and pension (C&P) examination, the evaluation of PTSD disability claims, and other PTSD compensation issues.


The committee reached a series of findings and conclusions that form the foundation for its recommendations for action and further research. In addition, it drew some general observations from its examination of VA’s PTSD disability compensation system. The sections below are synopses of the content of Chapters 47 and highlight their major points.

The PTSD Compensation and Pension Examination

For veterans presenting for PTSD compensation, the C&P examination provides a clinical evaluation by a mental health professional where information is gathered to:

  • establish the presence or absence of a diagnosis of PTSD,

  • determine the severity of PTSD symptoms, and

  • establish a logical relationship between exposure to military stressors and current PTSD symptomatology (VBA, 2002).

While it develops much of the same information as a conventional mental-health examination, the intent of the C&P examination is to generate documentation for disability evaluation purposes rather than to inform a treatment strategy.

VA identified several issues related to the conduct of C&P exams that were of particular interest: the role of the Global Assessment of Functioning (GAF) score2 in evaluating PTSD, the division of symptoms among PTSD and comorbid disorders, the value of standardized testing in the conduct of examinations, and the scientific literature regarding the length of time between the occurrence of the stressor thought to be associated with an applicant’s PTSD and the appearance of symptoms.

The committee concluded that the GAF score has limited usefulness in the assessment of the level of disability for PTSD compensation. The score is only marginally applicable to PTSD because of its emphasis on the symptoms of mood disorder and schizophrenia and its limited range of symptom content. The social and functional domains of the score provide some information, but if these are the sole domains of interest, better measures of


The GAF score is a standardized measure of symptoms and psychosocial function, with 100 representing superior mental health and psychosocial function and 0 representing the worst possible state.

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