Veterans Disability Info Blog

How to Obtain Service Connection for Depression

The VA defines depression as having marked feelings of intense hopelessness or sadness and potential loss of interest or pleasure in activities individuals used to enjoy. There may also be associated feelings of unworthiness, low self-esteem, and guilt. Individuals with depression may start avoiding being around people.

In order to obtain a depression VA rating, an individual needs to be diagnosed by a properly credentialed professional who will use the Diagnostic and Statistical Manual Fifth Edition Text Revised (DSM-V-TR) put out by the American Psychological Association (APA, 2022). The DSM-V-TR (APA, 2022) is utilized by psychologists, counselors, and other mental health professionals to properly diagnose mental health disorders.

Major depressive disorder is classified as a mood disorder in the DSM-V-TR (APA, 2022). The following are the criteria for this disorder (APA, 2022, 356):

DSM-5-TR Diagnostic Criteria for a Major Depressive Episode

A major depressive disorder requires two or more major depressive episodes.

A. Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

NOTE: Do not include symptoms that are clearly attributable to another medical condition.

Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observations made by others (e.g., appears tearful). (NOTE: In children and adolescents, it can be an irritable mood.)

Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day. (NOTE: In children, consider failure to make expected weight gain.)

Insomnia or hypersomnia nearly every day.

Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

Fatigue or loss of energy nearly every day.

Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by their subjective account or as observed by others).

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the direct physiological effects of a substance or to another medical condition.

NOTE: Criteria A through C represent a major depressive episode.

NOTE: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode, in addition to the typical response to a significant loss, should also be carefully considered. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for expressing distress in the context of loss.

D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

E. There has never been a manic or hypomanic episode.

The DSM-V-TR also covers other types of mood disorders, such as dysthymic disorder and bipolar disorder. Dysthymic disorder has the following diagnostic criteria:

Depressed mood most of the day for more days than not, for at least two years, and the presence of two or more of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning:

  • Poor appetite or overeating
  • Insomnia or sleeping too much
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration or difficulty making decisions
  • Feelings of hopelessness (APA, 2022, p. 380)

Bipolar disorder has the subcategories of Bipolar I, Bipolar II, and cyclothymic disorder.

Bipolar episode and bipolar disorder criteria are as follows (APA, 2022, 388-392):

Bipolar disorder is characterized by more than one bipolar episode.

There are three types of bipolar disorder:

  1. Bipolar I disorder, in which the primary symptom presentation is manic or rapid (daily) cycling episodes of mania and depression.
  2. Bipolar II disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization but are sufficient to be observable by others).
  3. Cyclothymic disorder, a chronic state of cycling between hypomanic and depressive episodes that do not reach the diagnostic standard for bipolar disorder (APA, 2000, pp. 388–392).

If you experience any of these symptoms as a result of your service, you could qualify for a Depression VA Rating.

Depression Treatment for Veterans

The VA provides services for depression, such as psychotherapy and medication. Psychotherapy is also referred to as “talk therapy.” Therapists use evidence-based practices to treat depression, such as Cognitive Behavioral Therapy, which is an approach that includes reframing thoughts of hopelessness and frustration so that they may influence healthy behaviors.

Medication can include antidepressants, anxiolytic, or antipsychotic medications based on the symptoms you are experiencing, your personal demographics like age and gender, how long you have been experiencing the symptoms, how extreme the symptoms are, how frequent they are, their intensity, and accommodating for medication side effects.

Antidepressants can ease symptoms of depressed mood and anxiety and are usually paired with psychotherapy. Examples of antidepressants include (but are not limited to) Celexa, Prozac, and Zoloft. An example of an anxiolytic medication is Buspar. This type of medication helps relieve anxiety and tension, and it may promote sleep. Antipsychotic medications include and are not limited to Seroquel, Abilify, and Saphris. These medications improve or reduce experiencing psychiatric symptoms.

In our experience, clients that do the best use a holistic approach when it comes to treating depression. Positive social support and community belonging also aid in depression treatment, based on our experience.

Accessing VA Services for Depression

To access VA services for depression, you may apply for VA Healthcare if you haven’t done so already. You may contact the VA general information hotline at 800-827-1000 or contact your local VA medical center.

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How to Get a Depression VA Rating

The contents of this blog are for educational purposes only, and it takes more than experiencing symptoms of depression to gain a VA rating for depression. There are four critical items necessary for you to be eligible for a depression VA rating.

  • You must have a medical diagnosis of major depressive disorder. In order to receive this diagnosis, see a board-certified psychologist for a proper assessment.
  • There must be evidence of an in-service event, disease, injury, or aggravation.
  • The symptoms of depression you are experiencing are current, severe, frequent, and long-lasting enough to affect your life and activities of daily living (ADL).
  • You must prove service connection. This means that your military service or other service-connected condition caused or aggravated depression. Obtain a nexus letter or an Independent Medical Opinion to assist you in establishing a service connection.

If you meet these four criteria, the VA will reward you with a rating percentage based on the VA Depression Rating scale. This is how the VA rates depression and will impact your compensation and VA services. This is because disability evaluations are determined by comparing your current symptoms with VA Depression Rating criteria and are based on average impairment and capacity to earn income. The following is the VA Disability Rating for Depression:

VA Depression Rating

The VA rates depression at 0%, 10%, 30%, 50%, 70%, and 100%, respectively. The VA uses a 6-tier scale to determine your VA depression rating.

0% VA Rating

There is a formal diagnosis; however, symptoms are not severe enough to interfere with social and occupational function or require continuous medication.

10% VA Rating

Established social and occupational impairment as a result of mild or transient symptoms, decreasing work efficiency, and the ability to perform occupational tasks under periods of significant stress or symptoms can be controlled by continuous medication.

30% VA Rating

Generally functioning satisfactorily, with routine behavior, normal conversation, and self-care, but experiencing social and occupational impairment with intermittent periods of instability in performing occupational tasks because of symptoms such as anxiety, depressed mood, suspiciousness, mild memory loss (e.g., forgetting recent events and names), panic attacks, and chronic sleep impairment.

50% VA Rating

Symptoms are creating social and occupational impairment with reduced reliability and productivity. Symptoms include:

  • Panic attacks more than one time per week
  • Flattened affect, difficulty understanding complex commands
  • Short and long-term memory impairment
  • Circumstantial, circumlocutory, or stereotyped speech
  • Impaired judgment, mood, and motivational disturbances
  • Difficulty establishing and maintaining effective social and occupational relationships
  • Impaired abstract thinking

70% VA Rating

Social and occupational impairment with deficiencies in most areas of life and ADLs. For example:

  • Family and social relationships, educational focus, occupational ability
  • Thinking, mood, or judgment due to symptoms such as suicidal ideation
  • Intermittently illogical, obscured, or irrelevant speech
  • Near-continuous panic or depression impacting the ability to have appropriate, effective, independent functioning
  • Obsessive rituals interfering with ADLs and routine activities, difficulty adapting to stressful situations in an occupational or work-like setting
  • Neglectful personal appearance and hygiene
  • Inability to establish and maintain relations that are effective, spatial disorientation, and impaired impulse control

100% VA Rating

Total occupational and social impairment as a result of symptoms, such as:

  • Persistent hallucinations and delusions
  • Grossly inappropriate behavior
  • Disorientation to time or place
  • Loss of memory (e.g., can’t remember own name or occupation, can’t remember names of close relatives, friends, and other relations)
  • Gross impairment of communication or thought processes
  • Intermittent inability to perform ADLs such as personal hygiene
  • In persistent danger of hurting self or others

Depression and TDUI (Link to TDUI Blog)

It is possible to get a VA Rating for Depression and also get TDIU. This would happen if your depression is so severe that you are unable or have difficulty maintaining “substantially gainful employment.” These criteria would make you eligible for TDIU. You can use VA Form 21-8940 to start a claim and see if you are eligible for this program. With this program, you can still be eligible for 100% compensation even if you do not earn a 100% VA depression rating. You can also contact Gang and Associates for further assistance.

Also, if you’ve been awarded a VA depression rating and disability for depression already, your symptoms either get better or go away, and you readjust to your ADLs and everyday routine, the VA could re-evaluate you. This could potentially decrease your VA depression rating.

Winning VA Disability for Depression Secondary to Other Disorders and Conditions

It is possible to win VA disability for depression secondary to other disorders or conditions. For example, if you have a VA rating for chronic pain, heart problems, severe gastrointestinal problems, diabetes, or other such conditions, you may be experiencing symptoms of depression as a byproduct. If this is the case, you should schedule an assessment with a medical doctor or another VA-approved practitioner to evaluate your condition. They will rate your condition and the extent to which it impacts depressed symptoms and the extent to which the depressed symptoms impact your ADLs.

Winning VA Disability for Depression Secondary to Chronic Pain

Individuals who suffer from chronic pain tend to also experience symptoms of depression as a result. This is referred to as a secondary service connection because the experienced symptoms of depression are not directly caused by military service but rather chronic pain that was caused by military service.

To gain a VA disability rating for depression secondary to chronic pain, an individual would need to establish a direct service connection for chronic pain and then establish that the symptoms of depression are directly connected to the chronic pain. One other item to consider is that if an individual is taking medications to assist with chronic pain, such as opioids, the risk of developing symptoms of depression is increased. One must show that your service-connected chronic pain led to your symptoms of depression.

Winning VA Disability for Depression Secondary to Orthopedic Conditions

When a major injury occurs, such as osteoarthritis, shoulder injury (or other joint injury), or radiculopathy, resulting depression can occur. If this is the case, you can have your service-connected orthopedic injury assessed for a VA rating, and if you can establish a direct connection between your service-connected orthopedic injury and your depression diagnosis, you can win VA disability for depression secondary to Orthopedic Conditions.

Winning VA Disability for Depression Secondary to Heart Problems

To win a VA disability rating for depression secondary to heart problems, an individual needs to seek expert medical opinion about the relationship between the heart condition and symptoms of depression.

A service-connected VA rating for heart problems must be established first. Then, there must be specific evidence supporting that the current experienced symptoms of depression are the direct result of the accepted service-connected heart condition.

Winning VA Disability for Depression Secondary to Severe Gastrointestinal Problems

Experiencing symptoms of depression can have a significant negative impact on ADLs and many areas of life due to the side effects of taking medications to treat mental health symptoms. Gastrointestinal (GI) problems are one of the major side effects of such medications. Two common occurring GI problems are irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD). You may also have a diagnosed primary service-related GI Problem/condition that you are taking medications for. This may cascade into experiencing symptoms of depression.

If this is occurring, you can apply for a depression rating secondary to severe gastrointestinal problems. The VA will rate your service-connected GI problems, and a direct connection between said GI problems and depression will need to be made. In other words, it must be medically evident that your depression is directly connected to your service-connected GI problems.

Winning VA Disability for Depression Secondary to Diabetes

If there is the presence of a diabetes diagnosis from your doctor, as well as an official depression diagnosis from your doctor, you can be considered for VA disability for depression secondary to diabetes. Medical evidence needs to be provided showing a direct connection between the service-connected diagnosed diabetes and depression.

There are three common themes in all of the instances where a different primary medical diagnosis or condition was discussed in order to earn a depression VA rating secondary to another condition:

  • No matter what the other condition or disorder is, a direct service connection needs to be established.
  • Your depression symptoms must be directly connected to the service-connected medical condition/disorder.
  • You need to have these evaluated by a properly credentialed medical professional.

If you have questions about starting a claim or where to begin, call Gang and Associates. They will start your process and help you navigate the process.

At Veterans Disability Info, we’re a law firm specializing in helping veterans obtain compensation for disabilities incurred in active military service. Call us today at 888-878-9350 for help with getting the support you need and deserve from the VA.

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