Veterans with PTSD often suffer from another mental health condition known as adjustment disorder. Both PTSD and chronic adjustment disorder can qualify for VA disability ratings. However, according to the VA’s “Avoidance of Pyramiding” rule, you may receive only one VA rating.
So, how can veterans benefit from multiple mental health disabilities?
If you developed adjustment disorder as a consequence of service-connected PTSD, new symptoms can be evidence of an increased severity of your overall disability. Read on to learn how the VA’s evaluation of this disorder can help you get the increased disability benefits you deserve.
Veterans can claim disability benefits for adjustment disorder in different ways:
- On its own, adjustment disorder is a ratable mental health condition;
- It can occur as a secondary service-connected disability;
- Chronic adjustment disorder is frequently an underlying symptom of PTSD and other mental disorders listed on the DSM-5 Schedule of Ratings.
Also, if these disorders prevent you from working, additional TDIU benefits may be available.
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What Is Adjustment Disorder?
Adjustment disorder is defined as emotional or behavioral responses to an identifiable stressful event that has occurred in the last three months. It is classified along with other stress-related disorders and is identified as a stress-response syndrome.
A person with adjustment disorder responds to stressful or traumatic life situations in maladjusted, negative, or exaggerated ways. These extreme reactions exceed the normal reactions one would expect and can result in significant breakdowns in life’s social, functional, and occupational aspects.
Adjustment disorders aren’t limited to military veterans. Yet military men and women are prone to these situations and have a greater risk of developing chronic adjustment disorder.
According to the Military Health System, adjustment disorder is the most commonly diagnosed mental health disorder in active duty service members.
- It accounted for nearly one-third of incident mental health diagnoses in the period from 2016 to 2020, far more than post-traumatic stress disorder, anxiety, or depressive disorders.
Chronic Adjustment Disorder Is Similar to PTSD.
Both disorders share some of the same symptoms. Like PTSD, adjustment disorder significantly impairs one’s ability to form or maintain relationships, function in social situations, and obtain and keep a job.
Even so, these two conditions are distinct from one another. While stressful events trigger both disorders, adjustment disorder is often linked to life changes or transitions and tends to be short-lived. In contrast, post-traumatic stress disorder is related to traumatic experiences that threaten life or safety.
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Symptoms of Adjustment Disorder Include:
- Feeling depressed, sad, hopeless
- Crying often
- Insomnia
- Avoiding family and friends
- Feeling overwhelmed, anxious, worried
- Reckless or impulsive behavior
- Loss of appetite
- Trouble functioning in daily activities
- Avoiding responsibilities such as working and childcare
- Panic attacks
- Social isolation
- Difficulty concentrating
- Drug or alcohol abuse
- Suicidal ideation
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How Is Adjustment Disorder Diagnosed?
The VA follows the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose, evaluate, and rate all mental disorders.
There are five diagnostic criteria for adjustment disorder:
1. The disorder might only be diagnosed if symptoms occur within three months of the identifiable stressor’s onset.
2. The clinical significance of adjustment disorder is demonstrated by one or both of the following criteria:
- Marked emotional distress that is out of proportion to what would be expected from a person who’s gone through a similar stressful event;
- There should be high levels of disturbance in social, occupational, and academic functioning.
3. The symptoms need to be related to the stressor.
4. The symptoms can’t be related to normal bereavement (grieving a loss).
5. If the stressor is removed or you begin to adjust to or cope with it, the symptoms disappear or significantly decrease after six months.
How Does the VA Evaluate Adjustment Disorder?
DSM-5 specifies six categories of adjustment disorders and the specifiers for each.
- Depressed Mood. Low mood, tearfulness, or feelings of hopelessness are predominant.
- Anxiety. Nervousness, worry, jitteriness, or separation anxiety is predominant.
- Mixed anxiety and depressed mood. A combination of depression and anxiety is predominant.
- Disturbance of conduct. Disturbance of conduct is predominant.
- Mixed disturbance of emotions and conduct. Both emotional symptoms (e.g., depression, anxiety) and a disturbance of conduct are predominant.
- Unspecified. For maladaptive reactions that are not classifiable as one of the specific subtypes of adjustment disorder.
How Can I Claim Disability Benefits for Adjustment Disorder that Is Connected to My PTSD?
The primary ways to claim benefits for adjustment disorder that is a consequence of PTSD include:
1) Claim Adjustment Disorder as an Underlying Symptom of PTSD
The VA may view your adjustment disorder to be an extending symptom attributable to your service-connected PTSD. This happens frequently because it is hard to distinguish mental disorder symptoms across several diagnoses. For instance, the VA may find you to be service-connected for PTSD with adjustment disorder. In this case, the VA does not assign a rating percentage for the adjustment disorder. However, the symptoms may be used as evidence of an increase in the severity of your service-connected PTSD disability.
2) Establish a Secondary Service Connection for Adjustment Disorder (Secondary to PTSD)
You file a secondary claim to get more disability benefits for a new disability that’s linked to a service-connected disability you already have. Let’s say you file a secondary claim because you developed an adjustment disorder caused by service-connected combat PTSD. The VA might then rate your claim, for example, as adjustment disorder with mixed anxiety and depressed mood secondary to PTSD.
3) Establish Direct Service Connection for Adjustment Disorder:
When adjustment disorder is your original disability claim, service connecting your adjustment disorder is your route. This involves filing a VA disability claim as you would for any mental health diagnosis. The VA must find a nexus (connection) between your service and your adjustment disorder. The VA will base the severity of your disorder on your total symptoms and assign a rating percentage according to the General Rating Formula for Mental Disorders, with a VA rating of 0%, 10%, 30%, 50%, 70%, or 100%.
It is important to note that, according to DSM-5 criteria, veterans can receive a VA rating for chronic adjustment disorder if their condition was caused or worsened by military service and persists longer than six months. DSM-5 refers to these cases as chronic adjustment disorders.
This may occur when the stressor is an enduring event. Examples of how adjustment disorder could continue beyond six months might be persisting unemployment, a drawn-out, contentious divorce, or grieving for a lost loved one that unduly persists.
Mental Disorder Rating Chart for Chronic Adjustment Disorder
VA rating percentages for all Mental Health disorders are the same, with the exception of eating disorders. The table below represents the General Rating Formula for Mental Disorders used for Chronic Adjustment Disorder, VA Diagnostic Code 9440.
| Chronic Adjustment Disorder | Rating |
| 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 minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name | 100% |
| 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 worklike setting); inability to establish and maintain effective relationships. | 70 |
| 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. | 50 |
| 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). | 30 |
| 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. | 10 |
| 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. | 0 |
We Can Help You Now with Your VA Disability Claim
The VA-accredited lawyers of Marc Whitehead & Associates handle compensation claims for military veterans across the U.S. with PTSD, adjustment disorder, and all other mental health conditions.
There are effective ways to increase your PTDS rating. An experienced veterans’ attorney can significantly improve these matters. We will help you verify the adjustment disorder stressor, establish nexus, develop objective medical evidence, and communicate the extent of your overall disability to the VA, ensuring your case is properly developed and presented.
Call Marc Whitehead & Associates for a free legal consultation. Ask us questions and get accurate answers. We understand how a mental condition can suddenly and unpredictably disrupt your family’s well-being and stability. We are ready to help with all aspects of your claim.
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