VA Disability For Depression & Anxiety
Emma Peterson: Good afternoon and welcome to CCK Facebook live at home. Today we’re going to be talking about depression and anxiety, before we dive in that we do want to know if you are a veteran or a family member of a veteran, a friend and are experiencing crisis, please reach out and call the veterans crisis line at 1-800-273-8255 and press one. This is not just for veterans who are having a mental health crisis, but really any life crisis they can get you assistance and point you in the right direction again that’s for veterans or friends or family members of veterans.
With that, I just want to a quick moment to introduce ourselves. I’m Emma Peterson and today I’m joined with Bethany Cook and with Nicholas Briggs, and we’re going to be talking like I said about depression and anxiety. Depression is probably the most one of the second most common service-connected mental health disorder among veterans. So we wanted to talk a little bit about how you go about getting service connected and how about the egos about rating that disability.
So Nick how would a veteran establish service connection for depression or anxiety?
Nick Briggs: As always there are three basic elements to service connection. First and foremost the veteran needs to have a current diagnosis of the condition. Then there needs to be some kind of in-service event the seizure injury and then there needs to be medical evidence linking that too. So oftentimes we see situations where a veteran is diagnosed with depression and anxiety, but they’re still, they still need to establish that the condition is related to something that happened in their service that can come through a number of different ways that we’ll talk about later, but one of the most important distinctions is that it doesn’t need to involve a stressor. One of the more common mental health disabilities that we see as post-traumatic stress disorder and in those situations VA requires credible evidence of the stressor that incurred in service, but a stressor isn’t required to establish service connection for depression, we’re really talking about any specific psychological symptoms that manifested during the veteran service that they still experience now.
Emma: So what are some examples you mentioned the three elements, one of which being in service and currents. What are some examples of in-service causes of depression or anxiety. Is it have to be due to service or due to a military activity?
Nick: No, absolutely not. It just needs to have happened during service. Again there are some situations where there might be a stressor that depression and anxiety could be related to, but often times we see that a veteran is experiencing problems that aren’t directly related to the military that still affects their functioning during service. For example, if the veteran is deployed to another country and they’re experiencing problems with their family at home they might become depressed and anxious over their inability to do anything to help their family while they’re stationed abroad. So even if the factors causing their symptoms and service are in and of themselves related to that service as long as the symptoms manifested during their period of active duty there still a means through which they can get service connection granted.
Emma: Now what if your depression was caused by let’s say your service connected for a really bad back disability, you know, you’re in constant pain, you can’t walk and that needs to depression. Is that something that veterans can file for service connection?
Nick: Absolutely. That’s what’s called secondary service connection where the underlying service-connected condition that’s causing the depression basically serves as a placeholder for the typical in service and currents. So as long as there’s some kind of medical and lay evidence supporting their connection between the hypothetical veterans severe back disability and their depression arising from maybe their inability to do activities the day they used to enjoy, things like that. That’s certainly a means through which service connection can be granted it as well.
Emma: Now sometimes you might not know, you know what condition you exactly have. I know we have a lot of clients and there are a lot of folks out there who might be diagnosed with multiple conditions, sometimes depression anxiety go hand-in-hand. Do you have to file claims for both, can you just file generally, you know if you have two conditions, so I have to get to claims going. What can a veteran do if they won, don’t know what they have or too they’ve got a lot of different diagnoses in their record.
Nick: For sure, obviously veterans typically aren’t you know qualified psychological experts. So from a certain perspective, they’re not going to know what their exact diagnosis is. All they can really test who are the symptoms that they experience and how they affect them and because of that VA has a duty to liberally construe a veteran’s claim. This was covered in the courts Clemens decision, which basically says even if the veterans files a service connection claim for a particular disability like PTSD, if there are other psychological diagnosis of record, the board is still required to consider whether or not those diagnoses are related to service even if the one is veterans specifically cleaned isn’t shown in the medical evidence.
Emma: Okay does VA you know, diagnose or evaluate, how do they go about diagnosing and evaluate the severity of a veterans, you know depression or anxiety?
Nick: Sure so from a diagnostic perspective, they rely on the DSM-5. So for PTSD there’s obviously the criteria requiring a stressor that’s criterion A, but major depressive disorder other depressive disorders and other anxiety disorders, all have their own separate diagnostic criteria and as long as the veterans particular symptoms meet the frequency and duration requirements outlined for those conditions in the DSM, they can still be diagnosed with those conditions and then from there once the diagnosis reached, VA will apply what’s called the general formula for rating mental health conditions, which will go into more detail on obviously.
Emma: All right. So Bethany we’ve gotten service connection for our veteran for depression or anxiety. How does VA go about using that general rating criteria that Nick does talked about, how they go about doing that and assigning a rating for a veteran with one of these mental health conditions?
Bethany Cook :Sure! So like Nick said how the VA rates depression and anxiety is using the general rating formula for mental health conditions. This is the rating criteria that the VA uses for all mental health conditions. The ratings range from 0, 10, 30, 50, 70 or a hundred percent and the VA basis these ratings on the occupational and social impairment that the conditions costs. So the VA’s going to assign a rating based on the severity. The 0% rating is the least severe. If the VA awards is 0% rating, they’re saying that the veteran has a diagnosis that the condition is due to service and the condition is due to service but the symptoms don’t impaired social or occupational functioning at all or require any medication. So a 0% rating of course as long isn’t going to result in any compensation for the veteran and then moving from there, the 10% rating is the next least severe. So with a 10% rating the symptoms of depression and or anxiety or mild periods of high stress might cause minor, social or occupational impairment, but essentially the VA saying the condition isn’t severe enough to cause any major occupational or social impairment. So it goes at that point from 30% to 50%, the 30% is just a step above 10%. The symptoms might be a little bit more severe but the VA is still saying that the condition doesn’t cause major occupational or social impairment and the 50% rating is where the VA saying that as a condition has causes regular impairment of work or social skills. So with a 50% rating, a veteran might still be able to work, but the condition is causing some impairment.
The next type of rating is the 70% rating. This is where of the rating criteria says that the condition is causing an impairment in most areas such as work, school, social relationships, judgment thinking and or mood. The symptoms that 70% greeting might manifest with would be suicidal ideation, obsessional rituals that interfere with routine activities near continuous panic and or depression and these symptoms are causing interference and independent functioning. So a 70 percent rating is still not the most severe even though it is causing impairment in most areas. The highest rating is a hundred percent rating and that’s what the VA is saying. The commission is causing a total occupational and social environment. So based on the rating criteria, a veteran who has a hundred percent disability rating, the VA is saying that you know they wouldn’t essentially not be able to have any kinds of social relationships or be able to function in a work environment.
How the rating criteria works is beyond just how the VA is saying what level of social and occupational impairment the condition causes. Each rating criteria also includes a list of symptoms that their rating kind of correlates with, but there is a case law it’s also in the VA’s regulations that the list of symptoms are not exhaustive. So it’s more other be able rate disabilities as what rating would best approximate the severity of the veterans disability.
Emma: Now, I must make a quick commentary here on that 0% criteria because this is always bothered me and I hope it bothers you, you neck but for those criteria for diagnosing someone with anxiety or depression. One of the criteria is that it causes clinically significant distress, I believe I’m using the right term or something along those lines. So in my opinion, I’m not quite sure how you have a diagnosis and it’s not causing you any impairment whatsoever at all, but that’s just me. I would certainly suggest that you reach out to a veteran service organization an accredited representative or attorney, whoever you’re working with on your claim if you do get credit service connection for one of these conditions and are assigned a zero percent rating, but that’s just my two cents on the issue. All right moving right along, Nick if I have two conditions like we talked about I’ve got depression and anxiety. Is VA going to award me two ratings, am I going to get you know a 30% for my depression and a 30% for my anxiety, how does that work?
Nick: So like we talked about at the beginning VA uses for most mental health disabilities a general formula and because the formula is meant to apply to all sorts of different diagnoses, you’re not going to get separate ratings for depression on the one hand and anxiety on the other, rather you’re going to get a single disability rating under the formula that accommodates and considers all of your particular symptoms. If you look back at the 30% criteria that Bethany mentioned you’ll see both depressed mood, anxiety and panic attacks listed under the same part of the rating schedule. So it’s not a matter of getting separate ratings for each condition is really a matter of figuring out what the severity of those symptoms are and then from there determining what the rating should be based off of the occupational and social impairment they caused. That’s not to say that there aren’t certain mental health conditions that can be rated separately. VA does have a separate set of criteria for eating disorders specifically. So there are certain circumstances where there might be separate rating involved, but they’re pretty few and far between for the most part of the conditions are going to be rated together.
Emma: Now Bethany what if depression and anxiety prevent you from working what happens then?
Bethany:Yep, so I you might have noticed when I was talking about the rating criteria that how the VA is thinking when they are kind of defining the different rating themselves is talking about occupational and social impairment. So the hundred percent rating was total, social and occupational impairment and it might be difficult to show that. So a veteran’s depression and anxiety could be extremely severe but only get the 70 percent rating because maybe they’re still able to kind of have have social relationships. So that’s where you can apply for a different benefit. So with the total disability rating based on individual unemployability, shortening TDIU, that’s the benefit that gets the veteran compensated out the 100% rate if they are unable to work obtain substantial gainful employment due to their service connected disabilities. So in theory a veteran could you know be maybe they’re underrated at 30% or 50% but if they can show that they’re unable to work due to their depression and anxiety, even if it is pretty a little rated, TDI you would be in an alternative way to get compensated up the 100% rate with a 70% rating based on the severity of those symptoms, it’s a little bit, it’s it can be a little bit more kind of straightforward obtaining the TDIU benefit based on the requirements for TDIU, but it is an option for a veteran to get compensated at the 100% rate even if their disability isn’t rated up at 100%.
Emma: Now what is some evidence, you know, both Bethany and Nick practice at our agency is accredited reps. What are some evidence that is helpful for our veterans that are seeking depression and anxiety a service connection or an increased rating. What’s some evidence that you all look for and try to develop?
Nick: So one of the most important go ahead Bethany.
Bethany:I was just going to say medical evidence. That’s probably the one of the most important how the VA will often rate disabilities is based on their VA compensation and pension exams. So having your private medical records or on your records from your treating physicians at the VA Medical Center’s, that can be a way to kind of show that the severity that your condition manifest with on a daily basis.
Nick: Absolutely, in addition to that we often find many of the veterans that we work with and represent don’t treat as often as other veterans do for whatever reason. Oftentimes they might be isolating and living in remote areas that make it difficult to seek treatment regularly and for that reason in addition to the usual medical evidence that you can get from treating doctor. We also like to gather lay evidence from both the veteran themselves as well as any family members or friends that know them and know how their symptoms affect them on a day-to-day basis because oftentimes like Bethany mentioned, VA’s going to rate the condition based solely off of the four corners of the VA examination, but oftentimes the veteran might be downplaying or otherwise failing to report certain symptoms at the time of the VA exam and at the end of the day that’s just a single snapshot of the veterans functioning during that particular examination on that particular day. So any evidence that you can provide from friends and family regarding your functioning over the course of months or years is going to go a long way in making sure that VA rates your condition properly.
Emma: And piggybacking off of what Nick said the friends and family lay statements are very important because you know, this stuff can be hard to talk about with a stranger and a VA exam that you know, you’ve never seen before. They’re not there to treat you necessarily and so opening up about these very personal issues is not an easy thing to do. So having a statement from your spouse, a sibling, a parent whoever’s in your life, you know, your neighbor who sees you and can provide a really clear accurate picture of what your symptoms are like and how it impairs you day to day can be really helpful and often provide a more realistic picture of what’s going on rather than as Nick’s said a snapshot of you know, how we were with a stranger for a few minutes in an exam room on one day. Do you all have any closing tips or thoughts for folks out there that are listening to this broadcast?
Nick: It’s worth keeping in mind that just like with other service-connected disabilities getting that 100% rating or getting TDIU might not necessarily be the end of the question or all of the benefits that you could be entitled to. There are certain situations where the veteran might need the aid and attendance of another person either because there are threats of themselves, a threat to others or because they need the assistance from another person to do even some of the most base activities like bathing and dressing and in those situations would be worth considering pursuing special monthly compensation. So there’s always that additional benefit to keep in mind if you think that your condition is even more severe than TDIU or 100% rating by encompass.
Emma: Bethany, any closing thoughts or tips?
Bethany:I would just echo I think you said it earlier Emma that if you believe that the VA did under rate. If you got service connection, you did believe that the VA is under rating your psychiatric disability that can be a really good time to seek representation. Whether it be with a with a VSO or with a private law firm to assist you in getting the evidence that you need to combat the rating that the VA has assigned or as well as in assisting you and obtaining a higher benefit like TDIU or SMC as an extent.
Emma: Great! So one more time, I’m just going to tell you all the Veterans Crisis Line in case anyone needs it. It’s 1-800-273-8255. Again, that’s for you as a veteran or if you are a friend or a family member of a veteran that’s in crisis. Please reach out to them and then would be happy to assist you in whatever way they can if you have any questions or thoughts about our facebook live today please feel free to post them in the comments, and we will try to get back to you just as soon as we can. In the meantime feel free to check out our website at cck-law.com look at our blog we have a lot further and more in-depth discussion about these various mental health disabilities, but with that we are going to sign off. Once again I’m Emma Peterson joined today by Nicholas Briggs and Bethany Cook and thank you for joining us for another episode of CCK Live.
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