Friday, March 11, 2022

VA Proposes Changes to Mental Disorders Ratings Schedule (Jennifer Morrell, Widener University Delaware Law School)

The Department of Veterans Affairs (VA) has proposed to amend the section of the Schedule for Rating Disabilities that addresses mental disorders—38 C.F.R. § 4.130.

The changes include a completely revamped general rating formula and the inclusion of eating disorders under the rating formula for mental disorders.  According to VA, this is the first substantive revision since 1996. The revised rating criteria are partly based on the DSM-5 and reflect an emphasis on ability to function in the work setting versus just symptoms.  VA states that symptoms determine diagnosis but do not always translate directly to functional impairment.

VA notes in its explanation for the proposed changes that employees with mental disorders are at higher risk for work absences than the general population.  VA also states that mental disorders reduce engagement in life activities more than physical disabilities.  Further, VA relies on studies that found veterans with mental disorders are undercompensated by the current rating schedule. 

VA’s proposed changes include an entirely new rating formula based on five separate domains:  1) cognition, 2) interpersonal interactions and relationships, 3) task completion and life activities, 4) navigating environments, and 5) self-care.  Each domain would be assessed for severity, with the components of severity being intensity and frequency.  Intensity would be measured as none, mild, moderate, severe, and total.  Frequency would refer to the percentage of time in the past month during which impairment occurs.  Generally, frequency is rated as being either less than 25% of the time or greater than 25% of the time, which is in keeping with how the World Health Organization and DSM-5 assess impairment.  VA acknowledges that impairments occurring over 25% of the time are more disabling socially and occupationally than those that occur less frequently.

Once the VA evaluates intensity and frequency of impairment for each domain, VA would then find the value—from 0 to 4—for each domain.  For example, a 4 would be assigned for total impairment that occurs 25% or more of the time.  A 3 would be assigned for severe impairment that occurs 25% or more of the time or total impairment that occurs less than 25% of the time. 

Based on its proof of concept study involving 100 veterans with mental disorders, VA claims the proposed rating changes are potentially more generous than the current formula.  One inarguably positive change VA proposes is doing away with the 0% rating for mental disorders, the idea being that if you warrant a diagnosis for a mental disorder you have some minimum level of impairment.

VA’s changes include a note directing evaluators to consider any ameliorative effects of medications prescribed for a mental disorder.  This would mean that evaluators would rate only the actual symptoms present, without speculation as to how severe the symptoms would be without medication.  

The proposed changes can be found here.  Comments are due by April 18, 2022.

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