VA Disability Benefits for PTSD and Depression

What is Post-Traumatic Stress Disorder (PTSD)?

According to the American Psychiatric Association, post-traumatic stress disorder (PTSD) is a psychiatric condition that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist attack, war/combat, rape, or other violent personal assault.  People with PTSD often have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended.  Furthermore, these individuals may relive the event through flashbacks or nightmares and cope with feelings of sadness, fear, or anger by avoiding situations that remind them of the traumatic event.

Symptoms of PTSD fall into four categories and specific symptoms can vary in severity:

1. Intrusive thoughts. Repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event.
2. Avoidance. Avoiding people, places, activities, objects, and situations that bring on distressing memories.  People with PTSD may try to avoid remembering or thinking about the traumatic event.
3. Negative thoughts and feelings. Ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); ongoing fear, horror, anger, guilt or shame; loss of interest in activities previously enjoyed; feeling detached from others.
4. Arousal and reactive symptoms. Being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being easily startled; or having problems concentrating or sleeping.

For some people, symptoms of PTSD may subside or disappear over time; however, VA’s National Center for PTSD recognizes that for many veterans, memories of their traumatic experiences can still be upsetting long after they served on active duty.  Many veterans do not even begin experiencing PTSD symptoms until decades later.

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What is Depression?

Depression is a serious mental health condition that affects the way a person thinks, feels, and acts.  Symptoms of depression tend to vary amongst individuals; however, common symptoms include the following:

• Persistent feelings of sadness, worthlessness, and hopelessness
• Lack of motivation or interest in activities that usually derive pleasure
• Difficulty sleeping and concentrating
• Change in appetite resulting in weight loss or weight gain
• Irritability
• Fatigue
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

• Persistent depressive disorder (dysthymia). Depressed mood that lasts for at least two years; marked by episodes of major depression along with periods of less severe symptoms.
• Seasonal affective disorder. Characterized by the onset of depression during the winter months, where there is less natural sunlight.  This depression generally lifts during spring and summer.
• Bipolar disorder. Someone with bipolar disorder experiences episodes of extremely low moods that meet criteria for major depression; however, a person with bipolar disorder also experiences extreme high (euphoric) moods called “mania”.

Importantly, if you or someone you know is experiencing symptoms of depression that result in suicidality, call the Veterans Crisis Line at 1-800-273-8255.

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Service Connection for PTSD and Depression

PTSD

Establishing service connection for PTSD is slightly different from the process involved in establishing service connection for depression.  To prove PTSD to VA and establish direct service connection, veterans must satisfy the following elements: (1) a current diagnosis of PTSD; (2) an in-service stressor; and (3) a medical nexus linking your current diagnosis of PTSD to the in-service stressor.  The in-service stressor requirement of service connection is what separates PTSD from other mental health conditions when seeking VA disability benefits.  A “stressor” is the traumatic event or incident that caused the veteran’s PTSD.  In some cases, veterans will have to provide VA with evidence to corroborate the reported in-service stressor.  Corroborating evidence involves evidence from a source other than the veteran, supporting the fact that the claimed in-service stressor occurred (e.g., buddy statements, military records, etc.).  However, if a veteran’s stressor is related to any of the following circumstances, they do not have to provide corroboration:

• Combat exposure
• Fear of hostile military or terrorist activity
• Prisoner of war
• Military sexual trauma

Depression

In order to establish direct service connection for depression, veterans must show evidence of the following:

• A current diagnosis of depression
• An in-service event (rather than stressor)
• A medical nexus between the depression and the in-service event

It is important to note that the in-service event can include anything that is specific to the veteran’s military service, occurring in the line of duty, or something that is unrelated to military service, but happens while the veteran is on active duty.  For example, if a veteran’s family member passes away while they are deployed and they begin to experience depression as a result, they could still receive service connection.  Again, the in-service event does not have to be military-related.  Instead, it can be any event that happens in the veteran’s life as long as they were on active duty at the time that it occurred.

How Does VA Rate PTSD and Depression?

Although the requirements for service connection are slightly different when it comes to PTSD and depression, the way VA evaluates the conditions for rating purposes is the exact same.  Specifically, 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%, and 100% using VA’s General Rating Formula for Mental Disorders (38 CFR § 4.130).  These ratings are based on the level of social and occupational impairment a condition presents.  The rating criteria for both PTSD and depression is as follows:

• 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 personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name
• 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 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; 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
• 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; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships
• 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)
• 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
• 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

GAF Scores

Previously, VA rated veterans’ mental health conditions, including PTSD and depression, using a Global Assessment of Functioning (GAF) Score.  As of August 2014, VA officially adopted the Diagnostic and Statistical Manual, Fifth Edition (DSM-5).  The DSM-5 does not feature GAF scores, therefore they are not used by VA when adjudicating claims for mental health conditions.

Will Veterans Receive Separate Disability Ratings for PTSD and Depression?

Since all mental health conditions are evaluated using the same criteria, veterans with multiple mental health conditions (in this case PTSD and depression) will likely be assigned one combined disability rating.  Similarly, veterans do not need to submit a separate claim for each mental health condition, although they are free to do so if they wish.

Veterans can only be rated for a symptom’s functional limitations once.  For example, veterans experiencing sleep impairment as a result of their PTSD and depression will only be rated for sleep impairment under the diagnostic code for one condition.  The diagnostic code for PTSD is 9411 while the diagnostic code for depression is typically 9434.  To have the same symptom considered under more than one diagnostic code is called pyramiding, which VA regulation strictly prohibits.

Hospitalization and Temporary Total Ratings for PTSD and Depression

If a veteran is hospitalized for 21 days or more due to their PTSD or depression, they may be eligible to receive a temporary total rating of 100%.  In order to qualify for a temporary hospitalization rating, veterans must be receiving treatment at a VA medical center or other VA-approved hospital.  If a veteran is assigned a temporary hospitalization rating, their effective date will be that of when continuous hospitalization began.  Benefits will continue until the last day of the month in which the veteran stopped receiving treatment for their service-connected conditions.