By Dr. Deborah Miller, PhD, HSPP
Licensed Psychologist and Independent Examiner @ vetnexusletter.com
Navigating the Veterans Affairs (VA) disability rating system for mental health disorders can be complex. Understanding the different severity ratings assigned for mental health disorders – 0%, 30%, 50%, 70%, and 100% – and the symptoms qualifying for each level is essential for veterans seeking support. This blog post aims to demystify these ratings and provide clear insights into what each percentage level means for your mental health disability claim. I'm a psychologist who has done hundreds of VA mental health disability exams, and I'm going to share with you some tips for understanding what these severity ratings mean and how you can effectively communicate your symptoms to your C&P examiner.
First, for mental health disorders including anxiety, depression, PTSD, and eating disorders, the VA assigns only one of 5 severity ratings. You can't be rated at 60% disability for mental health, so these percentage categories are important to note based on the symptom requirements.
Second, it is important to note that veterans are especially susceptible to minimizing their mental health symptoms. It's understandable - it's likely that for years, you relied on your strength and resilience to get you through the toughest circumstances, and historically the military has not been a place where people are encouraged to admit that they need support. However, your Compensation and Pension (C&P) or independent medical examination is NOT the time or place to minimize or discount your symptoms and struggles. This is your chance to accurately describe your experience in detail so that the VA can have all the information they need to fairly decide your case - otherwise, you could end up with a denial of your claim or a lower percentage rating than warranted.
When I'm doing an independent medical exam for mental health disability cases, I usually suggest that the veteran take some time to sit down and think about their symptoms - when they first started, what seemed to bring on those symptoms, and their progression over time; confer with a friend or spouse regarding potential areas of symptoms or impacts on daily functioning that might be outside of the veteran's personal awareness, and write down some notes of details they want to make sure to share during their exam. That way, all relevant information is readily available to you in case your mind goes blank during an exam - which can easily happen, especially if you are dealing with mental health symptoms that impact your concentration, focus, and memory!
Now - let's get down to the percentage ratings. The VA C&P Examiner works with a form called a Disability Benefits Questionnaire (DBQ), which they will fill out and check the boxes for symptoms they believe you are displaying based on your exam and your medical records. Your severity rating is connected to the symptoms that are checked by the examiner on your DBQ.
Here are they symptoms that typically lead to the different severity ratings:
0% Rating
A 0% rating indicates that the VA recognizes your mental health condition as service-connected but deems it does not significantly impair your functioning or require continuous medication. Key indicators for a 0% rating include:
Diagnosis of a mental health condition.
Minimal or transient symptoms that don’t impact occupational or social functioning.
No significant impairment in social or occupational areas.
To avoid falling into this category, make sure you are providing accurate details to the examiner - again, do not MINIMIZE your symptoms and their impacts. If things aren't going well in your marriage due to your mental health symptoms - say so. Provide accurate but concise details regarding any problems you face in life based on your mental health symptoms.
Additionally - it's not necessary but it can be helpful to have your mental health diagnosis in your medical records. Even if you aren't interested in medication or therapy, mention your symptoms to your primary care physician at your next appointment so you can establish evidence of a medical history of your diagnosis for your VA claims.
30% Rating
A 30% rating is assigned when symptoms are more pronounced but not debilitating. Indicators for this rating include:
Occasional decrease in work efficiency due to symptoms.
Symptoms such as mild depression, anxiety, and other mood disturbances.
Panic attacks occurring less than weekly (again, make sure to give your examiner these details if they do not ask directly!)
Difficulty in social relationships, but still able to maintain them.
Sleep disturbances
Mild memory loss and problems with concentration
50% Rating
At this level, symptoms are more impactful, creating significant challenges but not wholly disabling. A 50% rating is characterized by:
Reduced reliability and productivity.
Regular symptoms like frequent panic attacks or significant problems with memory - this can include starting projects and forgetting to complete them; forgetting medications, appointments, and other routine behavior unless it is written on a to-do list or calendar, etc.
Difficulty in establishing and maintaining effective work and social relationships. Veterans often tell me that they prefer to be isolated - at work they may stay in their office or ask for work assignments that they can complete on their own because they have difficulty interacting with others due to irritability, depression, low energy, or other mental health symptoms.
Flattened affect: a clinical distinction usually found in depression, Parkinson's, or psychotic disorders in which a person has almost no emotional expression in their face, tone of voice, and nonverbal behaviors even when discussing highly emotional topics.
Problems with mood swings or low motivation for normal daily activities, work tasks, hobbies, or fun activities.
70% Rating
A 70% rating indicates that your mental health condition has a substantial impact on your life. Symptoms at this level include:
Impairment in most areas, such as work, family relations, judgment, thinking, or mood.
More severe symptoms like suicidal ideation, obsessive rituals (think OCD-type symptoms or obsessive rituals around safety, cleanliness, etc), or intermittent inability to perform daily living activities. This typically includes not being able to get out of bed, missing significant time at work, and feeling so down or depressed that you lacked motivation to shower, brush your teeth, or complete basic self-care tasks. We may all have days like this once in a while, so to qualify for this symptom, it has to occur fairly frequently and disturb your life in significant ways.
Significant impairment in social interactions, with deficiencies in judgment and thinking.
Continuous panic or depression that makes it hard for you to function as a productive member of society - this could look like needing a LOT of assistance from supportive family or friends to keep you on track with normal daily functioning; moving from job to job due to inability to persist because of mental health symptoms, etc.
100% Rating
A 100% rating is given when a mental health disorder completely impairs a veteran's ability to function independently. Symptoms include:
Total occupational and social impairment.
Persistent delusions or hallucinations. This is not common except in cases of severe depression or psychotic disorders such as schizophrenia, schizoaffective disorder, bipolar disorder, etc.
Danger of hurting oneself or others, persistent danger of serious self-harm. This includes suicidal ideation with plan and intention; a history of suicidal behavior or attempts; or a history of violence toward others.
"Grossly inappropriate behavior" - this is a tricky one due to vague wording and can be interpreted different ways by different clinicians. It could include a variety of extreme behaviors - in this case "grossly" just means "very" (not gross or disgusting). Very inappropriate behaviors that Veterans sometimes experience are things like violent overreactions to small inconveniences (think, road rage or confronting strangers in the grocery store, getting into bar fights, etc.); aggressive or violent behavior toward people at work or family members at home; risky or dangerous behavior; criminal behavior and defying social norms. These are just some examples and again, because this category is so broad, it really depends on the examiner to use their clinical judgment to determine if behavior is considered "grossly inappropriate."
Disorientation to time or place - This is another category that isn't immediately clear to most. Disorientation to time and place commonly occurs in severe mental health disorders such as schizophrenia or psychotic disorders; and it can commonly occur in neurocognitive disorders like Alzheimer's dementia. It's easy to see the connection here, but most veterans won't have these disorders. This can also apply in disorders like PTSD - if you're having frequent flashbacks or episodes of dissociation where you are feeling disconnected from the world around you; this can also occur in anxiety and panic disorders if you experience symptoms of depersonalization or derealization - meaning, you feel as though you are not yourself, not in your body, watching yourself from the outside; or reality feels "unreal" like you might be living in a movie, dream, or video game. These are frightening and serious conditions that clinicians could consider to indicate a "disorientation to time or place." But again, this designation is up to your examiner's clinical judgment, so the more detail you explain about such symptoms, the better.
The examples provided above are in no way an exhaustive list - but it goes to show the complexity and subjectivity involved in a C&P examiner's decisions regarding which symptoms to list when it comes to your symptom severity rating.
This is where getting an independent medical exam and DBQ can come in handy. Personally speaking, when I perform independent exams and complete DBQs for veterans to submit with their VA disability claims, I take time to ask veterans about all relevant symptoms and ask specific questions about potential areas that could qualify a veteran for higher ratings, because I know it can be very confusing to try to say the "right thing" to your examiner. When I was performing C&P exams for the VA, I was always glad to see an independent exam in the C-file because it saved me time and provided a lot of background detail that the veteran may have forgotten to mention during our exam hour. Please contact me or book a consultation if you're interested in learning more about getting an independent exam and DBQ.
Navigating Your Claim
It’s important to remember that each veteran's case is unique, and these ratings are based on the severity of symptoms and their impact on social and occupational functioning. When filing a claim, it’s essential to provide comprehensive medical evidence and detailed personal statements to accurately reflect your condition.
Conclusion
Understanding the VA’s severity ratings for mental health disorders is crucial in advocating for your needs and ensuring you receive the appropriate level of benefits. If you're unsure about your rating or need assistance, reach out to VA services or a Veterans Service Organization for guidance and support.
For more information and resources, visit VA's official website or contact your local VA office.
If you need an independent medical exam to establish your diagnosis and symptom severity, we can do that! Our clinicians have years of experience performing hundreds of VA mental health disability exams, so we understand what it takes to perform an effective exam. Visit our website for more information, to book a free consultation or email us for more information.
Disclaimer: This blog post is for informational purposes only and does not constitute legal or medical advice. For specific guidance and diagnosis, please consult with VA medical professionals.
Author:
Dr. Deborah Miller, PhD, HSPP is a licensed psychologist in Indiana who has years of experience with performing VA disability claims for the VA and directly for veterans in the form of independent medical exams. During her career she's seen a high need for high quality independent mental health exams at an affordable price for veterans seeking disability. Learn more about her at vetnexusletter.com]
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