Proposed Changes to the Mental Health Ratings

PRELIMINARY RATINGS CHART FOR PROPOSED MENTAL HEALTH

Proposed Changes to the Mental Disorder Ratings

On February 15th, 2022, the VA published proposed changes to the Mental Disorder ratings. 

The VA last changed this section of the VASRD in 2015 when they updated the terminology to reflect the newly-published (at that time) Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). They didn’t, however, change the Psychological Rating System. 

The VA is now proposing changes to the Psychological Rating System in order to update it to better reflect modern treatments, understandings, and functional disabilities resulting from Mental Disorders. Research has shown that the current system does not properly compensate veterans for the loss of earning capacity, so the changes are also designed to more fairly and completely compensate veterans based on a more accurate measurement system.

With each set of proposed changes, the VA allows a period in which comments can be submitted. The VA then takes each comment into consideration and makes any additional changes that are warranted before publishing the final ruling. 

COMMENTING IS CLOSED:

AQ82-Proposed Rule - Schedule for Rating Disabilities: Mental Disorders

NOTE: As of September 23, 2022 no actual change date has not been published. Once the VA has finalized the proposed changes, there will be 60 days before any changes actually take effect. Check here at this website for any updates. 

•  VA target date of Spring 2025 for final rule publication.

The following are the VA’s new proposed changes to the Psychological Rating System. 

The changes are based on two assessment systems that are widely used today:  WHODAS 2.0 and CAPS-5. 

WHODAS 2.0 (World Health Organization Disability Assessment Schedule 2.0) “assesses the ability to perform tasks in six functional domains by measuring the impact of a disability across various life functions and assigning a score for each domain.”

CAPS-5 (Clinician-Administered PTSD Scale for DSM-5) “is a 30-item structured interview... that is used to render a diagnosis of PTSD and assess the severity of the 20 PTSD symptoms.” 

By combining the principles used in these two systems, the VA feels that it will “create a common language between clinicians and adjudicators, which VA believes will lead to more efficient and accurate adjudication of claims for mental disorders.”

The VA also states that the new “criterion should generally lead to more generous compensation for veterans than the current rating formula.” And this is true. You will find that the new changes will allow for higher ratings for mental disorders across the board, with less strict requirements for the higher ratings and a required minimum rating of 10% for any diagnosed mental disorder. 

Let’s jump in to the changes and see how the new system works.

First change:  Currently Eating Disorders are rated differently than all other Mental Disorders. The VA proposes to eliminate the separate rating system for Eating Disorders and simply rate them along with all other Mental Disorders on the proposed Psychological Rating System to ensure consistent, fair ratings based on how they impact daily functioning. 

Since none of the condition codes will be changing, we’ll simply present the proposed rating system below. You can find the current Psychological Rating System on our site to compare the changes. 

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-Proposed- Important Rating Principles

Only a single rating can be given for your overall psychological condition. If multiple mental disorders are diagnosed, they will be combined into a single condition when rating and all of the psychological symptoms will be used together to assign the rating.

Mental disorders are rated based on how they affect your social and occupational functioning. Can you hold a steady job? Do you have committed or stable relationships? The more the condition affects your social and occupational life, the higher the rating.

The severity of the condition "over the past month" is used to determine the rating. Because of this, you want to make sure that this month is clearly and thoroughly documented by your mental health provider. In most cases, this month will be the month prior to claim submission for the VA or the month prior to referral to the MEB for the DoD. 

All ratings are based on the symptoms that remain after treatment, so if medication decreases your symptoms, then the ratings will be based on the decreased symptoms, not on the symptoms that would be present without medication.

If a condition has both a mental and physical aspect, then it is rated under the mental or the physical, whichever best defines the overall disability. The exception to this rule is neurocognitive disorders (dementia), which can be rated in addition to a physical condition from the same cause (i.e. head injury, etc.).

-Proposed- The Psychological Rating System

A 100% rating is given if a Level 4 is given in one or more domains or if a Level 3 is given in two or more domains.

A 70% rating is given if a Level 3 is given in one domain or if a Level 2 is given in two or more domains.

A 50% rating is given if a Level 2 is given in one domain. 

A 30% rating is given if a Level 1 is given in two or more domains.

The minimum rating for any diagnosed Mental Disorder is 10%.

Criterion for Determining Domain Levels

All domains are evaluated based on symptoms present over the past month. Compare the criteria for each domain to the levels of impairment to assign a level to each of the 5 domains. Then use these domain levels to assign a rating based on the ratings noted above.

NOTE: If a single symptom applies to multiple domains, it can only be used to assign a level to one of the domains, whichever results in the higher level.

Levels of Impairment

·       Level 4. Total impairment 25% or more of the time.

·       Level 3. Severe impairment 25% or more of the time, or total impairment less than 25% of the time.

·       Level 2. Moderate impairment 25% or more of the time, or severe impairment less than 25% of the time.

·       Level 1. Any mild impairment, or moderate impairment less than 25% of the time.

·       Level 0. No impairment.

Domain Criteria

Domain 1. Cognition. This domain covers mental processes having to do with learning, communicating, and understanding. It includes things like memory, concentration, attention, goal setting, speed of information processing, planning, organizing, prioritizing, problem solving, judgment, making decisions, and the ability to adapt.

Criteria

·      Total Impairment: Incapable of even the most basic tasks in one or more aspects of cognitive functioning. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. 

·      Severe Impairment: Serious difficulties in one or more aspects of cognitive functioning. These symptoms significantly interfere with tasks, activities, or relationships.

·      Moderate Impairment: Obvious difficulties in one or more aspects of cognitive functioning. These symptoms interfere with tasks, activities, or relationships.

·      Mild Impairment: Slight difficulties in one or more aspects of cognitive functioning. These symptoms do not interfere with tasks, activities, or relationships.

·      No Impairment: No difficulties in any aspect of cognitive functioning.

Domain 2. Interpersonal interactions and relationships. This domain covers mental processes having to do with participation in society (being involved in social activities like church, book club, sports teams, politics, etc.) and interacting with other people, whether formally (co-workers/supervisors) or informally (friends/strangers). 

Criteria

·      Total Impairment: Incapable of even the most basic tasks in one or more aspects of interpersonal functioning. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. 

·      Severe Impairment: Serious difficulties in one or more aspects of interpersonal functioning. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or things being done to try to ease the social situations.

·      Moderate Impairment: Obvious difficulties in one or more aspects of interpersonal functioning. These symptoms interfere with tasks, activities, or relationships.

·      Mild Impairment: Slight difficulties in one or more aspects of interpersonal functioning. These symptoms do not interfere with tasks, activities, or relationships.

·      No Impairment: No difficulties in any aspect of interpersonal functioning. Able to have relationships and social interactions.

Domain 3. Task completion and life activities. This domain covers mental processes having to do with completing tasks and performing activities, whether at work, school, home, socially, caregiving, etc.

Criteria

·      Total Impairment: Incapable of even the most basic tasks in one or more aspects of task and activity functioning. Profound difficulties in two or more aspects of task and activity functioning, one of which must be vocational. Tasks were not able to be completed even with accommodations because of overwhelming stress.

·      Severe Impairment: Serious difficulties in two or more aspects of task and activity functioning. Tasks were able to be completed with significant stress and accommodations.

·      Moderate Impairment: Obvious difficulties in one or more aspects of task and activity functioning. Tasks were able to be completed with significant stress or accommodations.

·      Mild Impairment: Slight difficulties in one or more aspects of task and activity functioning. Tasks were able to be completed with minor stress or minor accommodations.

·      No Impairment: No difficulties in any aspect of task and activity functioning. No accommodations needed.

Domain 4. Navigating environments. This domain covers mental processes having to do with getting around and dealing with spatial environments, including leaving home, independently moving in surroundings, navigating new environments, driving, using public transportation, being in confined or crowded spaces, etc.  

Criteria

·      Total Impairment: Incapable of even the most basic tasks in one or more aspects of navigating environments. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships. 

·      Severe Impairment: Serious difficulties in one or more aspects of navigating environments. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or assistance.

·      Moderate Impairment: Obvious difficulties in one or more aspects of navigating environments. These symptoms interfere with tasks, activities, or relationships.

·      Mild Impairment: Slight difficulties in one or more aspects of navigating environments. These symptoms do not interfere with tasks, activities, or relationships.

·      No Impairment: No difficulties in any aspect of navigating environments. Able to navigate and function in any type of environment.

Domain 5. Self-care. This domain covers mental processes having to do with taking care of yourself, including things like dressing, eating, hygiene, etc. 

Criteria

·      Total Impairment: Incapable of even the most basic tasks in one or more aspects of self-care. These symptoms do not respond to treatment and completely interfere with tasks, activities, or relationships, even with coping techniques or assistance. 

·      Severe Impairment: Serious difficulties in one or more aspects of self-care. These symptoms significantly interfere with tasks, activities, or relationships, even with coping techniques or assistance.

·      Moderate Impairment: Obvious difficulties in one or more aspects of self-care. Without assistance or coping techniques in place, these symptoms interfere with tasks, activities, or relationships.

·      Mild Impairment: Slight difficulties in one or more aspects of self-care. These symptoms do not interfere with tasks, activities, or relationships.

·      No Impairment: No difficulties in any aspect of self-care. Able to appropriately care for themselves.