PTSD Rating Scale for VA Disability Claims Explained

[Music] so good afternoon and welcome to cck live my name is jenna zellmer i'm an attorney here at chisholm chisholm and kilpatrick practicing veterans law joining me today are kayla ginoffrio and rachel foster both of whom represent veterans before va and today we're going to be talking about the ptsd rating scale and try to trying to explain it a little bit as always please feel free to visit our website at we have a lot of blog posts and other information on ptsd claims in general and then the rating scale as well so um let's just give you a little bit of background before we get into how va rates ptsd so ptsd is post traumatic stress disorder it's one of the most common disabilities among veterans it's a mental health condition that can occur in people who have experienced or witnessed a distressing shocking or otherwise traumatic event so that kind of explains why it's one of the more common disabilities many veterans have come back from service um having experienced these traumatic events but the symptoms and severity of ptsd can vary from person to person and so that is why va has this rating scale that we're going to talk about in a second but before we get into reading we have to establish that a veteran service connected veteran is service connected for ptsd um so we have a lot of videos on how to establish service connections so i'd encourage you to check those out on our website but just as a brief refresher you need a diagnosis of ptsd and that needs to be uh given by a medical professional either a therapist a psychiatrist or a general practitioner you need a verified stressor event so like i said ptsd is occurs in people who have experienced a traumatic event and so that is often referred to in va as a stressor um we have a video all about stressors i would encourage you to check it out and then finally you need a medical nexus that determines that your stressor is the cause of your ptsd um and that that ptsd is related to service so some common stressors would be combat exposure fear of hostile military or terrorist activity um being a prisoner of war would count experiencing a military sexual trauma or a car accident i think those two are maybe the most surprising because it doesn't necessarily need to be something that you experience overseas or in a combat zone it can be something that occurs to you while you're serving um in in the united states um and even on base so now that we've kind of given you a framework for service connection and common stressors we're gonna start talking a little bit about how va rates ptsd once you determine or once you establish service connection so kayla can you talk a little bit about va's rating reading criteria um so va rates uh ptsd on what's called the general rating formula for mental disorders um and what that basically means is that ptsd is rated on the same scale as they rate really any other mental disorder that a veteran can be service connected for so whether it's ptsd major depressive disorder generalized anxiety disorder it's all going to be rated on the same scale generally speaking the more severe the symptoms are the higher the rating is going to be and va really uses this this scale and in looking at the social and the occupational impairment that the the disability causes and so how it affects the the veterans ability to function in both social and occupational settings um the scale itself does go up incrementally again the more severe the symptoms are the higher the rating is going to be and that scale ranges from 0 to 10 to 30 to 50 to 70 all the way up to 100 percent um and as you kind of go up that scale the the monetary value associated with those numbers um does sort of get higher um so starting with the zero percent rating um we're going to break down each of those different ratings and what's really entailed to get any one of them um so starting with the zero percent rating um this basically means that va has acknowledged that you have the diagnosis of ptsd and that the ptsd is related to your service but the symptoms themselves aren't really severe enough to interfere with your ability to function in any social or occupational setting or it doesn't require any continuous medication to regulate those symptoms um it's a zero percent rating which means that it's non-compensable which means that you won't have any monetary value associated with it on a monthly basis um having said that getting a zero percent rating can still be important um it can still open the door to other sort of benefits through va things like healthcare or treatment and it can also make increasing your rating later down the line a little bit easier you no longer have to worry about kind of meeting that threshold for service connection you can really focus your evidence and your arguments um and really everything geared towards va to just getting that rating up on that scale um and then we're going to move on to the 10 percent rating so at the 10 percent those ratings do get a little bit more severe um currently the monthly compensation rate for the 10 rating is 144.14 per month um so at 10 this is the lowest compensable rating so it's the lowest rating that you can get while still getting paid on a monthly basis um and the symptoms for this really reflect that the the symptoms are really minimal and they're well controlled um so specifically ten percent va will define the symptomology as 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 so basically what that means is that the veteran is generally functioning pretty well but their symptoms do have some impact on their ability to function um socially and occupationally especially when there is a more stressful event going on sure so with the 30 criteria we're still talking about an evaluation that's more on the mild side um you are going to see an increase in your monthly compensation benefits it will increase to 441.35 35 cents per month um still we're not seeing as much significant impairment in your day-to-day so what really defines the 30 criteria is that the level of occupational and social impairment results in an occasional decrease in work efficiency and intermittent periods of an inability to perform occupational tasks so the idea is kind of building on that prior evaluation you have a diagnosed condition you still continue to experience symptoms but they wax and wane they don't really persist long enough to really disrupt your day-to-day life so otherwise you're able to function in a satisfactory way you're able to follow your routines you can go about your day-to-day you are able to engage in self-care and carry on conversations as normal so um that's kind of the next highest and the more moderate level of impairment you can already kind of see how the difference between 30 and 10 is a little nebulous so i think you're gonna you're gonna prove my point in a second when you talk about 50.

So with the 50 evaluation we see those symptoms a lot of it overlap between the 30 and the 10 we really see them start to significantly increase and cause more disruption in the day-to-day so to reflect that level of impairment we'll see the compensation on a monthly basis increases about 460 more so if you're 50 rated for your ptsd you're gonna receive 905 dollars and four cents per month um and the 50 reading criteria is marked by really an escalation and the frequency duration and severity of your ptsd ptsd symptoms um that as i mentioned you see already from the lower um evaluations with this you'll notice more cognitive deficits um and the things that we were talking about 30 where before you were able to carry on a conversation now you're not able to do that any longer it's marked by circumstantial or stereotype speech there's general disruptions and how you're conversating with other people you have more of a flattened affect so essentially that means how you present yourself to other people so um you might be presenting more as blunted or not really expressive in general you might be experiencing an increase in panic attacks um impaired memory impaired ability to make sound decisions and choices and it's also more significantly affecting your ability to work develop those relationships stay on task um and in essence and 50 just reflects a reduced reliability um and productivity with the occupational and social impairment great thanks and then after 50 is 70 um building off of what both kayla and rachel said it's just an increasing level of both social and occupational impairment um to what va would consider deficiencies in most areas so if you're having deficiencies in work school family relationships judgment thinking or mood that's kind of what va is looking for at the 70 percent rating it's really one step below completely totally disabling um so it's a significant level of impairment in both social and occupational functioning um this might be marked by symptoms like suicidal ideation obsessive rituals you know if you're checking your locks multiple times a day if you're getting up in the middle of the night to check your locks um so the fact that those obsessional rituals are also interfering with your routine um speech again building off of what rachel had said your speech is illogical obscure or relevant um and increasing panic attacks to the point where they're either near continuous or if they affect your ability to function independently you also have even more impaired impulse control and judgment than the lower ratings and then difficulty establish adapting to stressful circumstances especially in the work setting um and inability to establish and maintain effective relationships so that doesn't necessarily mean you don't have any relationships because that would be what we would consider totally socially uh social impairment but you know maybe the relationships you have are fraught um maybe we wouldn't be able to characterize them as effective you know sometimes we have uh veterans who are experiencing a 70 rating who their only relationships are real um are really due to their family members or their friends trying to support them rather than them actually being engaged in the relationship so this represents a wide range of symptoms and again it reflects the progression of the symptoms from the lower ratings um you're essentially almost always in a state of panic or depression and that affects your ability to interact both socially and occupationally um they also might be a little bit more um uh unpredictable these symptoms than maybe if you get a 50 rating which again would um be a problem if you're trying to work with these symptoms and don't know when they're going to come on so that's a 70 rating and it would result in 1 44.71 cents per month so you can see that the the increase in severity is is reflected in the amount of money that you get per month and then finally va has the 100 rating which is the highest possible rating you can get under ptsd um i will or really any under any of the reading schedule um i will profess this by saying that a 100 rating for ptsd is extremely difficult to obtain um it essentially requires like we said total impairment and an inability to function in your everyday life um and something that's really interesting is that ptsd is or psych in general is one of the only reading schedules that contemplates social impairment the whole purpose of the rating schedule generally is to compensate for occupational impairment and though the amount that your service had a disability um you know prevents you from working and so you know to require both total social and total occupational impairment is a little bit unique in this reading schedule um but to compensate for total social and occupational impairment va pays veterans at three thousand one hundred and forty six dollars and forty two cents so that's a big jump even from the seven seventy percent and in order to get this rating you're really looking for gross impairment and thought processes processes and communications persistent delusions or hallucinations so if you're seeing things if you're hearing voices um if you have delusions that are not based reality grossly inappropriate behavior a persistent danger of hurting yourself or hurting others so that takes it from suicidal ideation which is a 70 rating to an actual suicide attempt or self-harm so you can see that escalation there and then an intermittent inability to perform the activities of your daily living maintaining normal hygiene um things like that so like i said 100 reading is extremely difficult to obtain but that doesn't necessarily mean that um you can't get a total rating due to ptsd um in other ways and so kayla what if maybe talk a little bit about what the alternative to getting 100 scheduler reading would be sure so um if you can show that the ptsd is severe enough to prevent you from working even if it's not rated at the 100 rate um you may still qualify for getting what's called tdiu or total disability rating based on individual unemployability and basically that benefit is to allow veterans to get that same rate as the 100 compensation per month um but they don't have to have that 100 percent rating on the on their combined disability rating or just for their ptsd alone but again you do have to show that the condition either ptsd or a combination of your service connected conditions um is what prevents you from working um now to qualify for tdiu va does have some what they call scheduler requirements for that in terms of the level of ratings themselves um so one way that you can get this scheduler requirement met is to have one service connected disability that's rated at sixty percent um so if you have ptsd rated at seventy percent you would qualify for it um alternatively you can have one service connected disability that's rated at forty percent with a combined rating of 70 so you have to have more than one thing service connected to meet um that threshold with the combined at 70 and one uh one at 40.

So um again if you have the ptsd rated at 70 you would automatically qualify for that benefit but even if you don't meet these scheduler requirements that doesn't mean that tdiu isn't available for you va can still grant tdiu on what's called an extra scheduler basis it's a little bit more difficult to get it that way but it's certainly not impossible um so just because you don't meet these this rating criteria doesn't mean that you're you're not gonna you're not eligible for tdiu necessarily yeah and i think we have a lot of videos and a lot of information on our website about tdiu it's a really big topic of interest and so um hopefully that's not new to anybody but it's just a reminder that even if you don't uh qualify for 100 scheduler you can still get that three thousand i have to remember the exact amount three thousand one hundred forty six dollars and forty two cents so it's it's the same amount of money whether or not you get a hundred percent scheduler rating or whether or not you get that tdiu rating um so kayla moving on you know we we just listed a lot of symptoms and a lot of uh like i said nebulous kind of distinctions between the ratings um does the veteran have to show every single one of these symptoms or kind of how does it work practically no they don't um so basically the list of symptoms that are associated with each of those different ratings um basically those symptoms are really just there to serve as examples that talk about the frequency and the severity of those symptoms themselves it's really not meant to be an exhaustive list you don't have to check off every single symptom that's listed under each one of those to get that particular rating um having said that va does mess that up pretty frequently they do often deny the benefit because a veteran doesn't meet every single one of those different criteria but you can still argue using um some case law called mourhan v principi which again just says that you don't have to have every single symptom that's listed there to get that rating um it's not an exhaustive list great and so for example angel if a veteran had you know something in the 30 rating like depressed mood or anxiety and mild memory loss and then they also had you know difficulty establishing and maintaining effective work relationships or you know suicidal ideation which is in the 50 and the 70 rating um what what does veteran do in that situation what should they ask for and how should va be um rating that disability so with va their standard approve essentially is 50 50.

So we see in service connection cases if there's 50 of the evidence in favor of the claim 50 against the claim the benefit of the doubt is supposed to go to the veteran um and they should be successful with service connection the same principle applies in inconstraining evaluations so in the scenario where you gave where they have um symptoms and 30 evaluation and they have symptoms in the higher evaluation and the evidence is relatively equal va should afford the veteran the benefit of the dow and grant them that higher evaluation great thanks and i think one other thing to point out is that there is um there's another case called vasquez claudio b shinseki and that kind of lays that out um you know it's not just about the symptoms that the veteran is experiencing but really what it comes down to is what level of impairment they have um which as we said is really hard to judge whether or not somebody has you know reduced reliability or just occasional deficiencies you know what what do those terms mean and so it's really important for veterans to try to be as specific as possible about kind of how their symptoms affect their daily life um both socially and occupationally so like i said more information can be found on our website and on our blog um kayla or rachel do you have any closing thoughts before we sign off um the only thing i was going to say goes back to tdiu as an alternative if you don't otherwise meet that 100 percent for your ptsd condition even if you don't meet the scheduler criteria with that single at least at fifty percent and then the combined at seventy percent as kayla had explained uh even if you're under the extra scheduler criteria if you still feel that your ptsd warrants an increased evaluation you can simultaneously ask for an increased evaluation for your ptsd as you're pursuing tdiu because of course there's a lot of overlap between the rating criteria and unemployability if we're talking about occupational social impairment and social impairment so um just wanted to throw that out there you don't necessarily have to wait first for your rating to get up you can work both simultaneously um and i would just add there's obviously a lot of small distinguishing factors between each of these different ratings and they can be kind of hard um to pull apart on your own if you're not sure whether you meet the next rating or what evidence you might want to submit to try to show that you do meet the next higher rating seeking help from an accredited representative can always be extremely helpful whether it's a veteran service organization an attorney's office an accredited claims agent someone can help you kind of parse out the details of those different ratings and you know show you the way to kind of get the next higher rating from there great i think that's a really good point too thank you guys um thank you for joining us today please don't forget to follow us on social media for all of our latest updates and check out our video library on youtube where you can find this video as well as lots of other helpful videos have a great day and we'll see you next week [Music] you

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