Posttraumatic stress disorder (PTSD) is often rated at a level that fails to reflect your actual disabilities and extent or stage of impairment. These and other issues make it very hard for you to get a handle on your PTSD rating.
A prevalent disability among U.S. service members, PTSD claims are hard fought battles for fair ratings to cover the life-altering symptoms the veteran suffers each and every day.
Swift and just compensation for PTSD is your right. It is important to fight for your benefits, and we are here to assist at a moment’s notice.
Generally, VA disability ratings represent service-connected injuries, illnesses or disabilities that affect your quality of life after leaving the military. Each disabling condition is given a percentage. Using a system of math calculations, VA combines multiple disability ratings into one overall score.
This is also true for PTSD claims, yet these evaluations are more complicated for a couple of reasons.
How VA Evaluates PTSD for Disability Compensation
First: the VA relies on two different sources when assessing a claim for PTSD, the first of which is an outside source:
- DSM-5: Required criteria for VA’s diagnosis of PTSD is found in the manual, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This is the authority for psychiatric diagnosis and research published by the American Psychiatric Association. You must have a subscription to be able to view the manual online.
- VA’s official rating schedule in the Code of Federal Regulations: You will find this online in 38 CFR § 4.130 – Schedule of ratings – Mental disorders.
Second: As of 2013, PTSD has been assigned to a new chapter and category within DSM-5 called Trauma- and Stressor-Related Disorders. Previously PTSD was categorized under “Anxiety disorders.”
NOTE: The DSM manual has progressively updated PTSD diagnosis criteria. DSM-III introduced the diagnosis of PTSD in 1980 with clear diagnostic criteria. Further updates to PTSD diagnostic criteria followed in various editions to reflect continuing research—the most current being DSM-5 released in 2013. The VA officially adopted the DSM-5 in August 2014.
GAF Scores No Longer Used
Before August 2014, the VA used the Global Assessment of Functioning (GAF) Score to rate PTSD and other veterans’ mental health disabilities. As of August 2014, VA adopted the DSM-5 which does not use GAF scores.
So, PTSD disability claims received by VA or that were pending VA review on or after August 4, 2014, will be evaluated under DSM-5 diagnostic criteria and rated according to CFR 38 § 4.130.
Presumption of Direct Service Connection – PTSD
Your service connection for posttraumatic stress disorder is presumed when the following events are met:
- Medical evidence of PTSD diagnosis;
- a link (nexus), established by medical evidence, between current symptoms and an in-service stressor; and
- credible supporting evidence that the claimed in-service stressor occurred.
Proving nexus is a very tough task, especially when the stressor event is often undocumented and seemingly unprovable. To help in this area, the VA has made provisions where, under the right circumstances, you may not need to prove the actual event from written military records, but in other ways such as lay testimony and other sources.
Compensation and Pension (C&P) Exams for PTSD
The above background is important because the veteran will be asked to attend a C&P evaluation to decide whether you have a valid diagnosis of PTSD.
VA requires that your PTSD diagnosis is made by a health professional who is specifically qualified to diagnose PTSD in a veteran’s case. These examiners will be board-certified or board-eligible psychiatrists or licensed doctorate-level psychologists, or other credentialed or qualified mental health professionals acting under the close supervision of a board-certified or board-eligible psychiatrist or licensed doctorate-level psychologist.
The long and short of it is, if you file a PTSD claim for disability—even if you already have an outside doctor’s diagnosis of PTSD—the VA will likely require you undergo the C&P exam for PTSD. The examiner will be trained and proficient in the DSM-5 diagnostic requirements and evaluation methods for PTSD.
Let’s look at the DSM-5 guidelines for PTSD.
Overview of DSM-5 Diagnostic Criteria for Veterans’ PTSD Ratings
PTSD New Category: Trauma- and Stressor-Related Disorders.
All of the conditions included in the new DSM-5 chapter, Trauma- and Stressor-Related Disorders, require exposure to a traumatic or stressful event as a diagnostic standard.
The disturbance, regardless of its trigger, causes clinically significant distress or impairment in the veteran’s social interactions, capacity to work or other important areas of functioning. It is not the physiological result of another medical condition, medication, drugs or alcohol.
The summary below outlines the DSM-5 diagnostic criteria for Posttraumatic Stress Disorder. All of the criteria are required for the diagnosis of PTSD.
PTSD Criterion A (one required) – Stressor
The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
PTSD Criterion B (one required) – Intrusion Symptoms
The traumatic event is persistently re-experienced, in the following way(s):
- Unwanted upsetting memories
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
PTSD Criterion C (one required) – Avoidance
Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related reminders
PTSD Criterion D (two required) – Negative alterations in cognitions and mood
Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
PTSD Criterion E (two required) – Alterations in arousal and reactivity
Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
PTSD Criterion F (required) – Duration of Symptoms
Symptoms last for more than 1 month.
PTSD Criterion G (required) – Functional significance
Symptoms create distress or functional impairment (e.g., social, occupational).
PTSD Criterion H (required) – Exclusion
Symptoms are not due to medication, substance use, or other illness.
- Dissociative Specification.In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
- Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).
- Delayed Specification.Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.
Veterans PTSD Rating Schedule
Along with using the expert outside resource of DSM-5 (summarized above), VA applies its own PTSD rating schedule as published in 38 CFR § 4.130 – Schedule of ratings – Mental disorders (and reproduced in the table below).
As with all VA mental health claims, the CFR rating scale for Mental Disorders has the following ratings: 0, 10, 30, 50, 70 or 100 percent, based on the severity of the posttraumatic stress disorder. Within the schedule, there are social and occupational factors that are considered, as well as severity and frequency of symptoms.
General Rating Formula for Mental Disorders (38 CFR § 4.130)
|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 work like 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%|
PTSD is also one of the many service-connected impairments that are eligible for Total Disability Individual Unemployability, or TDIU benefits.
What Does VA Pay in Disability Benefits for PTSD?
As of 2019, a veteran with no dependents with PTSD would receive the following monthly compensation after an award of VA benefits:
- 0% disability rating: $0.00
- 10% disability rating: $140.05
- 30% disability rating: $428.83
- 50% disability rating: $879.36
- 70% disability rating: $1,403.71
- 100 disability rating: $3,057.13
Note that with a 0 percent rating, the VA recognizes your service-connected PTSD is present, yet it is not to the extent that the condition damages your ability to perform gainful employment or interfere with daily activities.
If the condition deteriorates, you should request to increase your PTSD disability rating (rather than starting the claim process over.)
Traumatic Brain Injury (TBI) and PTSD
Many veterans with PTSD have also sustained a Traumatic Brain Injury. PTSD is frequently secondary service-connected to TBI, with both conditions resulting from the same event, and sharing many of the same symptoms. The conflicts in Afghanistan and Iraq (OEF/OIF) have generated growing numbers of veterans who have suffered TBI.
Send a Strong PTSD Claim to the VA
Understanding your PTSD rating is very complex. Many, many factors weigh in. Whether you are filing your initial application for VA compensation, requesting an increase in your PTSD rating, or fighting a denial on appeal, our veterans attorneys can help you receive the PTSD evaluation and rating you deserve.
With our representation, you have a final say about your case. If you are a veteran of any branch of the U.S. Military with a PTSD claim against the VA, contact Marc Whitehead & Associates for a free consultation. We will help you verify the stressor, establish nexus, and communicate the extent of your disability to the VA, making certain your case is properly developed and presented.
We understand that veterans may prefer to muscle-through their disability as opposed to seeking help. We have assisted many veterans who were hesitant to talk about catastrophic experiences, or reluctant to admit the possibility of PTSD.
Many wounds are the invisible kind. They are just as deep if not deeper than those that bleed. It may be several years later and now you’re here. We welcome your call.
We have represented veterans across the country since 1992, and will be proud to assist you.