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hi everyone thank you so much for tuning
in
for today's cck live discussion my name
is maura black
i'm joined today by kevin madirus and
rachel foster
today we're going to be discussing va
ratings for adjustment disorder
and anxiety so we've got some
information about what these two
conditions are
and then later we'll get into how va
rates these conditions
if they are service connected or if va
recognizes that these two
disabilities either alone or together
are related to a claimant's military
service
so rachel can you start us off by
explaining what adjustment disorder is
just for people who may not know some of
the specifics
so adjustment disorder is characterized
as a short-term condition
that occurs when a person has great
difficulty coping with or adjusting to a
stressful event
but one that's still within the normal
everyday range of human experience
it's sometimes referred to as
situational depression because it's
generally based on the current
circumstances
going on in someone's life some examples
of what these stressors can be
that trigger adjustment disorder could
be the ending of a relationship or a
marriage
losing or changing a job the death of a
loved one
the developing a serious illness
being the victim of a crime or living
through a trauma
having a serious accident or just
undergoing a major life change
such as a new baby or starting
retirement
while a lot of the characteristics are
shared unlike major depressive disorder
adjustment disorder does not involve as
many
of the full range of physical and
emotional symptoms of clinical
depression
so we're not seeing some significant
changes in sleep
appetite or energy it also doesn't tend
to involve the more intense levels of
severity
for example suicidal ideation that we
would see in major depressive disorder
adjustment disorder is also different
than post-traumatic stress disorder
and that ptsd occurs as a reaction at
least
one month after a life-threatening event
and its symptoms tend to last longer
that's all really helpful because one of
the things that
i think is particularly difficult to
understand about adjustment disorder is
how it might differ from other
psychiatric conditions it's not one of
the more
uh i don't think it's one of the more
commonly diagnosed i don't know for sure
but
i think we hear things like depression
generally and anxiety generally
and have a decent sense of what those
conditions entail but
but that's all good information about
how adjustment disorder specifically is
diagnosed
another hallmark feature of an
adjustment disorder is that
the the symptoms that come along with it
include emotional and behavioral
symptoms and
they are usually experienced between
three and six months following
the stressful event so that's another
descriptor or
differentiation from another psychiatric
condition is that
you can expect to see symptoms in
response to the
stressful event at issue between three
to six months following the event itself
we know that it it can take a long time
for
symptoms to manifest when people have
other psychiatric diagnoses are exposed
to trauma such as with ptsd
another thing that's different about
adjustment disorder
is that it involves a response to a
stressful event
that's sort of what beyond what would be
expected
for a person to experience in terms of
stress and difficulties adapting to the
situation
so that's another um
that's another consideration that comes
into play when thinking about how this
condition is diagnosed it's usually that
the response
is out of the norm or
excessive in terms of psychiatric
symptoms in dealing with a stressful
event
so i think that takes care of adjustment
disorder now kevin can you talk to us a
little bit about
what anxiety is i think this is
something that my people might think
they understand
a little bit more it's maybe discussed a
little bit more
but can you take us through what that
disability entails
yeah so um anxiety is defined as the
mind and body's reaction to a stressful
dangerous or unfamiliar situation
and it typically manifests by intense
excessive or persistent worry or fear
about
everyday situations and common symptoms
include feeling restless jumpy or on
edge
excessive worrying difficulty
concentrating
rapid heartbeat trembling or twitching
muscle tension
shortness of breath difficulty breathing
and difficulty sleeping and there are
several types of anxiety disorders i'm
sure most people watching this video
have experienced
anxiety at one point or another in their
life
but some that manifest to clinically
uh clinical um diagnosable levels
include
generalized anxiety disorder panic
disorder and
phobia related disorders great and then
there's
often sometimes a connection between the
two
which are as i said often sometimes so
that doesn't make a whole lot of sense
but
they're you you do sometimes see a
connection between adjustment disorder
or
an anxiety in other words they can
manifest
alongside each other and when both
conditions are present you can expect to
see
such symptoms as fear
separation anxiety jitters memory loss
suspiciousness sometimes even
suicidal ideation irritability
difficulty sleeping
things like that you tend to see if a
person is suffering from both
adjustment disorder and anxiety and we
know from our experience and we also
know from
the diagnostic and statistical manual of
mental disorders or the dsm that
adjustment disorder and anxiety are very
common conditions
among veterans so i think that takes
care of the basics
again what does each diagnosis entail
so rachel can you talk to us a little
bit about how
generally speaking a person might go
about
obtaining service connection for either
of these conditions
i know we have a lot of information on
our website cck dashlaw.com
about how to obtain service connection
in different ways but just generally
with respect to these two conditions
what are some things that people should
be mindful of
sure so when established establishing
service connection
va veterans must first establish the
in-service
incurrence or event the current
diagnosis
and a medical nexus linking the two when
developing for service connection va may
request evidence related to each element
of service connection
such as requesting that the veteran
attend a compensation pension
examination
requesting lay evidence maybe discussing
the details of the in-service events or
current symptomology
service medical or personnel records or
opinions from medical providers
va will use this evidence to evaluate
each element of service connection
and as maura mentioned um we have a lot
of information on our website so if
you're looking for more information
about
attending compensation and pension
examinations and the type of the
evidence va will gather during the
claims process please check out our
blogs at cck-law.com
which will give you more in-depth
information about what these processes
entail
but when it comes to establishing
surface connection there are a few
different avenues
um or theories so the first is that
classic
direct surface connection and it really
is just
all of the elements of the current
diagnosis so you have to have a current
diagnosis of adjustment disorder with
anxiety in this case
evidence of an in-service event injury
or illness
so the symptoms first started in service
or there's an
event that happened in service that as a
result of you now have the adjustment
disorder with anxiety
um and lastly the medical nexus linking
the in-service incurrence
um to the current diagnosed adjustment
disorder with anxiety so if all of those
elements are met and the relationship is
established
during the veteran's active period of
service that is direct service
connection
now another way to establish service
connection is on a secondary basis
so a veteran can show that an already
service-connected condition either
caused or
aggravated their adjustment disorder
with anxiety
so just as an example if during service
a veteran
sustained a traumatic brain injury that
they are now service connected for
years later the symptoms of their tbi
exacerbate their ability to handle
life stressors and as a result they've
now developed a diagnosis of adjustment
disorder with anxiety
because this new condition is due to a
service-connected disability
even though it didn't directly happen or
manifest in service
you can still get service connection on
a secondary basis
in the same way if it's not causally
related
but there is an increase of symptoms
you can get it on a secondary basis
through aggravation
lastly the type of service connection
we'll talk about is based on
aggravation through active military
service
so where a veteran upon entry if
adjustment disorder or anxiety
is noted on the entrance examination or
if it's not on the entrance exam
and va discovers that there's clear and
unmistakable evidence that a condition
existed prior to entry
if there is an increase of those
symptoms beyond the natural progression
of the disease
and they're shown in service then
service connection can be awarded
based on aggravation here i do just want
to note that aggravation can often be a
very complex legal theory
so if this is an avenue of service
connection um
that you're seeking you may want to
consider obtaining help from a veteran
service organization or an accredited
claims agent or attorney
that's great information rachel thank
you especially since we sometimes are
talking about conditions
during these presentations where direct
service connection versus secondary
service connection
one of the two avenues tends to be more
that we see it more often or it tends to
be more viable
but with respect to psychiatric
conditions especially adjustment
disorder
and anxiety or both really both have
ways to be related to military service
both on the direct side of things so
they may manifest in service they may be
due to an in-service event
or they may be secondary to an already
service-connected condition
they may arise due to a stressful event
that
occurs due to a service-connected
disability rachel was talking about the
tbi example i think that's a really
helpful one
and as rachel mentioned i totally agree
that
if aggravation of a pre-existing injury
is the pathway to service connection
that you're interested in it's
definitely important to read the rules
about
aggravation there are sort of two types
of aggravation
um we don't need to get too much into
the details i think what rachel said is
perfect and suffices for this
conversation
but that's where it definitely tends to
get more complex
something that's a little bit more
straightforward at least in my opinion
is how va rates psychiatric conditions
so
kevin can you explain if a veteran is
already service connected
for adjustment disorder or anxiety or
both
what can they expect in terms of the
evaluation or rating process
and what kinds of things is va going to
be looking at in determining what
disability rating
the person should receive the veteran
will receive a rating under the
diagnostic criteria that contemplates
psychiatric conditions
the regulation is 38 cfr section 4.130
and that provides ratings for veterans
um starting at zero
and going up um by increments of ten and
then
thirty percent and then fifty percent
seventy percent
and ultimately a hundred percent if the
veteran is is totally disabled from
the psychiatric condition each
rating contemplates the level first what
symptoms the veteran has and then
second the level of social and
occupational impairment
that those symptoms cause so each rating
will list a variety of symptoms and an
ultimate
social and occupational impairment um
that that that's being contemplated
but um one thing to know is that the
symptoms listed for
the for each rating don't necessarily
need to align exactly with what the
veteran has they're
they're listed as examples and the the
rater has to take into account the
frequency severity and duration of the
symptoms
and the ultimate social and occupational
impairment that's caused so
um the veteran doesn't need to have
if they're if they're rated at 30 say
and seek a higher rating than that
they don't have to have the exact
symptoms listed in the higher rating
criteria
if the symptoms that they do have are
severe enough to to
interfere sufficiently with their social
and occupational impairment
we all know especially kevin knows all
too well that
that is a common error that va makes
when rating psychiatric
conditions the rating criteria as kevin
explained
that are in the diagnostic criteria
or the rating schedule will contain a
list of symptoms
that might be expected to be seen with
the different levels of evaluation so
each level the 30 50
70 has a descriptor of occupational and
social impairment
reduced reliability and productivity is
something that's mentioned in the 50
criteria uh milder transient symptoms i
think is mentioned with the
10 criteria but it's really that level
of impairment that va is supposed to be
assessing
as a whole based on the veteran's whole
disability picture
and then the symptoms that follow are
meant to be examples of that level of
impairment
va tends to do the opposite they they
skip right to the symptoms part
they try to match the specific symptoms
that the veteran or the claimant has
to the symptoms that are listed in the
rating schedule and then pick the
evaluation that aligns with those
specific symptoms
the evaluation process isn't supposed to
work like that it's supposed to be a
holistic assessment
of the veteran's entire disability
picture and
it's a common error that we see from va
that they're not doing that they're just
sort of linking
what's in the reading schedule to what
is showing up in the veterans medical
records
um so it can be really helpful i think
if you're pursuing a claim for a higher
rating for a psychiatric condition
to include adjustment disorder and
anxiety but really any other psychiatric
condition that's rated under 38 cfr
4.130 to make sure that you are pointing
out facts to va that show
the occupational and social impairment
level and not just the symptoms that are
specifically listed
in the rating schedule and throughout
this conversation we have
spoken about psychiatric conditions in
general
and although this discussion is focused
on adjustment disorder and anxiety it's
important to note that
typically if a person has multiple
psychiatric conditions multiple
diagnoses even
that person shouldn't expect to get
separate ratings for all of those
psychiatric illnesses that's a common
uh question that we get if i have
depression
and anxiety in ptsd will i will i be
getting a separate
rating for each of those three
conditions and therefore
compensation three times for those
conditions and the answer is usually no
there won't be separate readings for
those three conditions the reason is
because as kevin mentioned
the criteria for psychiatric conditions
are pretty broad
and they typically encompass all of the
different symptoms that might be
manifesting
with different illnesses so the
symptoms for depression anxiety
adjustment disorder ptsd
they all tend to speak to a person's
level of occupational and social
impairment
which is exactly what the rating
schedule contemplates so va will tend to
rate them all
as one underneath whatever evaluation
level va decides is appropriate through
the rate their application of the rating
schedule so
it doesn't mean that if you believe that
your rating
for your psychiatric conditions if
they're service connected
should be higher it doesn't mean you
can't go for a higher rating by using
your other diagnoses
to show how severe your overall
disability picture is
assuming that all of your diagnoses can
be linked to service or a service
connected condition
but it is important to note that you
shouldn't expect to receive separate
readings for those different conditions
it's very very rare that we see that
um and the origin of that is that va has
rules against pyramiding or in other
words
getting duplicate ratings for duplicate
symptoms
um kevin and rachel do
either of you have anything to add um to
anything that we may have discussed
whether it's theories of service
connection
or rating issues that touch on these
topics
i think that um when once a veteran is
service connected
and you know seeking maybe a higher
rating that um
it's important or it's helpful to submit
late statements describing your symptoms
and how it affects you on a
day-to-day basis you know a lot of times
the va will have a veteran go to a va
exam and the examiner will
describe what you know they saw but it
might not
fully encompass what the veteran is
experiencing on a day-to-day basis so
submitting late statements describing
describing your symptoms
can can be very helpful in achieving a
higher rating the only other thing
i will add is that it does get tricky
sometimes when there are multiple
diagnoses
some which are service connected and
some which are non-service connected
common sense tells us that there's going
to be of course a lot of overlap between
those symptoms
and va law states that even symptoms
that are stemming
from non-service-connected psychiatric
condition
um the benefit of the doubt should apply
and if those can't be separated out
those
those symptoms should still go and be
compensated and evaluated under their
service-connected disability
thank you all for tuning in today we
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you again in the future
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take care
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you