Mental Disorders
NOTE: All MENTAL HEALTH diagnoses will typically be rated as one condition. If you are currently rated for mental health and file for another, this will not result in a new rating. This may result in an increase or reduction so be careful.
Examples:
Diagnosed insomnia and PTSD.
Diagnosed adjustment disorder and depression.
etc.
Although the Rating Authorities are able to interpret, they must show evidence from the medical reports supporting their rating decision. Evidence may also be in the form of a personal statement as well as spouse, family, friends and co-workers describing symptoms observed as well as impact on work and quality of life.
The following is a list of important terms that are used when rating psychological conditions.
Occupational and social impairment carry the most weight when deciding a rating.
– 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.
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
– Obsessive-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 service connected mental condition required 21 days or more of hospitalization or inpatient care, 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.
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.
It should be noted that a coexisting or comorbid mental health condition may be ratable even if non-ratable personality disorder exists.
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 general mental health rating system.
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 general mental health 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.
Somatoform Disorders (Pain)
Somatoform disorders are conditions that cause physical symptoms when there are no physical conditions or problems. All somatoform disorders are rated based on the general mental health 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.
Mood Disorders
Mood disorders include anything that is directly related to the emotions. All mood disorders are rated based on the general mental health 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.
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 general mental health 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.
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 general mental health 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 0305: 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.
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 general mental health rating system. Post-traumatic stress disorder (PTSD) is also considered an anxiety disorder.
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 stressors, 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. 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, but there is one difference that the DoD uses when rating PTSD.
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.