ptsd How The Va Rates Ptsd Claims

[Buck52]

For any veterans wanting to know this?

How The VA Evaluates Levels Of Disability

Once the VA has awarded service connection for PTSD, it will then review the most current clinical evidence of record to determine how the severity of your symptoms impairs your social and industrial (ability to work) capacity. The VA has a schedule of rating disabilities, located in title 38 C.F.R., Part 4. The VA has established Diagnostic Codes (DC) for various medical and psychiatric disorders, which include a description of the severity of related symptoms and a corresponding disability percentage (called a rating or evaluation). Although there are different DCs for covered psychiatric disorders, the VA evaluates the level of disability due to psychiatric disorders under the same criteria, regardless of the actual diagnosis. 38 C.F.R. §4.130, DC 9411, governs PTSD ratings. This regulation provides graduated ratings of 0%, 10%, 30%, 50%, 70% or 100%. A 0% rating is noncompensable, This means that you have service-connected PTSD, however, there is little or no impairment as a result. VA compensation payments begin at 10% and increase at each rating level.

The VA has adopted the criteria established in the DSM-5 as the basis for its psychiatric ratings, including PTSD. Although it is being slowly phased out in favor of more robust tests, there is a diagnostic matrix called the Global Assessment of Functioning Scale (GAF) that may be used to determine your level of disability. The lower the GAF score, the higher the level of social and industrial impairment. Section 4.130 is reproduced below. You can share this with your psychiatric provider of care, who can prepare a report or opinion letter for submission to the VA that describes your level of impairment.

Bear in mind that even if the severity of your symptoms do not satisfy the diagnostic criteria for a 100% (or total) evaluation under the rating schedule, if your rating is high enough, another VA regulation (38 C.F.R. § 4.16) allows the VA to pay you at the 100% level if medical evidence demonstrates that your are unable to obtain or maintain substantially gainful employment as the result of your service-connected PTSD. The technical term for this is a total rating on the basis of individual unemployability due to service-connected disability (TDIU or IU).

38 C.F.R. § 4.130, DC 9411

General Rating Formula for Mental Disorders:

Total occupational and social impairment, due to such symptoms as: gross impairment in thought process or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name ..100%

Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships ...................................... 70%

Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining Effective work and social relationships ..50%

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) ............................ 30%

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 .................. 10%

A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication .............................. 0%

To find the current VA disability compensation monthly payment rates, please go to the VA website at www.va.gov. From the homepage, click on Compensation, then on Rate Tables. Additional monthly payments may be available based on the beneficiarys number of dependents.

_____________________________________________________

Copyright © 2004, Vietnam Veterans of America, Inc. All Rights Reserved.

[freedomisntfree]

Buck,

The 331 code would be the category identifier under a ICD-9- CM codes or the DSM-5 diagnoses but without the subsection number that follows the . like 331.0 or 331.9 it would be hard to determine. Unfortunately the ICD and DSM code have changed a couple times and they are not archived in current engine searches. Right now the 331 code could range from Alzheimer's to cerebral degeneration, unspecified or even postconcussion syndrome.

One question that comes to mind is. Have you ever had any type of head injury or memory problems. If so the 331 code is apparently associated with it. With correct information one would be able to got back to the date the code was evaluated and assigned then determine what the code is identifying.

As far as the GAF score the VA has stopped assigning them. That doesn't mean when reviewing records and they see a GAF score they disregard it. They take into consideration all previous and current diagnosis's.

The VA is currently using the DSM-5 for there ratings and cross-references the two. But the social security system is still evaluating under the DSM-4. One government agency not online with the other.

If you know the date the code was assigned I might be able to narrow it down and help.

Edited August 7, 2015 by freedomisntfree

[Pete53]

I think that the VA rates on your ability to function in life. If you can't work higher rating. I don't think that I would have gotten 100% P&T for my symptoms except that I could not work and I suffered significant hardship because of my Depression and Panic Disorder with Agoraphobia. It was a schedular rating.

Who am I to even hazard a guess as to how the VA does anything.

[usmc1962]

GAF is not used anymore

[Buck52]

freedomisntfree,

I am not sure,

When they (VA MH) did an evaluation on me a few months ago they check my past history medical records

One of the MH Doc's mention I was diagnosed with 331 Depression back in 1999 in progress Notes and I never even knew it?

Although I knew I was depressed just hid it for years...pride or for whatever reasons.

I supposed I could ask him what it means? and if there's a connection from this recently diagnosis?

Thanks

....................Buck

Edited August 7, 2015 by Buck52

[Buck52]

freedomisnfree

I think this new depression diagnoses # is (sct 35489007)??