Will the VA Finally Take Mental Health Seriously in its Updated Disability Rating Criteria?

In February, the VA proposed changes to the VA Schedule for Rating Disabilities (VASRD) that would alter how disability ratings are calculated and assigned for tinnitus, mental health disorders, and respiratory conditions like sleep apnea. Veterans and the public at large will have until April 18^th, 2022, to share their opinions on the proposed changes via public comments on the proposal.

The VASRD is a scale that assesses the severity of disabling conditions as documented by medical records to determine the compensation a veteran would receive for disabilities related to service. The proposed changes to the VASRD would have the effect of being more exclusive for sleep apnea and tinnitus and more inclusive for mental health conditions. The reason for this difference is that the proposed changes to VASRD would take different approaches in assessing ratings for each condition.

Changes to auditory/respiratory conditions

The new approach to sleep apnea would take into account medical advancements that have made treatment more effective and evaluate a veteran’s disability rating based on their response to treatment. If sleep apnea symptoms are fully addressed by the use of a CPAP machine, then the veteran would receive a rating of 0% disability and thus receive no compensation.

The proposed VASRD approach to tinnitus would treat the condition as only a symptom of a more serious condition and provide compensation (if any) for tinnitus under the umbrella of the larger ailment.

Approaches to both conditions would have the effect of decreasing the number of veterans eligible for benefits.

Changes to mental health conditions

Given the fact that the new proposal would serve to bottleneck access to benefits for veterans affected by sleep apnea and tinnitus, it is a bit surprising that the proposed approach to evaluating compensation based on mental health conditions would loosen up access and allow more veterans to receive ratings that provide benefits.

The new approach opens access in two main ways:

• Increasing the minimum disability rating for mental health conditions from 0% to 10%
• Eliminating an archaic VASRD policy that prevents a Veteran from getting a 100% rating for a mental health condition when they are able to work any amount including part-time

Additionally, the new approach introduces a new set of criteria for assessment. The previous approach taken was to use the number of symptoms present in order to assign a rating, an approach that fails to understand the nature of mental health in that simply having a larger number of symptoms is not reflective of the decapacitating effects that a mental health issue can have on one’s ability to function effectively.

The new approach proposes an updated set of criteria that reflects a better understanding of that fact. This new approach would evaluate mental disorders based on how impactful the mental health issue is on functionality across five domains:

• Intellectual cognition
• Ability to successfully navigate interpersonal interactions and relationships
• Ability to perform tasks both personal and vocational
• Ability to perform life activities and navigate different environments
• Ability to care for oneself independently

The VA’s proposed new approach to assessing disability ratings for mental illness seems to indicate that the organization is taking mental health more seriously as a source of impairment that prevents normal job functioning. These proposed changes reflect what many already know about mental health: Mental health struggles can be debilitating, affecting all aspects of one’s life from job security to personal relationships. Adding financial stress to the situation only exacerbates anxiety and depression, making whatever issues one is dealing with seem all the more hopeless.

This is an excellent first step on the part of the VA to take its VSARD policies into the 21^st century regarding its attitudes toward mental health, but it is only a first step in crafting policies that reflect what physicians and civilians alike have long understood about the crippling effects mental health issues can have on day-to-day living. Ideally, this first step isn’t the last.

What the future holds

It’s important to keep in mind that this new proposal is just that and will not take effect in any form until some time after April 18^th when the public has had its opportunity to reflect and comment. For veterans and their loved ones who have thoughts on the proposed changes to assessing disability ratings, anyone can provide feedback via public comments.

It’s also important to note that no veteran will experience any retroactive change to their current rating if/when these proposals are finalized and take effect. Veterans with applicable conditions who already have a rating can apply for increased compensation after the proposal is adopted, but no veteran who already has a rating will receive a reduction in benefits due to any of these changes unless an improvement in the relevant condition occurs.