The VA's overview of how mental disorders are rated with notes.
§ 4.126 Evaluation of disability from mental disorders.
(a) When evaluating a mental disorder, the rating agency shall consider 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.
💡Annotation: Despite this holistic language in the regulation, beware of C&P evaluations resulting in an effective date of compensation as of the date of the evaluation. This is a common VA error, where the VA relies on the idea that the evidence supporting the claim only came to exist at the moment the C&P evaluation was conducted. This is an obvious error if the examiner him or herself relied on “all the evidence of record that bears on occupation and social impairment.” In that case, the effective date should be the date the claim was filed or the date of the earliest evidence supporting the evaluators conclusion.
(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.
💡Annotation:
This is a confusingly written paragraph, but it should be read to favor veterans. When we discuss the actual rating criteria, there are primary differences in the appropriate rating based on “occupational and social impairment” at each level of compensable rating. Read unfavorably, it could be interpreted to mean that an individual with extraordinary levels of social impairment secondary to a severe mental health impairment would not be entitled to any compensable rating if they don’t also have an “occupational” impairment. Instead, this paragraph should be read in the inverse. An individual with occupational impairment should not receive a lower rating solely on the basis of a relatively more intact level of social functioning. This is extremely important, as individuals with severe psychiatric impairment may self-select their social interactions so that outwardly, they may appear less limited. On the other hand, an individual with social limitations would struggle in work environments requiring interaction with coworkers, supervisors, or the general public, and so this paragraph should always be interpreted in the way that favors an individual veteran’s condition.
(c) Neurocognitive 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 neurocognitive disorders (see § 4.25).
💡Annotation
This is important when considering the impact of traumatic brain injuries, strokes or other neurocognitive impairments. It is most relevant when discussing visual, manipulative, pain-related (like headaches) or other non-psychiatric symptoms. The VA will try to blend these conditions into a single rating. This paragraph specifies when non-psychiatric symptoms should be rated separately.
(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).
💡Annotation
This refers primarily to somatic symptom disorders or conversion disorders. So for example, if an individual experiences psychosomatic headaches, with no known cause, whether the symptoms are better represented by the neurological rating for migraines or the mental health ratings will be determined by this paragraph. This provides an opportunity for advocacy, and somatic impairments shouldn’t be ignored when there are conditions with little known cause outside mental health.
(Authority: 38 U.S.C. 1155)
[61 FR 52700, Oct. 8, 1996, as amended at 79 FR 45099, Aug. 4, 2014]