PTSD Ratings Scale Explained
Jenna Zellmer: Good afternoon and welcome to CCK Live. My name is Jenna Zellmer. I’m an attorney here at Chisholm Chisholm and Kilpatrick Practicing Veterans Law. Joining me today are Kayla D’Onofrio and Rachel Foster. Both of whom were present veterans law for VA.
Jenna: And today we are going to be talking about the PTSD rating scale and try to explain it a little bit. As always, please feel free to visit our website at cck-law.com. We have a lot of blog posts and other information on PTSD claims in general and then the rating scale as well. So let us just give you a little bit of background before we get into how VA rates PTSD.
Jenna: So PTSD is Post-Traumatic Stress Disorder. It is one of the most common disabilities among veterans. It is a mental health condition that can occur in people who have experienced or witnessed a distressing, shocking or otherwise traumatic event. So that kind of explains why it is one of the more common disabilities many veterans have come back from service having experienced these traumatic events. But the symptoms and severity of PTSD can vary from person to person and so that is why VA has this rating scale that we are going to talk about in a second. But before we get into reading, we have to establish that a veteran service connected better in a service-connected for PTSD. So we have a lot of videos on how to establish service connection. So I would encourage you to check those out on our website, but just as a brief refresher, you need a diagnosis of PTSD and that needs to be given by a medical professional. There are therapists, a psychiatrist or general practitioner. You need a verified stressor event. So like I said, PTSD is occurs in people who have experienced a traumatic event and so that is often referred to in VA as a stressor. We have a better [inaudible] all about stressors. I would encourage you to check it out. And then finally you need a medical Nexus that determines that your stressor is the cause of your PTSD and that PTSD is related to service. So some common stressors would be combat exposure, fear of hostile military [inaudible] rest activity, being a prisoner of war would count, experiencing a military sexual trauma or a car accident. I think those two are maybe the most surprising because it does not necessarily need to be something that you experience overseas or in a combat zone. It can be something that occurs to you while you’re serving in the United States or in even on base.
Jenna: So now that we’ve kind of given you a framework for service connection and common stressors. We are going to start talking a little bit about how we rates PTSD once you determine or once you establish service connection. So Kayla, can you talk a little bit about VAs rating criteria?
Kayla D’Onofrio: So VA rates PTSD on what’s called the general rating formula for mental disorders and what that basically means is that PTSD is rated on the same scale as they rate really any other mental disorder that a veteran can be service-connected for so whether it is PTSD, major depressive disorder, generalized anxiety disorder. It is all going to be rated on the same scale. Generally speaking, the more severe the symptoms are the higher the rating is going to be and VA really uses this scale in looking at the social and the occupational impairment that the disability causes. So how it affects the veterans ability to function in both social and occupational settings. The scale itself does go up incrementally again, the more severe the symptoms are the higher the rating is going to be and that scale ranges from zero to ten to thirty to fifty to seventy all the way up to 100 hundred percent. And as you kind of go up that scale, the monetary value associated with those numbers does sort of get higher. So starting with the zero percent rating, we are going to break down each of those different ratings and what is really entailed to get any one of them. So starting with the zero percent rating, this basically means that VA has acknowledged that you have the diagnosis of PTSD and that the PTSD is related to your service but the symptoms themselves are not really severe enough to interfere with your ability to function in any social or occupational setting or it does not require any continuous medication to regulate those symptoms. It is a zero percent rating which means that it is non-compensable which means that you would not have any monetary value associated with it on a monthly basis. Having said that, getting a zero percent rating can still be important. It can still open the door to other sort of benefits through VA things like Health Care treatment and it can also make increasing your rating later down the line a little bit easier. You no longer have to worry about kind of meeting that threshold for service connection. You can really focus your evidence and your arguments and really everything geared towards VA to just getting that rating up on that scale. And then we are going to move on to the ten percent rating. So at the ten percent those ratings do get a little bit more severe. Currently, the monthly compensation rate for the ten percent rating is one hundred and forty-four dollars and fourteen cents per month. So at ten percent, this is the lowest compensable rating. So it is the lowest rating that you can get while still getting paid on a monthly basis. And these symptoms for this really reflect that the symptoms are really minimal and they are well controlled. So specifically ten percent VA will define the symptomatology as occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tax only during periods of significant stress or symptoms controlled by continuous medication. So basically what that means is that the veteran is generally functioning pretty well but their symptoms do have some impact on their ability to function socially and occupationally, especially when there is a more stressful event going on.
Rachel Foster: Snoring so would be thirty percent criteria. We are still talking about an evaluation that is more on the mild side. You are going to be an increase in your monthly compensation benefits. It will increase to four hundred and forty one dollars and thirty five cents per month. Still, we are not seeing as much significant impairment in your day-to-day. So what really defines the thirty percent criteria is at the level of occupational and social impairment results in an occasional decrease in working efficiency and intermittent periods of an inability to perform occupational tasks. So the idea is kind of building on that prior evaluation. You have a diagnosed condition. You still continue to experience symptoms but they wax and wane. They don’t really persist long enough to really disrupt your day-to-day life. So otherwise, you are able to function in a satisfactory way. You are able to follow routines. You can go about your day-to-day. You are able to engage in self-care and carry on conversations as normal. So that is kind of the next highest in the more moderate level of impairment.
Jenna: Are you going to already kind of see how the difference between thirty and ten is a little nebulous? So I think you are going to prove my point in a second when you talk about the thing.
Rachel: That is so with the fifty percent evaluation, we see those symptoms a lot of overlap between the thirty percent and the ten percent. We really see them start to significantly increase and cause more disruption in the day-to-day. All to reflect that level of impairments will see the compensation on a monthly basis increases about four hundred and sixty dollars more. So if you are fifty percent rated for your PTSD, you are going to receive nine hundred and five dollars and four cents per month and the fifty percent rating criteria is marked by really an escalation and the frequency, duration and severity of the PTSD symptoms, that as I mentioned you see already from the lower evaluations with a special notice more cognitive deficits and the things that we were talking about in thirty percent where before you are able to carry on a conversation. Now you are not able to do that any longer. It is marked by circumstantial or stereotype speech. There is general distractions and how your conversating with other people. You have more of a flattened affect. So essentially that means how you present yourself to other people so you might be presenting more as blunted or not really expressive in general. You might be experiencing an increase in panic attacks, impaired memory, impaired ability to make sound decisions and choices and it is also more significantly affecting your ability to work, develop those relationships, stay on task and thin[?] essence[?] a fifty percent just reflects a reduced reliability and productivity with the occupational and social impairment.
Jenna: All right. Thanks. Then after fifty percent is seventy percent. Building off of but with both Kayla and Rachel said, it is just an increasing level of both social and occupational impairment to what VA would consider deficiencies in most areas. So if you are having deficiencies in work, school, family, relationships, judgment, thinking, or mood, that is kind of what VA is looking for at the seventy percent rating. It is really one step below completely totally disabling. So it is a significant level of impairment in both social and occupational functioning. This might be marked by symptoms like suicidal ideation, obsessive rituals, if you are checking your locks multiple times a day, if you are getting up in the middle of the night to check your locks to the fact that those obsessional recruit tools are also interfering with your routine. Speech again, building off of what Rachel had said, your speech is illogical, obscure, irrelevant and increasing panic attacks to the point where they are either near continuous or if they affect your ability to function independently. You also have even more impaired impulse control and judgment than the lower ratings and then difficulty adapting to stressful circumstances, especially in the work setting and inability to establish and maintain effective relationships. So that does not necessarily mean you do not have any relationships because that would be what we would consider totally social impairment, but maybe the relationship you have are fraught, maybe we would not be able to characterize them as effective. Sometimes we have veterans who are experiencing a seventy percent rating who their only relationships are real, are really due to their family members or their friends trying to support them rather than actually being engaged in their relationship. So this represents a wide range of symptoms. And again, it reflects the progression of the symptoms from the lower ratings. You are essentially almost always in a state of panic or depression and that affects your ability to interact both socially and occupationally. They also might be a little bit more unpredictable these symptoms than maybe if you get a fifty percent rating which is in again would be a problem if you are trying to work with these symptoms and do not know when they are going to come on. So that is a seventy reading and it would result in one thousand four hundred and forty-four dollars and seventy-one cents per month. So you can see that the increase in severity is reflected in the amount of money that you get per month.
Jenna: And then finally VA has the one hundred percent rating which is the highest possible rating you can get under PTSD. I will or really any under any of the rating schedule. I will preface this by saying that a hundred percent rating for PTSD is extremely difficult to obtain. It essentially requires like we said total impairment and an inability to function in your everyday life. And something that is really interesting is that PTSD or [inaudible] is one of the only rating schedules that contemplates social impairment. The whole purpose of the rating schedule generally is to compensate for occupational impairment and the amount that your service having a disability prevents you from working and so to require both total social and total occupational impairment, VA pays veterans three thousand one hundred and forty-six dollars and forty-two cents. So that’] is a big jump even from the seventy percent. And in order to get this rating, you are really looking for gross impairment and thought processes and communications, persistent delusions or hallucinations. So if you are seeing things, if you are hearing voices, if you have delusions that are not based in reality, grossly and inappropriate behavior, a persistent danger of hurting yourself or hurting others, so that takes it from suicidal ideation which is in seventy percent rating to an actual suicide attempt or self-harm. So you can see that escalation there and then an intermittent inability to perform the daily activities of your daily living, maintaining normal hygiene, things like that. So like I said, a hundred percent rating is extremely difficult to obtain but that doe not necessarily mean that you cannot get a total rating due to PTSD in other ways. And so Kayla, what if… Maybe talk a little bit about what the alternative to getting a hundred percent scheduler rating would be.
Kayla: Sure. So if you can show that the PTSD is severe enough to prevent you from working even if it is not rated at the one hundred percent rate, you may still qualify for getting what is called TDIU or a Total Disability rating based on Individual Unemployability and basically that benefit is to allow veterans to get that same rate as the one hundred percent compensation per month but they do not have to have that one hundred percent rating on the their combined disability rating or just for their PTSD alone. But again, you do have to show that the condition on either PTSD or a combination of your service-connected conditions is what prevents you from working. Now to qualify for TDIU, VA does have some what they call scheduler requirements for that in terms of the level of ratings themselves. So one way that you can get this scheduler requirement met is to have one service connected disability that is rated at sixty percent. So if you have PTSD rated at seventy percent, you would qualify for it. Alternatively, you can have one service connected disability that is rated at forty percent with a combined rating of seventy percent. So you have to have more than one thing service connected to meet that threshold with that combined at seventy and one at forty. So again, if you have the PTSD rated at seventy percent, you would automatically qualify for that benefit. But even if you do not meet these scheduler requirements, that does not mean that TDIU is not available for you. VA can still grant TDIU on what is called an extra scheduler basis. It is a little bit more difficult to get it that way but it is certainly not impossible. So just because you do not meet these this rating criteria does not mean that you are not eligible for TDIU necessarily.
Jenna: Yeah, and I think we have a lot of videos and a lot of information on our website about TDIU. It is a really big topic of interest. And so hopefully that is not new to anybody but it is just a reminder that even if you do not qualify for a hundred percent scheduler, you can still get that three thousand. I have to remember the exact amount, three thousand one hundred and forty-six dollars and forty-two cents. So it is the same amount of money whether or not you get a hundred percent scheduler rating or whether or not you get that TDIU rating. So Kayla, moving on, we just listed a lot of symptoms and a lot of like I said nebulous kind of distinctions between the ratings. Does the veteran have to show every single one of these symptoms or kind of how does it work practically?
Kayla: No, they do not. So basically the list of symptoms that are associated with each of those different ratings. Basically, those symptoms are really just there to serve as examples that talk about the frequency and the severity of those symptoms themselves there. It is really not meant to be an exhaustive list. You do not have to check up every single symptom that is listed under each one of those to get that particular rating. Having said that, VA does mess that up pretty frequently. They do often deny the benefit because of Veteran does not meet every single one of those different criteria but you can still argue using some case law called Mauer Hand be principie which again just says that you do not have to have every single symptom that’s listed there to get that rating. It is not an exhaustive list.
Jenna: Great. And so for example of Rachel, if a veteran had something in the thirty percent rating like depressed mood or anxiety and mild memory loss and then they also had difficulty establishing and maintaining effective work relationships or suicidal ideation, which is in the fifty percent and the seventy percent rating. What does veteran do in that situation? What should they ask for and how should VA be rating that disability?
Rachel: So with VA, their standard improve essentially is the people fee. So we see in service connection cases, if there is fifty percent of the evidence in favor of the claim, fifty percent against the claim, the benefit of the doubt supposed to go to the veteran and they should be successful at service connection. The same principle applies an increased rating evaluations. So and the scenario where you gave where they have symptoms and thirty percent evaluation and they have symptoms of the prior evaluation and the evidence is relatively equal, VA should afford the veteran the benefit of the doubt and grant them that higher evaluation.
Jenna: Great. Thanks and I think one other thing to point out is that there is another case called the Vasquez Claudio v. Shinseki and that kind of lays that out. It is not just about the symptoms of the veterans experiencing but really what it comes down to is what level of impairment they have which as we said is really hard to judge whether or not somebody has no reduced reliability or just occasional deficiencies. What do those terms mean and so it is really important for veterans to try to be as specific as possible about kind of how their symptoms affects their daily life both socially and occupationally.
Jenna: So like I said, more information can be found on our website and our blog. Kayla or Rachel, do you have any closing thoughts before we sign off?
Rachel: The only thing I was going to say it goes back to TDIU as an alternative if you do not otherwise meet that one hundred percent for your PTSD condition. Even if you do not meet the scheduler criteria with that single at least at fifteen percent and then the combined at seventy percent as Kayla had explained, even if you are in under that extra scheduler criteria, if you still feel that your PTSD warrants an increased evaluation, you can simultaneously ask for an increased evaluation for your PTSD as you are pursuing TDIU because of course there is a lot of overlap between the rating criteria and unemployability if we’re talking about occupational, social impairment and social impairment. So just wanted to throw that out there. You do not necessarily have to wait first for your rating to get up. You can work both simultaneously.
Kayla: And I would just add, there is obviously a lot of small distinguishing factors between each of these different ratings and they can be kind of hard to pull apart on your own if you are not sure whether you meet the next rating or what evidence you might want to submit to try to show that you do meet the next higher rating. Seeking help from an accredited representative can always be extremely helpful whether it is a veteran service organization, an attorney’s office, an accredited claims agent, someone can help you kind of parse out the details of those different ratings and show you the way to kind of get the next higher rating from there.
Jenna: Great and it is really good point, too. Thank you guys. Thank you for joining us today. Please do not forget to follow us on social media for all of our latest updates and check out our video library on YouTube or even find this video as well as lots of other helpful videos. Have a great day and we will see you next week.
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