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PTSD Compensation and Military Service (2007)

Chapter: Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders

« Previous: Appendix A Committee on Veterans' Compensation for Posttraumatic Stress Disorder Public Meeting Agendas
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×

APPENDIX B
Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders

TITLE 38: PENSIONS, BONUSES, AND VETERANS’ RELIEF

Part 4—Schedule for Rating Disabilities


Subpart B—Disability Ratings

Mental Disorders

§ 4.125
Diagnosis of mental disorders

(a) If the diagnosis of a mental disorder does not conform to DSM-IV or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis.


(b) If the diagnosis of a mental disorder is changed, the rating agency shall determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. If it is not clear from the available records what the change of diagnosis represents, the rating agency shall return the report to the examiner for a determination.


(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.126
Evaluation of disability from mental disorders

(a) When evaluating a mental disorder, the rating agency shall consider

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×

the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination.


(b) When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment.


(c) Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see §4.25).


(d) When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14).


(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.128
Convalescence ratings following extended hospitalization

If a mental disorder has been assigned a total evaluation due to a continuous period of hospitalization lasting six months or more, the rating agency shall continue the total evaluation indefinitely and schedule a mandatory examination six months after the veteran is discharged or released to non-bed care. A change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.


(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

§ 4.129
Mental disorders due to traumatic stress

When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran’s release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran’s discharge to determine whether a change in evaluation is warranted.


(Authority: 38 U.S.C. 1155)

[61 FR 52700, Oct. 8, 1996]

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
§ 4.130
Schedule of ratings—mental disorders

The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. The schedule for rating for mental disorders is set forth as follows:

Schizophrenia and Other Psychotic Disorders

9201 Schizophrenia, disorganized type

9202 Schizophrenia, catatonic type

9203 Schizophrenia, paranoid type

9204 Schizophrenia, undifferentiated type

9205 Schizophrenia, residual type; other and unspecified types

9208 Delusional disorder

9210 Psychotic disorder, not otherwise specified (atypical psychosis)

9211 Schizoaffective disorder

Delirium, Dementia, and Amnestic and Other Cognitive Disorders

9300 Delirium

9301 Dementia due to infection (HIV infection, syphilis, or other systemic or intracranial infections)

9304 Dementia due to head trauma

9305 Vascular dementia

9310 Dementia of unknown etiology

9312 Dementia of the Alzheimer’s type

9326 Dementia due to other neurologic or general medical conditions (endocrine disorders, metabolic disorders, Pick’s disease, brain tumors, etc.) or that are substance-induced (drugs, alcohol, poisons)

9327 Organic mental disorder, other (including personality change due to a general medical condition)

Anxiety Disorders

9400 Generalized anxiety disorder

9403 Specific (simple) phobia; social phobia

9404 Obsessive compulsive disorder

9410 Other and unspecified neurosis

9411 Post-traumatic stress disorder

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×

9412 Panic disorder and/or agoraphobia

9413 Anxiety disorder, not otherwise specified

Dissociative Disorders

9416 Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple personality disorder)

9417 Depersonalization disorder

Somatoform Disorders

9421 Somatization disorder

9422 Pain disorder

9423 Undifferentiated somatoform disorder

9424 Conversion disorder

9425 Hypochondriasis

Mood Disorders

9431 Cyclothymic disorder

9432 Bipolar disorder

9433 Dysthymic disorder

9434 Major depressive disorder

9435 Mood disorder, not otherwise specified

Chronic Adjustment Disorder

 

Rating

9440 Chronic adjustment disorder General Rating Formula for Mental Disorders: Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name

100

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×

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

70

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

50

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

30

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication

10

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

0

(Authority: 38 U.S.C. 1155)

[9, Oct. 8, 1996]

Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 215
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 216
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 217
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 218
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 219
Suggested Citation:"Appendix B Federal Regulations Related to VA Compensation of PTSD and Other Mental Disorders." Institute of Medicine and National Research Council. 2007. PTSD Compensation and Military Service. Washington, DC: The National Academies Press. doi: 10.17226/11870.
×
Page 220
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The scars of war take many forms: the limb lost, the illness brought on by a battlefield exposure, and, for some, the psychological toll of encountering an extremely traumatic event. PTSD Compensation and Military Service presents a thorough assessment of how the U.S. Department of Veterans Affairs evaluates veterans with possible posttraumatic stress disorder and determines the level of disability support to which they are entitled. The book presents a history of mental health disability compensation of military personnel and reviews the current compensation and pension examination procedure and disability determination methodology. It offers a number of recommendations for changes that would improve the fairness, consistency, and scientific foundation of this vital program. This book will be of interest and importance to policy makers, veterans affairs groups, the armed forces, health care organizations, and veterans themselves.

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