claims, on-the-job training is the most effective means of training members of rating teams (GAO, 2001).
VA asked the committee to address several issues related to the rating criteria currently used to rate disability for veterans with service-connected PTSD. These included whether the current rating schedule regulation, which applies to all mental disorders, is appropriate for evaluating PTSD, what criteria should be included in any revised schedule, and whether there are other evaluation methods in existence that would be more appropriate than the one VA currently uses. In addition to addressing these issues, the committee also offers some comments on the training of raters.
The section begins with discussions of three topics—the rating criteria for PTSD and other conditions, trends in disability compensation, and the considerations underlying how other disability-benefits systems evaluate mental disorders—that lay the groundwork for the committee’s findings and conclusions.
Table 5-2 summarizes the VASRD rating criteria for several dozen conditions, with a particular focus on those that, like PTSD, are symptom-based or have a relapsing/remitting course. As the table illustrates, there is considerable variability among the conditions in how percentage ratings are determined. The variability is manifested in several ways, including:
The full range of disability ratings percentages (e.g., 10 percent, 20 percent, 30 percent, … , 100 percent) is seldom used. Instead, it is typical to employ somewhere between one13 and three to five categories.
Within a specific disorder, equivalent increases in percentage ratings do not necessarily correspond to equivalent increases in disease severity (that is, going from 10 to 30 percent may represent a very different change in disease severity than going from 30 to 50 percent or from 70 to 90 percent).
The degree of disability represented by a particular rating level (30 percent, for example) does not appear to be consistent across different disorders.
These issues may be traced to several factors. First and most important,