Should I File for a Mental Health Increase? An Examiner’s Guide to the VA Rating Formula

A lot of veterans don’t understand when it would be appropriate for them to file for an increase. Understandably, many are afraid to risk “poking the bear.”

As an examiner, some of my least favorite C&P exams are the ones where a veteran has filed for an increase because their symptoms truly have gotten worse, but that doesn’t translate into an increased rating. To understand why this happens, you have to look at your mental health through two very different lenses.

Requesting an Increase: Understanding The "Why" Behind the Rating

The Two Lenses for Mental Disorders: Forensic vs. Clinical

If you have a service-connected mental disorder, it is viewed through two different lenses:

1. ‍VBA (Forensic): This is about disability assessment. Its purpose isn't to treat you, but to "rate" you. It is a snapshot used to determine how much your disorder impairs your ability to work and maintain a social life. Information about your symptoms is used to determine a rating based on a specific formula.
2. ‍VHA (Clinical): This is about your treatment. Information about your symptoms is used to better inform your treatment. If you are having more nightmares or deeper depression, your doctor needs to know so they can adjust your care.

There are a lot of instances where your symptoms have gotten worse - increased nightmares, more frequent depressed mood, starting to get panic attacks, etc. Those have a very real impact on your daily life and are extremely important to bring up in a treatment setting.

And, most of those would have no impact on your disability rating unless they change your overall "Occupational and Social Impairment."

The DBQ: Where Your Story Meets the Formula

If you are wondering whether you should file for an increased disability rating, it’s helpful to understand exactly how the VA looks at your symptoms during an exam.

When looking at a Mental Disorders DBQ or a PTSD DBQ, you’ll see a Symptom List near the end. This is where the examiner checks off the symptoms you endorsed during the exam. These symptoms are pulled directly from the General Rating Formula for Mental Disorders. The General Rating Formula identifies the percentage and the description for each level of impairment. Starting with the 30% level, it includes examples of symptoms associated with that level.

However, there are two key things you should know about this list:

• The List is Not Exhaustive: As written, these symptoms are just examples. Other symptoms not on the list can result in the same level of impairment.
• "More" Isn't Always "Higher": More symptoms checked off at a specific level do not increase your rating. Ratings are based on the level of impairment that results from those symptoms. If you are already rated at 30% and you develop three new symptoms that also fall under the 30% category, your rating will likely stay the same. To get an increase, you typically need to be experiencing symptoms that fall under a higher level of impairment.

‍An Examiner’s Perspective: What to Consider Before Requesting an Increase

When I conduct an exam—whether it’s an Independent Medical Evaluation (IME) or a C&P exam—my priority is providing the information the VA needs for an accurate decision. I believe it is the responsibility of the examiner, not the veteran, to know which symptoms are most important to your rating percentage.

Here is how I approach the symptom list. Hopefully, it will help you determine if a higher rating might accurate for you.

A Quick Caveat: This is how I approach the symptom list based on my interpretation of the General Rating Formula and VA decision letters. There is often a lot of variation in how different C&P examiners approach this.

Breaking Down the Rating Levels

The 0% to 30% Level

Many symptoms fall under the 30% level (or below). At these lower tiers, the VA relies more on the specific wording of your impairment than on the higher levels.

For example, three different veterans could have the exact same three symptoms checked (depressed mood, anxiety, and suspiciousness), yet receive three different ratings:

• 0% Rating: Accurate if there is a diagnosis, but symptoms aren’t severe enough to interfere with functioning or require continuous medication.
• 10% Rating: Accurate if symptoms are "mild or transient" or are well-controlled by continuous medication.
• 30% Rating: Accurate if there is "frequent" occupational and social impairment rather than being mild/transient.

Symptoms that fall in this 0-30% range include:

• Depressed mood
• Anxiety
• Suspiciousness
• Panic attacks that occur weekly or less often
• Chronic sleep impairment
• Mild memory loss, such as forgetting names, directions, or recent events

The 50% Level

Many of the symptoms at this level are difficult for a person to self-identify because they are often neurological or clinical in nature.

Symptoms You Likely Need a Provider to Assess

I don’t recommend trying to figure out whether these apply to you on your own. These typically apply to veterans with a Traumatic Brain Injury (TBI), dementia, or a schizophrenia spectrum disorder. If you think these apply, I highly suggest asking your treating provider for their opinion on:

• Impairment of short- and long-term memory
• Flattened affect
• Circumstantial, circumlocutory or stereotyped speech
• Difficulty in understanding complex commands
• Impaired judgment
• Impaired abstract thinking

Symptoms You Can Possibly Self-Assess

These are the symptoms you are more likely to recognize in your daily life:

Panic attacks more than once a week:

‍People frequently are confused about what is and isn’t a panic attack. Therefore, this one is trickier. A panic attack is different than intense anxiety. It’s a much more physical experience than that.

‍Disturbances of motivation and mood:

Do you remember what it was like when you felt motivated to do something? Motivation can feel more energizing. It’s different than doing something because you have to do it to survive. If doing anything other than just sitting on the couch feels like a chore that you have no desire to do, you might be experiencing disturbances of motivation and mood.

‍Difficulty in establishing/maintaining relationships:

If you get along with coworkers and feel connected to family, this probably doesn't apply. However, if you have distanced yourself from everyone or are being reprimanded at work because of how you interact with colleagues, it probably does.

The 70% Level

Identifying 70% level symptoms can be challenging for a veteran. Some are purely clinical or neurological markers that require a provider’s assessment, while others are highly subjective and depend heavily on how an examiner interprets your specific level of impairment.

Symptoms You Likely Need a Provider to Assess

Speech intermittently illogical, obscure, or irrelevant:

This refers to a symptom usually seen in dementia or schizophrenia. It’s unlikely you are displaying this without also meeting the 100% criteria.

‍Spatial disorientation:

‍This happens when your eyes, ears, and body send mixed signals to your brain. Unless a doctor has told you this applies, assume it doesn’t.

Symptoms That are Highly Subjective (and More Examiner-specific)

Difficulty in adapting to stressful circumstances:

‍This is highly subjective. As an examiner, if a veteran is still able to maintain employment, I generally wouldn’t check this box. It implies a level of impairment that usually precludes a steady work environment.

‍Inability to establish and maintain effective relationships:

"Inability" is an all-or-nothing term. If you have at least one person in your life, even if the relationship is strained, I would only check "difficulty" (50%), not "inability."

‍Near-continuous panic or depression affecting the ability to function independently, appropriately and effectively:

For this to apply, every part of that sentence must be true. "Near-continuous" means almost all the time. It applies to both the symptoms (panic/depression) and the functional impact. If you are able to "adult" or manage your own affairs for a significant portion of the time, this symptom likely won't be checked.

‍Neglect of personal appearance or hygiene

The More Common 70% Symptoms

Suicidal ideation:

This isn't just thinking about death; it means having thoughts of ending your life. It exists on a scale—from a general feeling of wanting to "stop existing" to having a specific plan.

‍Obsessional rituals which interfere with routine activities:

‍These are repetitive actions (like checking locks) or mental steps you feel "forced" to do to quiet a distressing thought.

‍Impaired impulse control:

‍The most common example I see is when you go from 0 to 100 in a split second, resulting in an angry outburst. It is important to distinguish this from simply being intensely irritated or angry—those are feelings. It becomes impaired impulse control when you act on those feelings because you physically cannot stop yourself.

The 100% Level

Most symptoms here are severe enough that a veteran would likely need full-time care or monitoring. If your symptoms haven't resulted in hospitalization or legal custody, they likely don't apply, with a few exceptions.

Symptoms More Often Requiring Full-Time Care or Monitoring

• Gross impairment in thought process or communication
• Grossly inappropriate behavior
• Persistent danger of hurting self or others
• Intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene

Symptoms That Might Apply to You

However, there are a few symptoms that could apply to you. Because these are so significant, it is important to understand exactly what they mean.

Memory loss for names of close relatives, own occupation, or own name:

This isn’t describing the times you run through three of your kids' names before landing on the right one, or when a name is on the tip of your tongue but comes to you later. This is where information that was previously “locked in” beyond question—such as your own name, your occupation, or the name of someone you have known "forever"—is gone. In my experience, this level of memory loss is usually due to a TBI or dementia.

Note: If you are experiencing this, it may be worth filing for an increase. AND, if you haven’t already, I highly suggest you bring this up to your doctor immediately.

Persistent delusions or hallucinations:

A delusion is an odd belief that a person firmly insists is true despite evidence that it is not. Delusions are interpreted within the context of someone’s culture. If the belief is widespread, even if it might not be in line with your belief, it isn’t considered a delusion. It is also extreme. For instance, many people with PTSD might describe themselves as “paranoid.” They might feel suspicious of others and their motives. This is a common characteristic of PTSD. In contrast, an example of a paranoid delusion might be that someone is so convinced that someone at work is poisoning their lunch that they call the police.

A hallucination is when you hear, see, smell, taste, or feel things that appear real but only exist in your mind. To qualify here, this needs to be an ongoing experience.

This gets tricky because flashbacks can feel similar to hallucinations, but clinically they are separate. Flashbacks are specifically tied to a traumatic stressor, and strictly speaking, this box wouldn't be checked for them.

That being said, previous court decisions have pointed out that these listed symptoms are merely examples of what would be considered to fall under each level of impairment. They are not the only symptoms that might cause a particular level of impairment for someone.

Disorientation to time or place:

This is a state of confusion where a person loses track of dates, seasons, or their current location. This is not the same as forgetting what day of the week it is or realizing you "zoned out" while driving to work.

This is typically associated with dementia, acute illness, or neurological issues.

The exception I have encountered is with veterans who have PTSD with severe dissociative episodes. In my opinion, some of those veterans were experiencing symptoms that warranted checking this box. As with many of these symptoms, there is a significant level of subjectivity involved.

Conclusion: Making the Decision

Deciding whether to file for an increase is a major decision that requires balancing your current clinical reality with the VA’s specific forensic rules. As we’ve seen, "worse" doesn’t always mean "higher" in the eyes of the General Rating Formula. However, if your symptoms have shifted into a higher level of impairment, then your rating should reflect that reality.

Your next step

Take a look at your most recent VA Rating Decision letter. Read the "Reasons for Decision" and compare them to the categories above. If your daily life has shifted into a higher tier of impairment, it may be time to speak with a VSO about an increase.

Understanding the Rating Decision Letter

Your disability rating percentage reflects which mental health symptoms you're experiencing and their impact on your daily functioning. Each symptom falls within a specific "level of impairment" that corresponds to a rating percentage.

The General Rating Formula for Mental Disorders outlines these symptom classifications.

When you received your Rating Decision Letter, it provided three key pieces of information:

• Your current rating percentage
• The documented symptoms that determined this percentage (These are the boxes that were checked off on the Symptom List.)
• The symptoms that would need to be present for the next highest rating level

Gathering Strong Medical Evidence

If your symptom pattern aligns with a higher level of impairment, you can request a rating increase. The VA should schedule a Review examination to assess your current level of functioning.

You have options for your claim:

• Proceed with the VA's examination process
• Provide an Independent Medical Examination (IME) with your claim
• Wait for the decision and consider an IME if needed for appeals

Each approach has merit depending on your specific circumstances and the strength of your existing medical evidence.

‍Ready to move forward?