Mental Health — VA Disability Ratings

How Mental Health conditions are rated

Mental health conditions are rated under 38 CFR §4.130, with the rules for applying it in §4.125 through §4.129. Diagnoses follow the DSM-5, and under §4.125(a), a diagnosis that "does not conform to DSM-5 or is not supported by the findings on the examination report" goes back to the examiner.

Nearly every mental health code is measured against the same scale. Note 2 to §4.130 provides that codes 9201 to 9440 "will be evaluated using the General Rating Formula for Mental Disorders." The diagnosis decides the code; the formula decides the percentage, at 0, 10, 30, 50, 70 or 100 percent. The 100% level reads "Total occupational and social impairment," the 70% level describes impairment "with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood," and the 10% level includes "symptoms controlled by continuous medication." At 0%, the condition is formally diagnosed but its symptoms neither interfere with functioning nor require continuous medication. At the 30, 50, 70 and 100 percent levels, the symptoms follow the words "due to such symptoms as," so a rater may weigh symptoms that are not on the list.

Section 4.126 governs how the evidence is weighed. The rater considers "the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission," and assigns an evaluation based on all the evidence of record "rather than solely on the examiner's assessment of the level of disability at the moment of the examination." Treatment notes, hospital records, and statements from family, coworkers or employers can all bear on that picture. Social impairment counts, but under §4.126(b) the rater "shall not assign an evaluation solely on the basis of social impairment."

The schedule handles overlap in a few printed rules. When a single disability "has been diagnosed both as a physical condition and as a mental disorder," §4.126(d) directs one evaluation under the code that represents "the dominant (more disabling) aspect of the condition." Neurocognitive disorders are rated under the general formula, while neurologic deficits from the same cause, such as a head injury, are rated separately and combined (§4.126(c)). The schedule does not print a separate rule for two mental diagnoses at once, but §4.14 says evaluating "the same manifestation under different diagnoses" is to be avoided, and because both would be measured against one formula, VA often assigns a single evaluation that reflects the overall level of impairment.

Three more sections set special rules. Personality disorders and intellectual disability are "not diseases or injuries for compensation purposes," though a mental disorder superimposed on either may be service-connected (§4.127). A total evaluation assigned for a continuous hospitalization of six months or more continues indefinitely, with a mandatory examination six months after discharge (§4.128). And a mental disorder that develops in service from "a highly stressful event" and is severe enough to bring about release from service is rated at "not less than 50 percent," with an examination within six months of discharge (§4.129).

Eating disorders are the exception. Anorexia nervosa (DC 9520) and bulimia nervosa (DC 9521) use the Rating Formula for Eating Disorders, which turns on self-induced weight loss against "expected minimum weight" at the higher levels, on binge eating with self-induced vomiting or resistance to weight gain at the lower ones, and on incapacitating episodes, "a period during which bed rest and treatment by a physician are required." Its levels run from 0% to 100%. The PTSD, depression and anxiety pages walk through the general formula level by level.