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



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PTSD Compensation and Military Service 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

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PTSD Compensation and Military Service 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]

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PTSD Compensation and Military Service § 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

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PTSD Compensation and Military Service 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

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PTSD Compensation and Military Service 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

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PTSD Compensation and Military Service 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]