VA can still require DSM-V diagnosis before compensating for mental health

Martinez-Bodon v. Wilkie, CAVC No. 18-3721 (August 11, 2020)

“Man’s best friend helps NC Guardsman with PTSD [Image 1 of 8]” by DVIDSHUB is licensed under CC BY 2.0In Martnez-Bodon, the United States Court of Appeals for Veterans Claims (“Veterans Court”) revisited the evidence necessary to establish a current disability in the context of a mental health claim in the wake of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

The Federal Circuit, in its decision Saunders v. Wilkie, rolled back a long-time VA rule that pain alone without a diagnosis cannot constitute a disability for purposes of VA disability compensation benefits. It held that the word “disability” is not defined by statute (38 U.S.C. § 1110) and therefore must bet attributed its ordinary meaning, which the Federal Circuit provided: “functional impairment of earning capacity.” With this definition in hand, the Federal Circuit revolutionized how the VA must treat non-diagnosed illnesses, by ruling that the experience of pain “is an impairment because it diminishes the body’s ability to function and that pain need not be diagnosed as connected to a current underlying condition to function as an impairment.” Not all subjective reports of pain would qualify – the pain must cause functional impairment of earning capacity.

In Martinez-Bodon, the Veterans Court confronted the implications of Saunders for mental health claims. The essential question presented was this: If pain does not need to stem from a diagnosed illness to qualify as a disability, would psychological symptoms similarly require no diagnosed mental health disorder?

The Veterans Court’s answer was two-fold.  First, the Veterans Court held that Saunders’ analysis and holding applied for all kinds of disabilities, not just pain, including psychiatric conditions. However, the Veterans Court then held that because the VA’s rating schedule – regulations that govern how various disabilities are rated – explicitly required a diagnosis that conformed with the DSM-V.  The Veterans Court reasoned that the Federal Circuit citation to the schedule’s occasional reference to pain indicated that the schedule could serve as a roadmap to how the VA views how various impairments could serve as disabilities.  The Veterans Court reasoned that the VA’s multiple regulatory references to a DSM-V diagnosis in the schedule signaled its intent  to require a diagnosis for mental health disabilities.

Although the Appellant argued that the VA’s schedular regulations conflicted with Saunders and the statute, the Veterans Court stated it had no jurisdiction over such issues, being precluded by Congress from possessing jurisdiction over review of the VA’s rating schedule, absent of a Constitutional challenge.

The take-away here is that veterans must still obtain a proper DSM-5 diagnosis to obtain a rating on any mental health disabilities, even though the Federal Circuit’s Saunders decision has opened the door to non-diagnosed physical impairments potentially qualifying for disability compensation.

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