Mental Disorders

Topics:

The Psychological Rating System
Mental Conditions that are Not Ratable/Personality Disorders
Adjustment Disorders
Dissociative Disorders
Somatoform Disorders
Mood Disorders
Psychotic Disorders
Cognitive Disorders
Anxiety Disorders
Eating Disorders
Other Mental Disorders
DBQs for Mental Disorders
Principles that Apply

--The VASRD Codes and condition names for some of the Mental Disorders were changed on August 4, 2014. See the Historic VASRDs page for all codes and names from before this date.--

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

Note: Only a licensed psychiatrist or psychologist (referred to on this page as “mental health provider”) can perform the exam needed for the condition to be rated.

Double Note: It is essential that you tell the truth in your psychiatric examination. We’ve seen too many cases where the service member felt too macho or too tough, or was completely in denial that anything was wrong, to admit to any psychological problems. This only hurts you. If you do not allow the examining physician to truly see your condition, you will not get a proper rating. These ratings will affect the rest of your life. While the VA can change their rating over time, the DoD cannot. What the examining physician writes about your condition at the time of separation and any other evidence on record before that will be the only things affecting the DoD rating forever. So for your own sake, tell the truth!

A similar warning is justified for anyone trying to fake a mental condition. In most cases, the psychiatrist will easily be able to tell that the symptoms or reported problems do not completely add up. Be careful so as not to get into trouble. You can have UCMJ action taken against you for lying to your doctor. Although the Rating Authorities are supposed to be non-biased, it is easy to draw conclusions about someone through their psychiatric report. Again, this is not supposed to affect the rating, and most of the time it does not, but we have seen some cases where the Board will try to find any legal and justified way to give a lower rating because they feel that the service member is trying to exploit the system. Just don’t do it.

 


The Psychological Rating System

Mental conditions are rated based on how they affect the service member’s social and occupational functioning. Can they hold a steady job? Do they have any committed or stable relationships? This can be with family, a girl/boyfriend, a group of friends, etc. The more the condition affects the service member’s social and occupational life, the higher the rating.

The seriousness of the condition at the time of rating will be taken into consideration, but the overall picture of the condition, including the history of symptoms, periods of no symptoms, and the overall ability of the service member to function over time are all important factors upon which the rating is based. The condition shown right at separation may not demonstrate the true seriousness of the condition, and so the Rating Authorities may make decisions that may seem to contradict the evidence at the time if they see a different overall trend.

Make sure you discuss with your mental health provider any medications that are being taken, your ability to work, any relationships with friends and family, your social life, and any legal issues including substance abuse. These things could weigh heavily on your rating.

If there is a mental condition and a physical condition that are both caused by one single condition/injury, then it is rated only under the mental condition or the physical condition, whichever best defines the overall disability.

Each rating has a list of conditions that define the severity of the mental illness. Not every symptom or condition listed under a rating must be present to assign that rating, but if the overall condition is best described under a certain rating, then that is the rating that is assigned. If the condition is equally well defined under two different ratings, then the higher rating should be assigned. We’ll do a few examples to demonstrate all this in a bit.

Rating a mental condition is very difficult since it is up to the interpretation of the Rating Authorities. Each Authority should be as consistent as possible, but every case is so unique when dealing with mental conditions that it is hard to accurately predict what final rating the Authorities will assign. Because of this, all guidance on this page is strictly the overall idea and concepts that the Rating Authorities are required to follow. Unfortunately, we simply cannot guarantee that the ratings found on this page will match the ones the Rating Authorities assign, but we do aim to clearly explain the rating process and rating requirements.

Although the Rating Authorities are able to interpret, they must show evidence from the medical reports supporting their rating decision.

The following is a list of important terms that are used when rating psychological conditions.

Social impairment: Social impairment is how the mental condition affects the individual’s social life. Does he have solid, lasting relationships with friends, family, a significant other? Does he get involved in social activities—sports teams, church, quiz night at the pub, etc.?

Occupational impairment: Occupational impairment is how the mental condition affects the individual’s ability to work. Is he able to hold a solid, long-term job? Is he able to satisfactorily perform all the tasks required of his job? Are there regular problems at work that are directly caused by the mental condition?

Anxiety: Anxiety is a persistent feeling of concern or fear. An individual with anxiety will often worry all the time about things out of his control or that are irrational. It is not a phobia, but can often accompany a phobia. For example, if someone has a phobia of spiders (they are irrationally afraid of all spiders), they might also constantly worry about the possibility of a spider being in their house. They haven’t seen a spider or have any other proof that a spider is there, but they worry that there could be one anyway. This worry is the anxiety, not the fear of the spider itself. Anxiety can be mild or severely debilitating, making the individual unable to perform even the simplest tasks because they are completely absorbed by their anxiety. It can also be conscious (you know you're anxious) or unconscious (you don’t realize that you are anxious, or you realize you are anxious, but don’t know why). Common signs of anxiety include constant worrying, hyperarousal, poor concentration, jumping or startling easily, suspicion of other people, obsessive-compulsive behavior, constant uneasiness, and avoidance.

Delusions: A delusion is a firm belief in something that is completely illogical and incorrect, and it is caused directly by the mental illness. Even if the individual is shown proof that he is incorrect, he will still hold on to that belief. This is not because he simply believes in false information, but because his condition will not allow him to believe or accept anything that contradicts the belief.

– Hallucinations: A hallucination is a physical sensation that is not caused by any physical, real thing. It can stimulate just one sense or all of them (sight, smell, taste, feel, sound). When an individual is hallucinating, they sense things that are not actually there. Maybe they see something, or feel somebody touching them, or hear things that are not there at all, etc.

– Psychosis/Psychotic: A person is psychotic if they are completely detached from reality. In other words, a person suffering from psychosis will also constantly be suffering from delusions and hallucinations. They will not be able to grasp the reality of the events that go on around them, and they will not be able to think reasonably or rationally.

Obsessive-compulsive behavior: The term “obsessive-compulsive” can refer to a mental disorder, a personality disorder, or just a type of behavior. When an individual is behaving obsessive-compulsively, they repeat physical actions or behaviors over and over again because of a delusion or anxiety that can be caused by any mental condition. For example, someone may have to wash their hands for exactly 2 minutes every hour because they are obsessively afraid of germs or because they constantly believe that their hands are dirty, even if they are not. Obsessive-compulsive behaviors can be little things, like turning on and off a light switch a certain number of times every time they enter a room, to bigger things, like not being able to make any decision, no matter how small, without being told what choice to make by another person. An obsessive-compulsive person may know that their actions are not logical, but they are unable to stop.

Panic attacks: A panic attack is a period of severe fear that completely overcomes the individual’s ability to function. They occur suddenly, and can last a few minutes or hours, depending on the severity of the attack and the cause. Panic attacks can occur for any number of reasons, but are usually caused by the individual being in a stressful situation where they feel out of control.

Probative value: While not a mental health term, probative value is very important when rating mental health conditions. Basically, the probative value rule states that if two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on. For mental health conditions, this is extended a bit. Not only is the exam with the most thorough data or performed by the most qualified person used, but also the exam that is closest to the target date. For the DoD, this date is the date of separation. For the VA, this is the date the most recent valid evaluation is performed. Also, the information (symptoms, circumstances) that is most consistent over time is also given more probative value in mental health cases. So if nightmares are reported in every exam, then it is taken as an important symptom. If it is only mentioned once, then it probably does not play a significant role in the condition.


The majority of mental conditions are rated on the following schedule. Each rating has 5 main categories of symptoms/circumstances. Not every single symptom or circumstance has to be present in order to be assigned the rating, but the rating that most closely defines the condition should always be used.

 

100% rating: This rating will have the majority of the following circumstances and symptoms:

The Ability to Care for Yourself: This individual cannot take care of himself at all. Constant or near-constant hospitalization and one-on-one supervision is required.

Medications: This individual requires psychiatric medication at all times.

Symptoms: Some or all of the following symptoms will be present.

– Regular or constant delusions or hallucinations and the inability to tell fact from fiction
– Completely inappropriate behavior (like drooling, mumbling, shouting, etc.)
– There is constant danger of hurting self or others (including suicidal tendencies)
– Significant memory loss, including not being able to remember names of close friends, family, or self, and other important information
– The individual cannot understand the idea of time or place
– The individual cannot properly reason, think or communicate logically
– Constant anxiety, fear, suspicion

The Ability to Work: This individual cannot work at all.

Social Relationships: This individual cannot participate in any relationships. In other words, they cannot interact or build a relationship with another person. Family members may care for them, but it is only a one-way relationship. They cannot seek, invite, or encourage any relationships.

70% rating: This rating will have the majority of the following circumstances and symptoms:

The Ability to Care for Yourself: This individual cannot take care of himself most of the time. He is in the hospital or a care facility or is being taken care of by family members all of the time, and requires one-on-one supervision 50% of the time. This person cannot take care of his own personal hygiene.

Medications: This individual requires psychiatric medication at all times.

Symptoms: Some or all of the following symptoms will be present.

– There is the regular possibility of hurting self or others (including suicidal tendencies)
– This individual often cannot communicate logically
– This individual is actively psychotic, but may have intermittent contact with reality
– Obssessive-compulsive behavior that causes repetitive physical actions that interfere completely with daily necessary activities
– Severe, constant anxiety
– Mood often changes radically, without warning.
– Almost constant severe depression or panic, with the inability to function at all in stressful situations
– This individual cannot control impulsive actions like anger, violence, etc.
– Often disoriented to time and place

The Ability to Work: This individual may not be able to work at all or may be severely under-employed (such as a former intelligence analyst now working part time as a custodian).

Social Relationships: This individual cannot participate in any relationships most of the time. In other words, they cannot interact or build a relationship with another person. Family members may care for them, but it is normally only a one-way relationship. They cannot seek, invite, or encourage any relationships the majority of the time.

50% rating: This rating will have the majority of the following circumstances and symptoms:

The Ability to Care for Yourself: This individual is occasionally hospitalized, but can mostly take care of the basic personal needs like bathing or going to the bathroom, although their personal hygiene may not be kept up regularly. They may also be able to function in areas like shopping, driving, cleaning, etc.

Medications: This individual requires psychiatric medication at all times.

Symptoms: Some or all of the following symptoms will be present.

– Trouble expressing or showing emotions (This doesn’t mean that they are just reserved. It basically means that they are completely blank the majority of the time), or shows the wrong or inappropriate emotion for the situation
– Always shows significant signs of anxiety
– Regularly gives unnecessary or unrelated details when communicating
– Two or more panic attacks a week
– Trouble understanding complex directions
– Trouble remembering things (forgetting to complete tasks, etc.)
– Trouble thinking logically and often has poor judgment
– A serious lack of, or a seriously increased, mood or motivation
– Occasional delusions or hallucinations
– Regular to nightly trouble sleeping (nightmares, insomnia, anxiety, etc.)
– Complaints of physical symptoms, like pain, that do not have a physical cause
– Suicidal thoughts, but no definite plan to hurt himself

The Ability to Work: This individual may try to work, but will not be able to hold a job for more than 3 or 4 months because of their inability to remember or follow all directions or other similar reasons based on the symptoms or circumstances described under this rating. (In other words, they wouldn’t lose their job simply because they have anger issues and would regularly get in fights. A person like that could also not hold a job more than 3 or 4 months, but they would still be considered able to work). This individual would only be hired for jobs like cleaning, picking up trash, or other simple-task jobs.

Social Relationships: Like his ability to work, this individual may try to build and engage in relationships, but these relationships would not last long in most situations. Divorce or other breaks in relationships and friendships could occur due to his inability to properly participate in a relationship.

30% rating: This rating will have the majority of the following circumstances and symptoms:

The Ability to Care for Yourself: This individual may have occasional, short hospitalizations, but can entirely take care of himself most of the time.

Medications: This individual usually requires medication to function normally.

Symptoms: Some or all of the following symptoms will be present.

– Spikes or drops in mood, like depression
– Often anxious or becomes easily stressed
– Panic attacks occur, but no more than once a week
– Difficulty sleeping (nightmares, insomnia, anxiety, etc.)
– Mild memory loss could include regularly forgetting names or directions
– Often suspicious of other people, particularly ones he does not know

The Ability to Work: This individual will be able to work and will usually function normally. There may, however, be occasional times where he is unable to properly fulfill all job requirements. This could result in occasionally losing his job.

Social Relationships: Like his ability to work, this individual will normally have fairly stable relationships. These relationships, however, will not be great and will often be strained by the symptoms of his condition. Divorce or breakups could occur, but not in every case.

10% rating: This rating will have the majority of the following circumstances and symptoms:

The Ability to Care for Yourself: This individual will always be able to take care of himself and will very rarely, if ever, be hospitalized.

Medications: This individual may or may not be taking medication. Meds may be taken all the time, or only during stressful times. They satisfactorily keep all symptoms under control.

Symptoms: Some or all of the following symptoms will be present, but only during times of significant stress. The majority of the time there are no symptoms.

– Mild depression or other mood changes
– Mild to moderate anxiety
– Mild panic attacks may occur, but very rarely
– Occasional difficulty sleeping (nightmares, insomnia, anxiety, etc.)
– A range of other, very mild symptoms, which could include suspiciousness of strangers and hyperarousal

The Ability to Work: This individual will be fully employable and will very rarely have any problems at work that are caused by the mental condition.

Social Relationships: This individual will have full, functional relationships with only occasional, mild stresses that are caused by the condition.

0% rating: If a mental condition has been diagnosed but there are no symptoms that impair social or occupational functioning or require medication, then it is rated 0%.

If the mental condition required 21days or more of hospitalization, the condition is rated 100% while being treated. The 100% rating will continue for duration of hospitalization, and then return to the previous rating after the service member is discharged from the hospital. If the condition requires hospitalization for 6 months or more, the 100% hospitalization rating will continue for an additional 6 months after the service member is discharged. After this 6-month period, the condition will be re-evaluated and rated based on any remaining symptoms.

The majority of the rules governing how to rate mental conditions will best be explained through examples. (PTSD has some special circumstances, so it will be discussed in its own section below).

Example 1. A service member was diagnosed with Major Depressive Disorder after returning from deployment to Iraq. Symptoms included nightmares, hyperarousal, startling easily, depression, low energy, poor concentration, and no interest in social activities. He suffered from survivor guilt and auditory hallucinations although he was not himself exposed to traumatic events. He was prescribed anti-depressants but did not always take them. He reported suicidal tendencies.

Six months later, at the time he was separated from the military, he had improved somewhat, but still had nightmares and mild anxiety. Thought processes were logical and normal, communication was normal, memory was normal, marriage and family were intact, but social activities were still decreased. He was unemployed, but actively seeking work and thought he would soon be employed. There were no more suicidal tendencies. Twelve months after separation, the service member reported in a VA examination that his condition was significantly worse. He was unemployed and on probation for domestic violence. He also reported depression, anger, and trouble concentrating.

Okay, now that we have a very simplified version of events, we can start to try to rate the condition. A few important notes first:

– The psychiatric report will be pretty similar to the above paragraphs but will include much more information. Psychiatrists don’t write reports, they write novels. Try to pick through it to find the stuff that directly relates to rating (the fact that you wore a blue track suit with a silver stripe up the leg to the examination is really not relevant—it would be relevant however if you’d clearly not worn anything else for a week or more). Obviously you know your own condition, but the Rating Authorities will be rating it based on the information in the report, so use only the stuff in the report here.
– Remember that for DoD Disability, the condition is only rated as it existed at the time of separation. The Rating Authorities will, however, consider evidence during the months following separation to see how the condition progresses. This will especially occur if the condition is PTSD, or if the service member is put on TDRL. Service members with mental health conditions are often placed on TDRL to see if they will improve enough over time to resume full duties. When the mental condition is evaluated for DoD Disability, all exams will be taken into consideration, but one exam will be assigned the highest “probative value,” meaning that that exam will be relied on for rating evidence more than others because it was either closest to the time of separation or it was conducted by the most qualified physician in that specialty. The VA, however, will always continue to rate the condition as it develops over time.


Okay, so this condition poses an interesting challenge. There are three different exams. The first was conducted 6 months before separation. The next was conducted at separation, and the last was conducted 12 months after separation.

Let’s start by making a table of all his symptoms or circumstances that provide evidence about his condition. Let’s break them down into the 5 main categories.

Exam →
Symptom/Circumstance ↓

6 months before

At separation

12 months after

The Ability to Care for Yourself

He could take care of himself.

He could take care of himself.

He could take care of himself.

Medications

He was prescribed medication, even if he was not taking it regularly.

Not mentioned

Not mentioned

Symptoms

Anxiety:
    – Hyperarousal
    – Startling Easily
    – Poor Concentration
Trouble Sleeping:
    – Nightmares
    – Low Energy
Depression
Guilt
Hallucinations
Suicidal Tendencies
No interest in social activities

Mild Anxiety
Trouble Sleeping:
    – Nightmares
No Suicidal Tendencies

Anxiety:
    – Trouble Concentrating
Depression
Anger

The Ability to Work

Clearly had trouble functioning satisfactorily in his military duties or he would not be separated.

He was unemployed, but actively looking for work and seemed fully capable of working.

He was unemployed, but no reason is given for his unemployment.

Social Relationships

Little is said about his personal relationships, but he does not have interest in social activities where he would build such relationships.

Marriage and family relationships are intact, but he still has a decreased interest in social activities.

Personal relationships are significantly affected since he is on probation for domestic abuse.


Now you might notice something interesting about this chart. Each examination (most often done by different people) includes different bits of information. Rarely does each examiner comment on every symptom. Thus, a lot of deduction must be done by the Rating Authorities to create a somewhat consistent and true-to-the-evidence picture of the condition at separation.

Let’s next go through each exam and find the rating that is closest to the condition at that time.

First exam: Start by determining which rating each of the 5 categories fits best. To do this, start with the 100% rating and work backward until the majority of all conditions/symptoms are covered by the rating definition. You can click on the Rating link in the last column to be taken back to the rating discussion.

Symptom/Circumstance

6-months-before exam

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

100%-50% is easily eliminated since he has never been hospitalized and can care for himself. So the debate is between 0%, 10% and 30%. For each rating, the individual can take care of himself.

0% - 30%

Medications

He was prescribed medication, even if he was not taking it regularly.

100%-50% is again easily eliminated since he would have to be taking it at all times to qualify. 30% would still require fairly regular medication, and since he isn’t taking it regularly, a 10% might be the best way to go. This is a tough one, since often people with mental illness won’t take their medications for whatever reason. It doesn’t mean that they don’t need to be taking them. Since he is still fairly able to function without them, however, a 10% seems best in this case.

10%

Symptoms

Anxiety:
    – Hyperarousal
    – Startling Easily
    – Poor Concentration
Trouble Sleeping:
    – Nightmares
    – Low Energy
Depression
Guilt
Hallucinations
Suicidal Tendencies
No interest in social activities

Symptoms are always the hardest to rate since some symptoms might correlate with a higher rating, but most of the others a lower one, etc. Again, the key is to assign the one that shows the closest overall picture. Both 100% and 70% can again be easily eliminated. He is not psychotic or unable to communicate normally. 50% has a few more, like suicidal tendencies, occasional hallucinations and trouble sleeping, but he is able to think clearly, communicate. 30% also is pretty close. He has depression, anxiety, difficulty sleeping. His symptoms are definitely worse than the mild ones described for a 10% rating. So it seems to be a toss up between 30% and 50%, maybe leaning closer to a 30%.

30% - 50%

The Ability to Work

Clearly had trouble functioning satisfactorily in his military duties or he would not be separated.

This guy can definitely work, even if he cannot fulfill all his duties in the military, so 100% to 50% is out. It is more than a 10%, however. A 30% seems reasonable since he overall functions fine, but he is occasionally unable to fulfill his duties, which in this case is causing him to loose his job.

30%

Social Relationships

Little is said about his personal relationships, but he does not have interest in social activities where he would build such relationships.

100% to 50% is definitely out since his marriage/family relationships are not strained enough to be commented on. Just not being interested in socializing is not enough in this case to really warrant more than a 10% with the limited details we have.

10%


So looking at these ratings, we have three 10%’s, three 30%’s, and a slight 50%. With that possible 50% pulling things up a bit, let’s go ahead and assign a 30% to this exam. This is a perfect example of the tough decisions Rating Authorities have to make. The members of the Rating Authority could easily choose a 10% instead of a 30% in this case, and have enough proof to back it up. It could be argued either way. See why rating these conditions can be hard to predict? There is a lot left up to interpretation. Normally, however, if it is a really close call, the Rating Authorities are supposed to choose the higher of the two ratings.

Moving on to the next exam.

Symptom/Circumstance

At separation

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

100%-50% is easily eliminated since he has never been hospitalized and can care for himself. So the debate is between 0%, 10% and 30%. For each rating, the individual can take care of himself.

0% - 30%

Medications

Not mentioned

100%-50% is again easily eliminated since he would have to be taking it at all times to qualify. 30% would still require fairly regular medication, and since it isn’t even mentioned as a major factor in his condition at this time, a 10% is the best rating.

10%

Symptoms

Mild Anxiety
Trouble Sleeping:
    – Nightmares
No Suicidal Tendencies

100% all the way to 30% can be easily eliminated this time. He has much fewer symptoms that are serious enough to mention, and even those are considered mild. 10% definitely.

10%

The Ability to Work

He was unemployed, but actively looking for work and seemed fully capable of working.

This is a tough one. He is being discharged and hasn’t found another job yet. How do you really determine his ability to work? Overall, however, his ability to work is determined by his overall severity, which is pretty minor at this time.  Can’t really support more than a 10%.

10%

Social Relationships

Marriage and family relationships are intact, but he still has a decreased interest in social activities.

100% to 50% is definitely out since his marriage/family relationships are not strained enough to be commented on. Just not being interested in socializing is not enough in this case to really warrant more than a 10% with the limited details we have.

10%

Overall rating: 10%

 

Now for the final exam.

Symptom/Circumstance

12 months after

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

Still between a 0 and 30%.

0% - 30%

Medications

Not mentioned

100%-50% is again easily eliminated since he would have to be taking it at all times to qualify. 30% would still require fairly regular medication, and since it isn’t even mentioned as a major factor in his condition at this time, a 10% is the best rating.

10%

Symptoms

Anxiety:
    – Trouble Concentrating
Depression
Anger

100% all the way to 50% can still be easily eliminated. He definitely has more severe symptoms than he did in the last exam, so a 30% could be more appropriate. Since it is not clear that he was taking constant medication, however, we can’t give him more than 10%. This is because the higher ratings are for symptoms that are not taken care of by the medication. So, if he were taking meds at all times and still had these symptoms, then it would rate a 30%. If this were the case, the mental health provider would definitely mention it. Since they didn’t, 10%.

10%

The Ability to Work

He was unemployed, but no reason is given for his unemployment.

Again, a tough one. We know he is unemployed, but we don’t know why. Was he able to find a job and then was fired because of his mental health condition? If the job loss is not directly caused by the condition, then it cannot really be rated. In cases like this, however, the Rating Authorities will not rate the condition on the facts of his employment, but on the severity of his symptoms and how those might affect his ability to work. In this case, the symptoms only rate a 10%, so a 10% is really the most we could give for his unemployment.

10%

Social Relationships

Personal relationships are significantly affected since he is on probation for domestic abuse.

100% and 70% ratings are both out since he is able to participate in relationships, albeit badly. Likewise, both a 10% and 30% are out since his relationships are definitely not stable or intact. This leaves us with a 50%.

50%

Overall Rating: 10%


Now that we have an idea of the various ratings at these three main exams, let’s discuss how this condition might be rated for DoD Disability. Again, they rate only once right around the time of separation, but they can consider evidence from before separation and up to 12 months after separation (although with the IDES process, rarely will there be this much evidence after separation since it no longer takes this long). In this case, the second exam should hold the most probative value for them since it is closest to separation. Additionally, since this exam is rated 10% and two of the three exams rate 10%, it is fairly logical to assume that the DoD will rate the condition 10%. They could decide to rate it 30%, but this would be extremely rare with the evidence we have here. 10% is unquestionably more reasonable. It is, however, simply up to the Rating Authorities.

The VA’s rating works a bit differently. Instead of really looking at the condition over time, they are more concerned with the condition at the time of their examination (in this case the last exam). They will look at the other evidence when considering their rating, but since their exam hits the 10% and the last exam before that also was a 10%, it is pretty safe to say that they would definitely rate this condition as 10%.

In this case, both the DoD and the VA rated the condition the same. This does not always happen, but with the IDES process, it does happen quite a bit more than it used to since both the ratings for both VA and DoD disability are done at the same time now, close to separation.

Got it? There is a lot left up to interpretation, but hopefully with these steps, it may be easier to grasp how the decision-making works.

Now on to another example.

An active duty surgeon complained of constant itchiness across his entire body. Tests and examinations were performed, and no physical medical causes could be found. The itching continued to get worse, causing the service member to have trouble being still. Eventually he was referred to a psychiatrist who diagnosed him with somatic symptom disorder. Over the next 6 months, he developed a slight shaking in his hands that made him unable to hold a scalpel steady enough to perform surgeries, although he generally functioned well in every other aspect.

Three months later, he was separated from the service. At separation, he reported continued severe constant itchiness across his entire body with occasional trouble sleeping and the inability to keep his hands still. His mental functioning was fine, and his commander reported satisfaction with his job performance in every way except for surgery. The commander also noted that the service member was dedicated to his responsibilities and had a strong desire to remain in the military. At the VA exam 6 months after separation, the service member reported that he still had severe itchiness across his entire body and that his hands continued to shake. He also reported that he was employed as a professor at a medical university.

Okay, so this condition poses an interesting challenge. Before getting into the grey zones, let’s look at just the facts. There are roughly three time periods we can look at (3 exams: one before, one at or closest to, and one after the date of separation is the ideal number the Rating Authorities like to base things on. Other evidence is welcome and considered, but at least 3 exams is ideal. Two or less don't give as much sound evidence). The first is about 3 months before separation. The next exam was conducted at separation, and the last was conducted 6 months after separation.

Let’s start by making a table of all his symptoms or circumstances that provide evidence about his condition.

Exam →
Symptom/Circumstance ↓

3 months before

At separation

6 months after

The Ability to Care for Yourself

He could take care of himself.

He could take care of himself.

He could take care of himself.

Medications

Not mentioned

Not mentioned

Not mentioned

Symptoms

Hallucinations:
    – Itchiness
Hands Shaking

Hallucinations:
    – Itchiness
Trouble Sleeping
Hands Shaking

Hallucinations:
    – Itchiness
Hands Shaking

The Ability to Work

Could not perform surgeries and so could not function in his military duties.

Could not perform surgeries and so could not function in his military duties.

He was employed as a professor and had no problem with this new job.

Social Relationships

Not mentioned

Not mentioned

Not mentioned

 

The only thing that was not commented on in each exam was trouble sleeping. It was only mentioned at separation, and in a case like this, it is hard to know whether that truly came from the condition or because of having to separate from the military, etc. Since it wasn’t noted at any other time, however, it might be fair to assume that it wasn’t terribly severe, at least not severe enough to have a significant impact on his abilities.

Let’s next go through each exam and find the rating that is closest to the condition at that time.

First exam: Remember to start with the 100% rating and work backward until the majority of all conditions/symptoms are covered by the rating definition. You can click on the rating link in the last column of the table to be taken back to the rating discussion.

Symptom/Circumstance

3 months before

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

For 0%, 10% and 30% ratings, the individual is fully capable of taking care of himself.

0% - 30%

Medications

Not mentioned

If it’s not mentioned, we assume it’s perfectly normal.

0%

Symptoms

Hallucinations:
    – Itchiness
Hands Shaking

This is a bit complicated. He really only has the one mental symptom: hallucinations. The hallucination, however, is pretty severe since it is constant and definitely affects his physical abilities. Looking at just that symptom, it would warrant a 50% rating. Looking at the fact that there are no other real symptoms, however, makes it difficult to warrant a 50% rating since the rating for the symptoms needs to have more than one. A 30% is more likely, but there is one more factor – medications. A 30% rating for symptoms require that the symptoms be present despite any medications. Since medications are not mentioned, the most we can give is a 10%. (The Rating Authorities could decide, however, that a 30% is still warranted, but it is unlikely).

10%

The Ability to Work

Could not perform surgeries and so could not function in his military duties.

This is a bit more straightforward. Was he able to perform all the duties of his job? No. But he was able to satisfactorily perform the rest of his work just fine (his commander told us so. Often reports from commanders can give a good idea of the service member’s overall functioning, so they are often used when rating mental conditions). So, 100%-50% are definitely out since he is able to function in most ways. 30% seems to define it perfectly: overall able to perform his duties with occasional times when he cannot (in his case, the surgeries).

30%

Social Relationships

Not mentioned

Not mentioned.

0%

Overall Rating: 10%

 

Second exam:

Symptom/Circumstance

At separation

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

For 0%, 10% and 30% ratings, the individual is fully capable of taking care of himself.

0% - 30%

Medications

Not mentioned

If it’s not mentioned, we assume it’s perfectly normal.

0%

Symptoms

Hallucinations:
    – Itchiness
Trouble Sleeping
Hands Shaking

Again a bit complicated. We have an additional symptom now: the sleeping, but it’s not clear how serious it is. Regardless, however, he is still not taking medications. There’s not enough additional evidence to really affect the rating. Best to stay at 10%.

10%

The Ability to Work

Could not perform surgeries and so could not function in his military duties.

Same as first exam. 100%-50% are definitely out since he is able to function in most ways. 30% seems to define it perfectly: overall able to perform his duties with occasional times when he cannot (in his case, the surgeries).

30%

Social Relationships

Not mentioned

Not mentioned.

0%

Overall Rating: 10%

Last exam:

Symptom/Circumstance

6 months after

Rating Comparison

Rating

The Ability to Care for Yourself

He could take care of himself.

For 0%, 10% and 30% ratings, the individual is fully capable of taking care of himself.

0% - 30%

Medications

Not mentioned

If it’s not mentioned, we assume it’s perfectly normal.

0%

Symptoms

Hallucinations:
    – Itchiness
Hands Shaking

Nothing has changed except that trouble sleeping is not mentioned. Best to stay at 10%.

10%

The Ability to Work

He was employed as a professor and had no problem with this new job.

Here comes the big change. He is employable and functions absolutely fine in his new position. Basically, there is nothing to rate.  

0%

Social Relationships

Not mentioned

Not mentioned.

0%

Overall Rating: 10%


For this last exam, the average rating would be 0%. To qualify for a 0% rating, however, there has to be extremely mild or no symptoms. Since there are symptoms in this case, we think a 10% rating is most appropriate. Regardless of our opinion, however, the Rating Authorities could easily justify a 0% rating since he is fully employed in a good job and has no social problems. It’s just up to them.

Let’s determine the DoD Disability rating for this condition. This is an easy one. Each exam is 10%. It is unlikely for the DoD to give him something else since he is fully functional in every way except performing surgeries. They might argue a 0% with the evidence of this last exam, especially since being unable to perform surgeries does not decrease his ability to work since he is fully employed just a few months after separation. Really, the DoD could go either way, but we think it’s pretty safe to say that they will rate this condition as 10%.

How will the VA rate the condition? The VA bases its rating mostly on its exam—the one 6 months after separation. He had a job, was fully functional, and only had his few symptoms. This rating will most likely be 10% with the evidence of the DoD examinations, but the Rating Authorities could judge it a 0%.

You now should have a pretty good idea of how this rating system works. It’s not a clear-cut math equation, unfortunately. These ratings we’ve given in these examples are just a guess at what the Rating Authorities would actually rate them. More often than not, we are probably right. If we were the Rating Authority, this is what the guy would get. Since we aren’t, we don’t know what opinions the members on the Rating Authority rating your condition will have. Sorry we can’t be more specific than this.

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Mental Conditions that are Not Ratable/Personality Disorders

There are some mental conditions that are not ratable. These are conditions that, in most cases, either do not seriously limit the overall functioning of the person, are caused by natural causes (and thus not service connected), or are caused by the person’s own bad decisions.

The following cannot be rated:

Mental retardation or learning disabilities
Personality disorders: Behaviors that clash with social expectations like stuttering, always laughing too loud, always invading people’s physical space—anything that makes them significantly stand out. Often some of the symptoms of personality disorders are present in other mental conditions. If, however, only a personality disorder is diagnosed, then it cannot be rated. These disorders are further explained below.
Impulse control disorder (ICD) is defined by the inability to resist any urge or impulse that could cause harm to yourself and/or others.
Substance abuse. No drug, alcohol or any other addictive substance abuse can be rated at all.
– All other abuse disorders or addictions (excluding anorexia or bulimia).

These conditions and any symptoms they cause CANNOT be rated. Most of the time these conditions are present in addition to another mental condition, and some are caused by other mental conditions. Even if they help make another condition unfitting, these conditions and their symptoms cannot be rated.

So let’s say a service member has schizophrenia that causes him to become a kleptomaniac. While being a kleptomaniac could easily cause him to be fired from a job, it is not ratable. The schizophrenia is ratable, but when analyzing the condition for a rating, the fact that he lost his job because of stealing things cannot affect the rating. The schizophrenia can only be rated based on how severe it would be without the kleptomania.

Any symptom or circumstance that is directly caused by one of these conditions cannot be taken into account when rating, even though it may make him unfitting.

Personality disorders are divided into 3 main groups:

Odd or Eccentric Disorders

Paranoid Personality Disorder is a condition where the individual is always irrationally suspicious of others.
Schizoid Personality Disorder is a condition where the individual is not interested in social interaction or relationships.
Schizotypal Personality Disorder is a condition where the individual behaves or thinks in odd ways, like mumbling or saying completely unrelated things in a conversation.

Dramatic, Emotional or Erratic Disorders

Antisocial Personality Disorder is a condition where the individual doesn’t care about the basic rights of others. People with this condition are often doing illegal things or violating people.
Borderline Personality Disorder is a condition where the individual sees everything as distinctly right or wrong (no gray area). These people will often have trouble with relationships and with their own self-esteem and self-identity.
Histrionic Personality Disorder is a condition where the individual is constantly seeking attention. People with this condition will do radical and often inappropriate things to get attention.
Narcissistic Personality Disorder is a condition where the individual is excessively self-involved. These individuals care little for others, are often deeply involved in grand dreams and fantasies, and feel like others should always admire them.

Anxious or Fearful Disorders

Avoidant Personality Disorder is a condition where the individual is very shy, feels inadequate, and is very sensitive to rejection. People with this condition suffer from excessively low self-esteem and never feel that they are good enough. They often avoid any kind of social interaction.
Dependent Personality Disorder is a condition where the individual depends too much on others to meet their emotional and physical needs. This dependency can be fixed on one particular person or multiple people. A person with this condition would not be able to make any decisions for himself or perform various tasks.
Obsessive-Compulsive Personality Disorder is a condition where the individual is very strict about following every rule and being extremely orderly. A person with OCPD tends to be a perfectionist. They may withdraw emotionally when they are not able to control a situation. This can interfere with their ability to solve problems and form close relationships.

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Adjustment Disorders

Code 9440: Chronic adjustment disorder is a condition that is caused by a particularly stressful period or event. Symptoms often include sadness, anxiety, hopelessness, anxiousness, trouble sleeping, etc. This condition is rated based on the Psychological Rating System.

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Dissociative Disorders

Dissociative disorders cause the brain to disconnect with various aspects of a person’s personality. Symptoms could include loss of memory, personality, identity, awareness and/or numerous other defining characteristics. All dissociative disorders are rated based on the Psychological Rating System.

Code 9416: Dissociative amnesia and dissociative identity disorder (multiple personality disorder) are both rated under this code. Amnesia is the loss of memory, and can be long- or short-term memory. Identity disorder is a condition where a person has at least 2 separate personalities that alternately control the person’s actions.

Code 9417: Depersonalization disorder and derealization disorder are both rated under this code. Depersonalization disorder is a condition where a person feels disconnected from his physical self. For example, he may feel like he is not in control of his body, that he is not a part of his body, that he is separated from his feelings and thoughts, that he cannot connect with his personality, that his reflection in a mirror is not actually him, etc. Derealization disorder is a condition where a person feels disconnected from the world, like it is fake or unreal. Both of these conditions are often the result of severe emotional and mental trauma. 

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Somatoform Disorders

Somatoform disorders are conditions that cause physical symptoms when there are no physical conditions or problems. All somatoform disorders are rated based on the Psychological Rating System.

Code 9421: Somatic symptom disorder is a condition where the person regularly sees many different doctors complaining of pain, sexual problems, stomach problems, or nerve problems. These symptoms do actually exist in the patient, but there are no physical causes. The most common explanation, although not proven, is that the physical symptoms are the brain’s way of dealing with stress.

Code 9424: Conversion disorder (functional neurological symptom disorder) is a condition where there are neurological symptoms without any neurological causes. Symptoms can include blindness, fits, numbness, paralysis and other nerve conditions.

Code 9425: Illness anxiety disorder is a condition where a person (a "hypochondriac") obsessively believes that he has a serious medical condition (often the believed medical condition changes regularly), but there is nothing at all wrong with his body.

Code 9422: Other somatic symptoms or similar disorders that are clearly defined, like pain disorder, are rated under this code.

Code 9423: Other somatic symptoms or similar disorders that are not clearly defined are rated under this code. Basically, this code is used if somatic symptoms are present, but no particular disorder is diagnosed.

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Mood Disorders

Mood disorders include anything that is directly related to the emotions. All mood disorders are rated based on the Psychological Rating System.

Code 9431: Cyclothymic disorder (cyclothymia) is a condition where you alternate between very happy, euphoric moods and depression. It is like being bipolar, but the highs and lows are not as severe. There can also be periods of normal moods in between each high and low period.

Code 9432: Bipolar disorder is a condition where you fluctuate between extreme happiness (mania) and extreme depression. There is more to bipolarity than just mood, however. When experiencing mania, the entire body works harder and stronger. The brain speeds up and high energy levels are present. This can cause you to be radically impulsive and make bad decisions and behave inappropriately.

Code 9433: Persistent depressive disorder (dysthymia or “chronic depression”) is a condition where there is depression that lasts a long time (at least 2 years), but is less severe than major depressive disorder.

Code 9434: Major depressive disorder (clinical depression) is a condition characterized by severe depression that causes low self-esteem, low energy levels, no motivation, no interest in social activities, etc.

Code 9435: All other depressive disorders are rated under this code.

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Psychotic Disorders

Psychotic disorders are mental conditions that cause the person to believe things that are not true. They are separated from reality in some way. This is more than just forgetting things, but believing in a different reality. All psychotic disorders are rated based on the Psychological Rating System.

Code 9201: Schizophrenia is characterized by delusions, a separation from reality, and a separation from logical thought processes and communication. There are many different severities and types of schizophrenia. 

Code 9208: Delusional disorder is a condition where a person has delusions that are not illogical, just not real. Normally these delusions are small and do not interfere with the person’s overall functioning. A person diagnosed with schizophrenia cannot also be diagnosed with this condition.

Code 9211: Schizoaffective disorder is a condition that is a combination of a psychotic disorder and a mood disorder. The mood can be an extreme high or an extreme low or both. In addition to the mood, the individual has flawed mental processes that can cause hallucinations, paranoia, and delusions.

Code 9210: All other psychotic disorders or unspecified schizophrenic disorders are rated under this code.

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Cognitive Disorders

Cognitive disorders are conditions that cause problems with thought processes, the ability to solve problems, memory, learning new things, etc. Often cognitive disorders come from injury to the brain. In cases like this, the cognitive disorder can be rated in addition to any other ratings for all other conditions caused by the brain injury. Only one psychiatric condition can be rated, however. All cognitive disorders are rated based on the Psychological Rating System.

The majority of the following cognitive disorders are neurocognitive disorders, like dementia. All areas of mental functioning can be affected by a neurocognitive disorder. Symptoms can include memory loss, inability to communicate, confusion, disorientation, loss of logical thinking, etc.

Code 9300: Delirium is a condition characterized by severe confusion. This is often a symptom of Alzheimer’s. It can come on suddenly and last for a few hours or days. Some episodes can be worse than others.

Code 9301: Neurocognitive disorders due to HIV or other infections are a severe loss of mental ability because of an infection. For an infection to cause a neurocognitive disorder, it must be present over a long period of time. The neurocognitive disorder will slowly develop with the progress of the infection. Infections that can cause neurocognitive disorders include HIV, syphilis, brain infections and more. 

Code 9304: Neurocognitive disorders due to head injury are a severe loss of mental ability because of an injury to the brain. In cases of head injuries, the neurocognitive disorder usually comes on suddenly, but it can also get worse or better over time. 

Code 9305: Vascular neurocognitive disorders are a severe loss of mental ability caused by the brain not getting enough blood. For a vascular neurocognitive disorder, the lack of blood to the brain must be present over a long period of time, and the neurocognitive disorder will develop slowly. 

Code 9312: Neurocognitive disorders due to Alzheimer’s are a severe loss of mental ability because of the Alzheimer’s disease. In cases of Alzheimer’s, the neurocognitive disorder will usually grow gradually over time as the disease gets worse. 

Code 9326: Neurocognitive disorders due to medications, substances, or any other medical condition are a severe loss of mental ability because of another medical condition or substance. Medical conditions that can cause a neurocognitive disorder include endocrine system disorders, metabolic disorders, Pick’s disease, brain tumors, and more. Substance abuse, like drugs, alcohol, etc., can also cause a neurocognitive disorder. All areas of mental functioning can be affected by a neurocognitive disorder.

Code 9310: All other neurocognitive disorders are rated under this code.

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Anxiety Disorders

Anxiety disorders are mental conditions that are characterized by severe fear, worry, and unease. All the following anxiety disorders are rated based on the Psychological Rating System. Post-traumatic stress disorder (PTSD) is also considered an anxiety disorder, but is dealt with a bit differently and discussed in the next section.

Code 9400: Generalized anxiety disorder is severe, uncontrollable worry about day-to-day things. This worry is often irrational.

Code 9403: All phobias, including social anxiety disorder (or social phobia), are rated under this code. Phobias are irrational, severe fears that are tied to specific things. Phobias can range from fear of things like spiders, strangers, blood, etc., to fear of situations like big crowds, flying, leaving the house without your pants on, etc. Phobias are more than just basic fear or dislike. They are often so severe that they lead to extreme behaviors like violence or panic attacks. A specific phobia must be diagnosed in order to be rated under this code.  

Code 9404: Obsessive-compulsive disorder is a condition where anxiety causes repetitive actions that are performed to reduce the fear. For example a person afraid of germs will wash their hands obsessively. Often the repetitive action is associated with numbers: washing their hands 14 (20, 5, whatever) times. These repetitive actions can interfere with the ability to work or perform daily tasks.

Code 9412: Panic disorder and/or agoraphobia are rated under this code. Panic disorder is a condition where severe panic attacks occur in stressful or fearful situations. Panic attacks are episodes of severe fear that causes the inability to act rationally. With panic disorder, the panic attacks can occur at any time and can last for a few minutes to many months. Agoraphobia is not the same as panic disorder, but often exists along with panic disorder. It is the fear of public places that can also cause panic attacks.

Code 9411: Post-traumatic stress disorder is an anxiety condition that is caused by experiencing a traumatic event. A traumatic event can be defined as many different things, including car crashes, combat, death, abuse, extreme fear caused by an event, physical trauma, sexual abuse, or any other event that conflicts with an individual’s moral/natural ideals.

There are many requirements that a condition must meet before it can be considered PTSD. Not everyone exposed to a traumatic event can be said to have PTSD. Full requirements for diagnosing PTSD can be found on our PTSD page. If the condition fulfils all the requirements, it can then be diagnosed as PTSD. PTSD is rated on the same rating system as all other mental conditions (the Psychological Rating System), but there is one difference that the DoD uses when rating PTSD.

For all PTSD cases, the DoD is required to put the service member on TDRL for 6 months before being permanently separated. For these 6 months, the DoD must rate the PTSD condition as 50%, regardless of its severity. At the end of the 6-month period, the condition will be re-evaluated and then a permanent rating (based on the Psychological Rating System) will be given and the service member will be officially separated from the military. If the condition fulfills all the requirements, it can then be diagnosed as PTSD.

This 6-month period is required so that the DoD’s rating can reflect the severity of the condition with the transition to civilian life. For some service members, being out of a military environment could make their symptoms better. For others, the stress of trying to get another job and not being in a regularly controlled environment could make their symptoms worse. Adding this 6-month TDRL period helps make sure that the rating the DoD gives for this condition is as accurate and suitable in each case as possible.

Code 9410: All other specific anxiety disorders that are not noted elsewhere are rated under this code. 

Code 9413: All other unspecified anxiety disorders are rated under this code. Basically, any anxiety disorder that doesn’t have a particular name is rated here.

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Eating Disorders

Only eating disorders that cause extreme weight loss can be rated. They are both rated on the same system.

Code 9520: Anorexia nervosa is an eating disorder where excessive weight loss is caused by not eating at all or very little.

Code 9521: Bulimia nervosa is an eating disorder where excessive weight loss is caused by throwing up any food that is eaten.

The ratings for eating disorders:

An important part of rating eating disorders is the percentage of minimum weight. The minimum weight is the absolute least that someone that height should weigh. This is not the normal expected weight, but the absolute minimum. The ratings are based on the percent of the minimum weight. So if someone weighs less than the minimum, it is rated on the percentage of their actual weight to the minimum weight.

The following chart notes the height, absolute minimum weight and the various percentages that are important for rating. The same chart is used for both men and women (Why? I don't know).

Height

Minimum Weight
(in pounds)

85% of minimum
(in pounds)

80% of minimum (in pounds)

4’ 10”

91

77

73

4’ 11”

94

80

75

5’

97

82

78

5’ 1”

100

85

80

5’ 2”

104

88

83

5’ 3”

107

91

86

5’ 4”

110

94

88

5’ 5”

114

97

91

5’ 6”

117

99

94

5’ 7”

121

103

97

5’ 8”

125

106

100

5’ 9”

128

109

102

5’ 10”

132

112

106

5’ 11”

136

116

109

6’

140

119

112

6’ 1”

144

122

115

6’ 2”

148

126

118

6’ 3”

152

129

122

6’ 4”

156

133

125

6’ 5”

160

136

128

6’ 6”

164

139

131

6’ 7”

168

143

134

6’ 8”

173

147

138

Add 6 pounds for every additional inch to find the minimum for men and 5 pounds for every additional inch to find the minimum for women.

 

Also for rating, an “incapacitating episode” is a period of bed rest that is prescribed by a physician.

The ratings:

A 100% rating is given if your weight is less than 80%, and there were incapacitating episodes adding up to 6 weeks or more a year, and the condition required hospitalization for nutrition or tube feeding 3 or more times a year.

A rating of 60% is given if your weight is less than 85% of the minimum, and there were incapacitating episodes adding up to 6 weeks or more a year.

A 30% rating is given if your weight is less than 85% of the minimum, and there were incapacitating episodes adding up to between 2 and 6 weeks a year.

A rating of 10% is given if an eating disorder is diagnosed, there were incapacitating episodes adding up to 2 weeks or less a year, and there is binge eating with vomiting or other ways to prevent weight gain or you are resistant to gaining weight even if you are below your minimum weight.

If there are no incapacitating episodes, then the condition is rated 0%.

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Other Mental Disorders

All other mental conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQs for Mental Disorders

Here are the Disability Benefits Questionnaires (DBQs) used for mental disorders: Eating Disorders DBQ, PTSD DBQ, and Mental Disorders (other) DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the mental disorder (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

For conditions of the brain, see The Central Nervous System page. For conditions of the skull, see The Skull page, and for mental conditions caused by trauma to the brain, see the Traumatic Brain Injury (TBI) page.

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