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The Department of Veterans Affairs (VA) amends the portion of the rating schedule pertaining to mental disorders, including revising the General Rating Formula for Mental Disorders and removing the separate General Rating Formula for Eating Disorders in the VA Schedule for Rating Disabilities. This final rule reflects changes made by the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) advances in medical knowledge, and recommendations from VA's Mental Disorders Work Group.

Statement of Need:

Similar to 2900-AQ72 and 2900-AQ73, this final rule will update the VASRD to incorporate medical advancements that have occurred since the last revision, update current medical terminology, and provide clear evaluation criteria for mental disorders. 

Summary of the Legal Basis:

38 U.S.C. 1155. VA will revise 38 CFR 4.126 and 4.130, which pertain to mental disorders.

Alternatives:

VA cannot update the VASRD through non-regulatory action.

VA could choose to leave the VASRD criteria as is, but failure to update the criteria would result in continued application of outdated medical, scientific, and economic data in the evaluation of disabilities. The current criteria for mental disorders was adopted in 1996 based on the fourth edition of the Diagnostic and Statistical Manual (DSM-IV), but the DSM-5 was published in 2013 and updated evaluation criteria. Continuing to evaluate mental disorders using criteria based on the now outdated DSM-IV could be inadequate and in conflict with current scientific knowledge, medical practice, and the economic understanding of disability. By implementing new evaluation criteria that more accurately reflect functional impairment caused by mental disorders, VA will conform with current medical standards and provide more adequate compensation for the earnings losses experienced by Veterans with service-connected mental disorders. 

Anticipated Costs and Benefits:

The total budgetary impact is estimated to be $24.5 billion over five years and $62.1 billion over 10 years.

Risks:

By processing claims for compensation benefits using outdated criteria, VA risks overcompensating or undercompensating Veterans for these service-connected conditions.