How the VA Rates Depression and Anxiety

This is part two. Part one, Mental Health Caused by Your Service-Connected Conditions, covers how depression and anxiety get service connected. This one covers how the VA rates them. A mental health rating can be a big part of a combined rating, and it can reach 100 percent on its own.

The free Claim Map shows the conditions the VA rates, with their diagnostic codes and rating percentages.

How the formula works

Depression, anxiety, and most other mental health conditions are rated with the General Rating Formula for Mental Disorders. The diagnosis does not change the math. Major depressive disorder (code 9434), unspecified depressive disorder (9435), generalized anxiety disorder (9400), persistent depressive disorder (9433), and chronic adjustment disorder (9440) all use it. So does post-traumatic stress disorder (PTSD).

The formula asks one question. How much do the symptoms get in the way of work and relationships? The VA's rating schedule calls that occupational and social impairment. The formula has six levels, from 0 to 100 percent. Here is its language at the 30, 50, and 70 percent levels.

30 percent:

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).

50 percent:

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.

70 percent:

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.

What those words mean for you

Read those lists again. Chronic sleep impairment. Depressed mood. Anxiety. Disturbances of motivation and mood. If you live with daily pain, you probably recognized yourself in there. The words "such symptoms as" mean the lists are examples, not checklists.

The rater has to weigh how often your symptoms come, how bad they are, and how long they last. The rating rests on all the evidence about work and social life, not just what the examiner saw in one appointment.

Two more rules. The diagnosis has to conform to the DSM-5, the manual used to diagnose mental disorders, and the exam findings have to support it. And the VA cannot rate the same symptom twice. Your pain is rated with the physical condition. The depression caused by the pain is a separate disability with its own symptoms. Once it is service connected, it is rated on its own.

The free Claim Map shows the rating percentages for each condition you choose.

The written playbook has a chapter for each of your main conditions, up to eight, with its rating ladder. Each one also shows what the Board granted and denied in cases like yours. See what the playbook covers.

What if you cannot work?

A separate rule allows a total rating when your service-connected conditions leave you unable to get or keep a substantially gainful job. Marginal work does not count. Earning no more than the Census poverty threshold for one person generally marks work as marginal. Work above that line can be marginal too, depending on the facts, such as a job in a family business or a sheltered workshop.

The rule also sets rating levels. You need one condition at 60 percent or more. With two or more conditions, you need one at 40 percent or more and a combined rating of 70 percent or more.

If your service-connected conditions keep you from working but your percentages fall short, that is not the end of it. The rule says rating boards should send those cases to the Director, Compensation Service, for extraschedular consideration, a review outside the usual levels. Ask for that in writing. A mental health rating is one of the things that carries a veteran there.

I'm not your representative. Read the rules, read the decisions, and file what is true.