Today we're going to talk about how mental health conditions are rated by the VA
My name is Zack Evans.
I'm a veterans disability benefits attorney with Woods and Woods Attorneys in Evansville,
Indiana.
The book that I have in front in me is the Code of Federal Regulations.
This is the CFR.
Specifically 38 CFR, Section 4.130 is the section we're looking at today.
That's 38 CFR 4.130.
This is the VA's rule book on mental health disorders.
I use this every day in my job.
Anyone that is familiar with the claims process has probably seen it before.
The first thing you'll see under this section of the CFR is a listing of diagnoses which
fit into this mental health category.
We have everything from schizophrenia, major depressive disorder, posttraumatic stress
disorder, somatic symptom disorder.
That's a really important nuance because if you're having problems sleeping and insomnia
is your chief complaint outside of any anxiety or depression, anything like that, those are
actually going to be considered as mental health claims.
We can get into sort of those procedural wrinkles in another video, but we're going to stick
to the rating formula itself for the purposes of this video.
After you have this listing of example diagnoses, which is not exhaustive, you'll see the general
rating formula for mental disorders.
You have several ratings tiers, zero, 10, 30, 50, 70, all the way to 100, so those are
in increasing severity.
Zero means essentially you have a diagnosis, but you have few if any symptoms that will
impact work.
This is somewhat of a rare rating to see.
It's certainly more common out of regional offices than it is after a case has gone to
the Board of Veterans Appeals.
This is generally because if a veteran has a complaint of some sort of mental health
condition, it's generally affecting them above a level of zero.
Another one to consider here is the other end of the spectrum.
We just talked about a zero.
What does 100 mean?
Well, 100 means total occupational and social impairment.
They're somewhat rare, but we do see them.
I work with them relatively regularly.
It requires very compelling evidence, so these are your really standout cases where you read
the records, you read the file, and you just think how is this person not already awarded
a total impairment?
They really bark at you.
A good example of symptoms that you'll see in the 100 tier is someone with advanced schizophrenia
and you're seeing persistent delusions and hallucinations that aren't controlled with
medication.
Most of the mental health cases that we see fall somewhere between 30 to 70.
You have three ratings tiers in there, 30, 50, and 70, and the 70 rating itself qualifying
a veteran for total disability and individual unemployability, TDIU, IU benefits, so the
70 itself will qualify you.
The lower ratings of 50 or 30, you can make an extra scheduler argument to win your IU
case, or what we commonly do is we look for holistic consideration of everything that
the veteran is dealing with.
If they have a back problem plus this moderate mental health condition and bad ankles, the
total picture renders that veteran unemployable.
You can get to your unemployability benefits through either just your mental health rating
alone or in concert with everything else that's going on with you physically.
I want to talk about what these different levels mean, the 30, 50, and 70.
A 30 essentially means you have an occasional decrease in efficiency and intermittent ability
to perform occupational tasks.
A good way to think about this is if you sometimes have a bad day where, and it sounds like I'm
oversimplifying it, but if it's less often than not I guess, you are having the kind
of day where you can't really keep up, you can't stay focused on your tasks, if sometimes
you have attendance problems at work, those suggest, again outside of seeing the medical
evidence itself, those are indicative of a 30 rating.
A 50 rating is reduced reliability and productivity.
The way that I think about this is we're looking at moderate effects across the board with
relative frequency.
So if John in the previous example has 30 and he's doing okay for most of the month,
and then on the last week, he's got a run of two or three really bad days there and
then he's back to normal, and he's feeling himself again at the beginning of the next
month, he comes back on Monday and things are back to normal, he may have a 30 rating.
A 50 rating is someone who is consistently suffering from the effects of their mental
health disorder.
This is someone who just about every aspect of their life is affected in some way, especially
social and occupational functioning.
Now a 70 rating suggests deficiencies in most areas.
This includes work, school, family relations, judgment, thinking and/or mood.
Just by the way the rating is described in the CFR, you can tell this is a much more
serious situation.
Not only is it affecting all aspects of a veteran's life, but we're seeing a drastic
impact in all of these areas of functioning.
These are typically veterans who have a very limited social network, a very limited support
system.
We see a lack of access to mental health services as an ongoing problem.
Maybe there's been a missed diagnosis or an undiagnosed condition for a long period of
time that allowed a veteran to decompensate while not under the care of a physician or
psychiatrist/psychologist.
There are various symptoms that appear at these different ratings, so I'll give you
a couple of examples here straight from the CFR.
We have a 30 rating here, depressed mood, some anxiety, suspiciousness, panic attacks
either weekly or less often.
Higher frequencies can get you into higher ratings.
Chronic sleep impairment, mild memory loss, names, directions, recent events.
Some examples of your 50 symptoms, we're looking at circumlocutory or stereotype speech, panic
attacks more than once a week, difficulty in understanding complex tasks, impaired judgment,
impaired abstract thinking, disturbances of motivation and mood.
Then moving up to the 70 rating, they're again getting a little bit more severe every time,
we're looking at illogical, obscure or irrelevant thoughts and near-continuous panic or depression
affecting the ability to function independently, appropriately, and effectively.
This is also where we start to see impaired impulse control and unprovoked irritability
with periods of violence.
The reason that is important is because when you start seeing emotional outbursts as a
symptom of a mental health condition and that's present in the evidence of your claim, there
is a significant thing to be said about your employability.
If you're having trouble maintaining or regulating your mood and it is affecting you, and you're
having outbursts at work, this is why those symptoms are present in the 70 rating that
automatically qualifies you by the schedule for a TDIU consideration, so as long as you
submitted some evidence that your service-connected mental health disorder actually does prevent
you from working.
If you have any questions about your mental health rating, please go online or give us
a call here at Woods and Woods.
We'd love to help you.