment due to PTSD ranges from no diagnosis to total occupational and social impairment, with various levels in between. Veterans should be honest and forthcoming about how their PTSD affects their everyday life. Doing so will further help the examiner see the full extent of the condition.
How VA Rates PTSD for VA Disability
After the C&P exam is complete, VA adjudicators will review it along with all the other evidence in the veteran’s claims file. Once a veteran’s PTSD is service-connected, VA rates this condition under 38 CFR § 4.130, Diagnostic Code 9411, the Schedule of Ratings for Mental Disorders.
VA then assigns a disability rating ranging from 0 to 100 percent with in-between ratings of 10, 30, 50, and 70 percent. These ratings are based on the level of social and occupational impairment, as well as the frequency, duration, and severity of symptoms.
0% PTSD Rating
A 0 percent PTSD rating is the lowest possible rating on the PTSD rating scale. This rating will be assigned when:
- “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.”
Importantly, 0 percent ratings are non-compensable, meaning the veterans will not receive VA disability compensation for a 0 percent PTSD rating. However, veterans can be eligible for other benefits from VA with a non-compensable rating.
10% PTSD Disability Rating
A 10 percent PTSD rating 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 symptomology. When assigning a 10 percent PTSD rating, VA will look for the following:
- “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 symptoms are not always present and therefore do not significantly interfere with occupational and social functioning. Moreover, when symptoms are present, it is likely that you can control them with treatment or medication.
30% PTSD Disability Rating
Again, each rating under the General Rating Formula for Mental Disorders outlines 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 a 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 as reflected by the rating scale.
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 every symptom named in the PTSD rating scale 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.
Is PTSD an Automatic 50% Rating?
Many veterans are under the impression that they can receive an automatic PTSD rating of 50 percent. Unfortunately, this is not entirely accurate as there are specific circumstances under which the automatic 50 percent 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 percent rating will only be granted to veterans if they were discharged from military service due to their PTSD.
Additionally, this automatic 50 percent disability rating will only last for six months following the veteran’s separation from service. After six months have passed, VA will conduct a new PTSD evaluation to determine the veteran’s current condition. While it is possible that the veteran will again be assigned a 50 percent rating for their PTSD, it is also possible that the rating will be reduced.
What is the Average VA Disability Rating for PTSD?
On average, most veterans who receive VA disability for their service-connected PTSD are rated at the 70 percent level. Per VA’s rating criteria, a 70 percent PTSD rating reflects impairment in most areas such as, work, school, family relations, judgment, thinking, and mood.
This PTSD rating also lists several symptoms that affect occupational and social function. A veteran with a 70 percent disability rating for PTSD may be struggling to find or maintain employment. In such cases, it may be beneficial for the veterans to file a claim for total disability based on individual unemployability.
VA Unemployability (TDIU) for 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.
How Much VA Disability Compensation Can I Receive for PTSD?
The amount you receive in monthly benefits depends on the disability rating assigned for your PTSD. Each disability rating percentage increment on VA’s rating schedule corresponds to a different monthly benefit amount. The higher the disability rating, the more a veteran receives in monthly compensation.
As of December 1st, 2020 the VA disability rate benefit amounts are as follows:
- 0 percent disability rating: $0.00 per month
- 10 percent disability rating: $144.14 per month
- 30 percent disability rating: $441.35 per month
- 50 percent disability rating: $905.04 per month
- 70 percent disability rating: $1,444.71 per month
- 100 percent disability rating: $3,146.42 per month
Additional Benefits for Dependents
Veterans with conditions rated at least 30 percent disabling can qualify to receive additional benefits for dependents in their household, such as a spouse, child, or dependent parent. For example, if a veteran has a 100 percent disability rating with a dependent spouse, they can receive additional compensation.
Need Help with Your PTSD VA Disability Claim or Appeal?
VA is a large, bureaucratic administration not known for efficiency or transparency, and the decisions it makes are not always correct. Many veterans with legitimate service-related medical conditions are denied the first time they apply for benefits.
If you receive a denial, the appeals process can be lengthy and difficult. The accredited VA disability attorneys at Chisholm Chisholm & Kilpatrick LTD can assist you with the appeals process. With over 30 years of experience representing veterans, we have the knowledge and expertise to deal with the VA and its complexities.
The consultation is always free, so call our office today at 800-544-9144 to see if we can assist you.
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