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Current Axis And Gaf According To Dsm- Iv


Here it be:

The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and described in the DSM-IV-TR on page 34. The highest ratings are 91-100, "Superior functioning in a wide range of activities.. No symptoms" and the lowest ratings (besides a 0, for "Inadequate information") are 1-10, "Persistent danger of severely hurting self or others...OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death."

Global Assessment of Functioning (GAF) Scale• Consider psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. Do not include impairment in functioning due to physical (or environmental) limitations.

Code (Note: Use intermediate codes when appropriate, e.g., 45, 68, 72.)

100-91 Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his/her many positive qualities. No symptoms.

90-81 Absent of minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities,socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

80-71 If symptoms are present, there are transient and expectable reactions to psycho-social stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

70-61 Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful relationships.

60-51 Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers).

50-41 Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

40-31 Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

30-21 Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home or friends).

20-11 Some danger of hurting self or others (e.g., suicidal attempts without clear expectation of death; frequent violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

10-1 Persistent danger of severely hurting self or others (e.g., recurrent violence)OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

Axis codes:

* Axis I:

Clinical Disorders, most V-Codes, and conditions that need Clinical attention.

Diagnosis Flow Charts.

* Axis II:

Personality Disorders and Mental Retardation.

* Axis III:

General Medical Conditions.

* Axis IV:

Psychosocial and Environmental Problems.

* Axis V:

Global Assessment of Functioning Scale.

Edited by ranger11bv

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7 answers to this question

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And your point or question is ?

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Question: How is it that I fall in line with the DSM-IV perimeters yet not rated??

Point: as far as I can tell, this is the most up to date list. Nothing special. Plus a few members asked about it since Im going through all the VA BS they thought I would know. I just Googled it. No big.Why?

Edited by ranger11bv

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Question: How is it that I fall in line with the DSM-IV perimeters yet not rated??


The first hurdle is to get the disability SC'd, then they evaluate the percentage and effective date.

The GAF score is only one issue they factor into the percentage of disability to be granted.

Heck, one could have a GAF score of 08 - but if it is determined to not be SC'd, then the GAF score

isn't relevant at all.

GAF's can change from day to day - week to week and month to month.

The following is a copy and paste authored by Patrick428, he has given me permission to share this

with VBA claimants anywhere that I deem it to be appropriate.

To begin with I am a Licensed Psychologist with 25 years of practice experience with specialization in PTSD, Mood Disorders (Depression and Anxiety), Forensics, and Psychological testing.

My experience ranges from individual therapy to working with veterans both in the VA and Social Security System.

I am currently retired and 100% by the VA for wounds, mental and physical problems related to Agent Orange that came as a result of my time as a Marine Force Recon in Vietnam.

So to start with I will describe many common terms needed to be understood and given examples when warranted.

R/O (Rule Out): Is a term found on either Axis I or II saying that there is not enough evidence to support the diagnosis at this time.

Deferred: Is a way of a clinician saying, "I just met you and I am not sure if you have this or not." Usually found when the patient has first entered the mental health system or has been out of the mental health system for a long period of time.

Secondary: Disorders that have manifested because of the first or primary disorder and also contribute to the severity of the primary disorder.

A full diagnostic example is as follows.

There are varieties of how they are written, but this is the universally accepted model:

Axis I: Major depression, recurrent without psychotic features (Primary)

Generalized Anxiety Disorder (Secondary)

Axis II: Borderline Personality Disorder or None

Axis III: Ulcers and heart problems (usually medical problems that contribute to the mental disorder)

Axis IV: Psychosocial Stressors: Lose of employment and child abuse

Severity: 1 None; 2 Mild; 3 Moderate; 4 Severe; 5 Chronic

Axis V: Current GAF: 50

Highest GAF past year 60 GAF :

Is referred to as Global Assessment of Functioning.

This is a scale from 1 - 100 suggesting a pattern of behavior at any given movement in time. GAF is a fluid score and is never static (think of your blood pressure when applying GAF).

The lower the score more problematic behavior becomes.

91 - 100 Not much happening and you can tolerate most stress very easily.

(Blood pressure normal)

81 - 90 Some minor setbacks, maybe late bill that was not paid causing a flurry of minor stress, but is usually resolved. (Blood pressure slight elevated, but returns to normal rapidly)

71 -80 Minor problems within the home (work) and some stress that is enduring, but usually dealt with. They called about the bill that you forgot to pay (Blood pressure slightly elevated).

61 - 70 Minor to moderate problems such as not having the money to pay the bill and you are under pressure by your creditor to pay it. (Blood pressure is elevated and in need of attention).

51 - 60 Your being sued for not paying your bill, and your wife or husband has announced they are tired of living this way. Your kids do not know who you are anymore. (Blood pressure above 140/90 and dual medications are needed).

41 - 50 Wife or husband announces they are leaving and the bill collector has placed a lien on your property. You have called your creditor and your spouse idiots and you say to hell with them. (Blood pressure is severe and strong doses of medication are needed)

31 - 40 You threaten to kill your creditor and your spouse and everyone around you is against you. (Blood pressure is in the stroke range).

21 - 30 You bought a weapon and can of gas and your going to resolve the issue once and for all. It causes you to be either incarcerated or committed. (Blood pressure is causing severe chest pains and your stroking).

11 - 20 The best you can do is verbally babble and drool on yourself. (Blood pressure has caused a stroke).

0 - 10 You are no longer with us as you now live in a parallel universe. (It does not matter now).

It is not my intention to make light of the scale, but I wish to show the reality of the levels.

Axis I. A grouping of mental syndromes from a common etiology or pathology. What is usual found on Axis I disorders are: Mood, Sexual, Psychotic Substance Abuse, Child Disorders (except Mental Retardation), and Organic Syndromes (e.g.,Depression caused by a stroke).

Axis II. Are disorders of the Personality and Mental Retardation. Here Personality Disorders in Cluster A, B, and C are found.

Cluster A. Disorders deemed to be problems associated with peculiar behaviors(Schizoid).

Cluster B. Disorders where the individual violates the right of other people and often has little regard for others (Antisocial).

Cluster C. Disorders where dependency and inability to fit in socially with others is the common theme(Avoidant).

Personality is how one perceives, relates, and thinks about the environment and of oneself.

Personality Disorder is a maladaptive problem with the personality that causes extensive interference and ability to function in society. This is a pervasive pattern of behavior manifesting itself in the early development of an individual and prevents the individual from functioning normally in society.

Illusion: An illusion is a visual perception or misinterpretation of something real.

Hallucination: A hallucination is a false perception of a sensory experience (tactile, visual, auditory, taste, smell, or in body experience).

Delusion: Is a false belief carried to an extreme.

Psychotic. Loss of touch with reality

Depersonalization: Feelings of detachment from others. Feelings like being one's own dream.

Affect: Mood behaviors. Moods can be blunted, flat, inappropriate, labile (frequent mood changes), and restricted.

PTSD: Post-traumatic Stress Disorder. Can come in forms of mild, moderate, severe, chronic and delayed. May be seen on Axis I written as: PTSD, Chronic and Delayed.

Psychiatrist: Is Medical Doctor who specializes in mental illness and uses medications for its' treatment.

Psychologist: Is a person who performs psychological testing, assessment, and therapy.

M.S.W. Master's in Social Work and usually coordinates community-based programs and also performs therapy. But is restricted to therapy only.

Psychological Battery includes:

Personality Inventory (MMPI, etc)

Intelligence Scale (IQ test Wechsler or Stanford-Binet)

Neurological Tests (Bender-Gestalt, Wechsler Memory Test, etc).

Mood Inventories (Depression Scale; Anxiety Scales)

Trauma Scales (Mississippi, TSI)

Mental Status Examination

Mental Status Examinations:

Mini Mental Status exam - 20 minutes

Full Mental Status Examination - 1 hour

Specialized Tests as warranted for the purpose of narrowing the cause of many problems.

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Question. What about stays in a VA hospital? All metal related.

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Question. What about stays in a VA hospital? All metal related.


If the VBA has your hospital admissions in the record then they should be factored into

the adjudication of your claim issues.

Still, the most important item of all is for the VBA to grant SC of the issue/s.

You can't even argue percentage and effective date assigned, until the issue is granted.

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My experience so far with VA is that GAF is only used when it hurts the Veteran's chances for a rating.

If I see my shrink and am feeling great he gives me a 50. If I feel bad he gives me a 50.

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      LOCAL TITLE: C&P Audiology 13294
      DATE OF NOTE: JUN 02, 2016@08:24:04 ENTRY DATE: JUN 02, 2016@08:24:04
      Hearing Loss and Tinnitus
      Disability Benefits Questionnaire
      Name of patient/Veteran m…..Xxxxxx 1234
      Is this DBQ being completed in conjunction with a VA 21-2507, C&P
      [X] Yes [ ] No
      ACE and Evidence Review
      Indicate method used to obtain medical information to complete this
      [X] Review of available records (without in-person or video telehealth
      examination) using the Acceptable Clinical Evidence (ACE) process
      the existing medical evidence provided sufficient information on which
      prepare the DBQ and such an examination will likely provide no
      relevant evidence.
      Evidence Review
      Evidence reviewed (check all that apply):
      [X] VA e-folder (VBMS or Virtual VA)
      Page 18 of 44
      [X] CPRS
      This exam is for: Hearing loss and/or tinnitus (audiologist or
      non-audiologist clinician, using audiology report of record that represents
      Veteran's current condition)
      If using audiology report of record, date audiology exam was performed:
      1. Objective Findings
      a. Puretone thresholds in decibels (air conduction):
      | A | B | C | D | E | F | G |
      | 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
      | Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
      | 30 | 50 | 75 | 85 | 95 | 105+ | 100+ | 76 |
      LEFT EAR
      | A | B | C | D | E | F | G |
      | 500 | 1000 | 2000 | 3000 | 4000 | 6000 | 8000 | Avg Hz |
      | Hz* | Hz | Hz | Hz | Hz | Hz | Hz | (B-E)**|
      | 35 | 50 | 70 | 80 | 85 | 105+ | 100+ | 71 |
      * The puretone threshold at 500 Hz is not used in determining the
      evaluation but is used in determining whether or not a ratable hearing
      loss exists.
      ** The average of B, C, D, and E.
      *** CNT - Could Not Test
      b. Were there one or more frequency(ies) that could not be tested: No
      c. Validity of puretone test results: Test results are valid for rating
      d. Speech Discrimination Score (Maryland CNC word list):
      | RIGHT EAR | 56% |
      XXXXXX, xxxxxx
      Page 19 of 44
      | LEFT EAR | 56% |
      e. Appropriateness of Use of Word Recognition Score (Maryland CNC word
      Right Ear:
      Is Word Discrimination Score available? Yes
      Word Discrimination Score appropriateness:
      Use of word recognition score is appropriate for this Veteran.
      Left Ear:
      Is Word Discrimination Score available? Yes
      Word Discrimination Score appropriateness:
      Use of word recognition score is appropriate for this Veteran.
      f. Audiologic Findings
      Summary of Immittance (Tympanometry) Findings:
      | | RIGHT EAR | LEFT EAR
      | Acoustic immittance | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Ipsilateral | |
      | Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Contralateral | |
      | Acoustic Reflexes | [ ] Normal [ ] Abnormal | [ ] Normal [ ] Abnormal
      | Unable to interpret | |
      | reflexes due to | [ ] | [ ]
      | artifact | |
      | Unable to obtain/ | |
      | maintain seal | [X] | [X]
      Page 20 of 44
      2. Diagnosis
      [ ] Normal hearing
      [ ] Conductive hearing loss ICD code:
      [ ] Mixed hearing loss ICD code:
      [X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
      ICD code: H90.3
      [X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
      higher frequencies)** ICD code: H90.3
      [ ] Significant changes in hearing thresholds in service***
      LEFT EAR
      [ ] Normal hearing
      [ ] Conductive hearing loss ICD code:
      [ ] Mixed hearing loss ICD code:
      [X] Sensorineural hearing loss (in the frequency range of 500-4000 Hz)*
      ICD code: H90.3
      [X] Sensorineural hearing loss (in the frequency range of 6000 Hz or
      higher frequencies)** ICD code: H90.3
      [ ] Significant changes in hearing thresholds in service***
      * The Veteran may have hearing loss at a level that is not considered to
      a disability for VA purposes. This can occur when the auditory
      thresholds are greater than 25 dB at one or more frequencies in the
      500-4000 Hz range.
      ** The Veteran may have impaired hearing, but it does not meet the criteria
      to be considered a disability for VA purposes. For VA purposes, the
      diagnosis of hearing impairment is based upon testing at frequency
      of 500, 1000, 2000, 3000, and 4000 Hz. If there is no HL in the
      Hz range, but there is HL above 4000 Hz, check this box.
      *** The Veteran may have a significant change in hearing threshold in
      service, but it does not meet the criteria to be considered a disability
      for VA purposes. (A signi
      ficant change in hearing threshold may indicate
      Page 21 of 44
      noise exposure or acoustic trauma.)
      3. Etiology
      [X] Etiology opinion not indicated as:
      [X] Service connected condition
      [X] VBA did not request etiology
      4. Functional impact of hearing loss
      Does the Veteran's hearing loss impact ordinary conditions of daily
      including ability to work: Yes
      If yes, describe impact in the Veteran's own words: DIFFICULTY
      5. Remarks, if any, pertaining to hearing loss:
      1. Medical history
      Does the Veteran report recurrent tinnitus: Yes
      Date and circumstances of onset of tinnitus: FROM 2.16.16 EVALUATION:
      describes a subjective, bilateral, constant tinnitus with an unsure
      2. Etiology of tinnitus
      [X] Etiology opinion not indicated as:
      [X] VBA did not request etiology
      3. Functional impact of tinnitus
      Does the Veteran's tinnitus impact ordinary conditions of daily life,
      including ability to work: No
      4. Remarks, if any, pertaining to tinnitus::
      No response provided
      NOTE: VA may request additional medical information, including additional
      examinations if necessary to complete VA's review of the
      NIC…., MARK
      Page 22 of 44
    • By Michigander
      My heart goes out to all of my fellow survivors of MST ...
      For me, I have found I can no longer suppress and manage the daily physical and emotional affects of the sexual assault that took place on December 25, 1985 while serving on active duty.  In effort to find some help, relief and hopefully someday healing I am starting the uphill journey to deal with this and try to share some of the highlights of my battle.  I will be the first to admit I have no idea what I am doing and can only hope that God the father.... will guide my feet day by day. 
      First step locating documentation of the event.  A few weeks ago I was able to locate the police dept. and requested a copy of the report.  I received a copy of the 15 page report this past week and it makes me emotionally and physically sick just to look at the envelope it's in.
      I also tried to locate medical records over the years from prior mental health therapists and physicians that would have documented my history as it related to these events, but the practices were closed or my records were no longer available due to time.
      April I called the VA to inquire about mental health services for MST and hesitated to start the process because the MST would not be marked in my record for all my providers to see.  This was a big hurdle mentally as I have always hid this event at all costs from my providers.   I am sure this did not help my physicians treat me and fully understand my ongoing medical problems especially those in which are usually brought on by some big life event which I always adamantly denied when asked. 
      May 2nd 2017, I submitted a "intent to file".
      May 4th 2017, I went to a VSO rep?? to asked questions about the process to file a claim related to MST.  The rep was belittling, insulting, hurtful, rude and I walked out of that office with no more information and the psychological affects were pretty devastating.  At the encouragement from my daughter to go straight to the patient advocate office and file a complaint....I did just that.  I found myself have a total mental breakdown just trying to give the details of what just went down and was thankfully met with support and many reassurances that I would have a team of people helping moving forward and that person would be brought in...dealt with and re-trained.  I will spare you all the details.
      My next step is hearing from the mental health dept. to set up an appt. to do some type of baseline evaluation of my symptoms etc. as it related to MST... I guess to get an official diagnosis on record and to get me the specific therapy I need started.  I will likely opt for tele-therapy once I have a few sessions onsite at the VA. 
      That's it for now
    • By bright
      I have been 100% perm and total since 2003, before that i was 70%.
      I just got an appointment for a C and P exam to reevaluate. WHY!
      Has anyone ever heard of this?  Has anyone ever had one after being perm and total?
      What is going on?
    • By mrkman123
      Forgive the first effort, injuries have a way of making things difficult.....   Twenty-four years of dealing with the VA, and the difficulties at hand ensure negative results.....  These are the copies of a C and P recently done at the VA, and leaves me to doubt this system is capable of conducting themselves in an ethical manner.   Enjoy the insanity, this veteran is tired of paying the piper; Eighteen Years were Enough !!!!    (Remand posted earlier.)  Still waiting to address attorney with the results of this remand and the Shabby, Disrespectful, and unethical way in which this Veteran has been treated at the VA hands......   Document 1.pdf ...   Comments, opinions, and suggestion greatly needed and appreciated....   Sincerely, Mark
      Document 38.pdf
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