Weight Of Occupational And Social Functioning Choice On Mental Health Rating

[ExAirman]

After weeks of digging through information on how claims are rated, I've come across the following area in the Mental Health C&P Examination Worksheet:

"Effects of the Mental Disorder on Occupational and Social Functioning"

The reason this area stands out is because the statements from which the C&P evaluator can choose are directly associated with the Mental Health Rating Schedule (I've included the % rating that the statement comes from in the rating schedule):

Total occupational and social impairment... (100%)

Mental Disorder signs and symptoms result in deficiencies in most of the following areas... (70%)

There is reduced reliability and productivity due to Mental Disorder signs and symptoms... (50%)

There is occasional decrease in work efficiency... (30%)

There is Mental Disorder signs and symptoms that are transient or mild... (10%)

Mental Disorder symptoms require continuous medication... (10%)

Mental Disorder symptoms are not severe enough to require continuous medication.. (0%)

Mental Disorder symptoms are not severe enough to interfere with occupational and social functioning... (0%)

I understand that many factors go into determining a Mental Health rating, but I am curious what weight the VA raters puts on the C&P evaluators choice above when deciding a rating.

Thanks.

[WAC-Vet75]

I believe they put a good deal of weight on the occupational/social functioning, as many Vets rated at 70% receive an extra schedular evaluation of TDIU! The requirement for 100% under mental health includes such things as hallucinations, psychotic thought process, etc., which many 70%'ers do not suffer from, BUT due to their PTSD, anxiety, etc., their occupational functioning IS severely impaired.

[Hoppy]

There are a lot of court cases and instruction that apply to your question. I am having a little trouble finding some references to instructions. However the bottom line is that the level of disability is determined by the raters general perception of the level of disability based on many different factors. Raters are not bound by any one examine report.

Check out some of the following. I am pretty sure this is all current.

Further, in evaluating PTSD, b § 4oth 38 C.F.R. § 4.130 (1991) and 38 C.F.R..2 (1991) are relevant. Section 4.130 states:

[T]he objective findings and the examiner's analysis of the symptomatology are the essentials. The examiner's classification of the disease as "mild," "moderate," or "severe" is not determinative of the degree of disability, but the report and the analysis of the symptomatology and the full consideration of the whole history by the rating agency will be.

and section 4.2 instructs:

It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability presented. .

Also see Mauerhan v. Principi, 16 Vet. App. 436, 441-443 (2002).

Below is from Citation Nr: 0320203 The specified factors for each incremental psychiatric rating are not requirements for a particular rating but are examples providing guidance as to the type and degree of severity, or their effects on social and work situations. Thus, any analysis should not be limited solely to whether the symptoms listed in the rating scheme are exhibited; rather, consideration must be given to factors outside the specific rating criteria in determining the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002).

[carlie]

I understand that many factors go into determining a Mental Health rating, but I am curious what weight the VA raters puts on the C&P evaluators choice above when deciding a rating.

Thanks.

ExAir,

You might be over analyzing all of this.

The VBA decision makers are the only ones with the authority to

assign weight to the evidence.

A claimant does not have to have every symptom for the different evaluation

levels of percentage but they must have the majority of the level that is awarded.

The VBA decision maker's do assign alot of weight to the evidence contained in the C&P

examinations.

With VA disability - the effects on working and employment are always a big consideration

as that is the main reason compensation is paid to begin with.

When it comes to VBA Mental Health disability - anything over zero percent is based on

Occupational and Social impairment.

JMHO

[john999]

I think occupationsl impairment is the key to higher ratings. Difference between 50% and 100% is "Are you working". You can be hiding in your bunker all day and night but if you can work no dice for 100% for PTSD.

[ExAirman]

You might be over analyzing all of this.

Carlie,

You are correct , I am most likely over analyzing the system, but I am a scientist at heart and like to live by hard facts and rules (Math) rather than mushy generalizations (English)! Thus I am trying to get a handle around the system by applying a logical framework to the process.

Unfortunately, because this is a system of individual raters making determinizations using their own view points and some guiding principles, I understand that it is difficult to make this a 'Mathematics' exercise, as I would like to see.

I guess I am looking for the 'Golden nugets' in the field of information to help me get a better handle on how ratings are assigned.

I've seen an awful lot of discussion about the GAF score and how that really has limted bearing on the ultimate rating, and thought, when I came across the "Occupational and Social Functiong" area that it might be a better 'nugget' in my hunt for a fact or rule. I personally would like to see a 'Flow chart' that guides a rater to a decision on a rating - that is how I did things for years as a leader - made mine and everyone's job easier. But I know that is pie in the sky concept with something like menal health!

Truthfully, I guess since I am awaiting my ratings I am passing the time seeing if I can pre-determine in my head what my rating might be, and hopefully my questions (and the answers provided) assist others in their pursuit here as well.

Thank you!

[carlie]

ExAir,

All the decision maker is supposed to do is apply the

medical evidence of record to the specific criteria of the

different percentage evaluations.

We can not allow decision makers to use their "view points"

and must force them (sometimes, as Sgt. Friday would say)

just stick to the facts.

Schedule for Rating Mental Health Disability's (Except Eating)

http://edocket.access.gpo.gov/cfr_2009/julqtr/38cfr4.130.htm

If you want some research links to be "scientific" here's a link

for M21-1MR that shows how they are supposed to apply the 38 CFR regulations.

This should keep you fairly busy while you're waiting on your decision : - )

http://www.benefits.va.gov/warms/M21_1MR1.asp