What is the Bipolar Disorder VA Rating?

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VA ratings for bipolar disorders range from 0% to 100% with breaks at 10%, 30%, 50%, and 70%.

Your final VA rating for bipolar depends on the frequency (how often), severity (how bad), and duration (how long) of your mental health symptoms and how those symptoms negatively impact your work, life, and social functioning.

In this article, Brian Reese the VA Claims Insider will explain everything you need to know about bipolar disorder VA ratings and how to understand your symptoms in the context of the VA’s mental health rating criteria.

Let’s begin!

Summary of Key Points

• VA Bipolar Ratings: The VA rates bipolar disorder under 38 CFR § 4.130, Schedule of Ratings for Mental Disorders, Diagnostic Code (DC) 9432 from 0% to 100% with breaks at 10%, 30%, 50%, and 70%. The average VA rating for bipolar disorder is 70%.

• How the VA Rates Bipolar: Your final VA rating for bipolar disorder depends on the frequency, severity, and duration of your mental health symptoms and how those symptoms affect your occupational and social impairment.

• Types of Bipolar in Veterans: Veterans can experience various types of bipolar, including Bipolar I, characterized by severe mood episodes from mania to depression, and Bipolar II, involving milder hypomanic episodes alternating with severe depression. Cyclothymic Disorder, another type, features chronic mood instability with periods of hypomania and mild depression. Additionally, veterans may develop bipolar disorder due to trauma, brain injuries, or substance use related to their service.

• Service Connection for Bipolar Disorder: You need to provide a formal medical diagnosis that conforms to DSM-V criteria as well as evidence showing that your symptoms began or worsened due to your military service. Additionally, you’ll likely need a Nexus letter from a healthcare provider linking your bipolar disorder to your service, along with documentation of continuous symptoms and treatment.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition characterized by significant mood swings, including extreme highs (mania or hypomania) and extreme lows (depression).

These mood swings can affect sleep, energy levels, behavior, judgment, and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year.

Types of Bipolar Disorder

• Bipolar I Disorder: This type involves periods of severe mood episodes from mania to depression.

• Bipolar II Disorder: A milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression.

• Cyclothymic Disorder (Cyclothymia): A chronically unstable mood state in which people experience hypomania and mild depression for at least two years.

• Other Types: These include bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.

Bipolar in Veterans: Common Symptoms Explained

Bipolar symptoms in veterans typically fall within manic episodes, depressive episodes, cognitive impairment, and emotional instability.

The stress and challenges associated with military life—such as deployments, combat exposure, and the transition back to civilian life—can exacerbate the symptoms or complicate the diagnosis and treatment of bipolar disorder.

Manic Episodes (Extreme Highs):

• Increased Energy and Restlessness: Veterans may experience periods of significantly increased energy and activity levels, often resulting in overcommitment to projects or activities.

• Euphoria or Irritability: Intense feelings of euphoria or extreme irritability, which can be especially challenging in high-stress environments or during readjustment to civilian life.

• Rapid Speech and Racing Thoughts: Speaking rapidly or experiencing racing thoughts, which can lead to jumping quickly between topics and ideas without logical connections.

• Impulsive Behavior: Engaging in impulsive or reckless behaviors, such as spending sprees, risky investments, or inappropriate social conduct.

• Reduced Need for Sleep: Feeling rested after only a few hours of sleep or displaying an inability to sleep for several days without feeling tired.

Depressive Episodes (Extreme Lows):

• Persistent Sadness or Hopelessness: Chronic feelings of sadness, hopelessness, or emptiness that don’t seem to go away, impacting daily functioning and relationships.

• Loss of Interest in Activities: A noticeable loss of interest or pleasure in all or most daily activities, including those that were once enjoyed.

• Fatigue or Loss of Energy: Overwhelming fatigue or energy loss, even when not physically active.

• Feelings of Worthlessness or Excessive Guilt: Veterans may struggle with feelings of worthlessness or inappropriate guilt, often related to their service or personal expectations.

• Changes in Appetite or Weight: Significant weight loss or gain, or decreases or increases in appetite, not associated with dieting or changes in physical activity.

• Thoughts of Death or Suicide: Frequent thoughts of death, suicidal ideation, or suicide attempts, which require immediate attention and intervention.

Cognitive Impairment:

• Difficulty Concentrating: Problems with focus and decision-making, which can impair personal and professional life.

• Indecisiveness: Inability to make decisions, even about small or routine matters.

Emotional Instability:

• Mood Volatility: Severe mood swings from highs (mania) to lows (depression) that are more intense and disruptive than typical emotional ups and downs.

Risk Factors for Bipolar Disorder in Veterans

Genetic Predisposition:

• Family History: Veterans with a family history of bipolar disorder or other psychiatric conditions are at a higher risk of developing the disorder themselves.

Environmental Stressors:

• Combat Exposure: Exposure to combat and the associated stresses can trigger psychiatric disorders including bipolar disorder, particularly in individuals who are genetically predisposed.

• Traumatic Experiences: Military service can involve exposure to traumatic events, which not only increase the risk of PTSD but can also trigger or exacerbate symptoms of bipolar disorder.

Physical Injuries:

• Traumatic Brain Injury (TBI): TBIs are common in military populations due to training accidents, combat, and other physical activities. Such injuries can lead to changes in brain function and structure that may trigger symptoms of bipolar disorder or other mood disorders.

Substance Use:

• Alcohol and Drug Abuse: The use of substances as a coping mechanism for stress or to self-medicate can alter brain chemistry. Substance abuse is a significant risk factor for the development or worsening of bipolar disorder.

Psychological Factors:

• High Stress: The high-stress environment of military life, including the pressures of deployment and the uncertainty of combat, can contribute to the onset of mental health disorders.

• Difficulty Reintegrating into Civilian Life: Transitioning from military to civilian life can be a profound source of stress and can destabilize an individual’s mental health, particularly if they are predisposed to mood disorders.

Lack of Early Intervention:

• Delayed Treatment: Veterans may not receive immediate or adequate treatment for bipolar symptoms due to stigma, lack of awareness, or inadequate access to mental health services. Early intervention is crucial in managing bipolar disorder effectively.

Disruption to Personal Relationships:

• Social Isolation: Difficulties in maintaining stable personal relationships and social isolation after leaving the service can exacerbate feelings of depression and mania, common in bipolar disorder.

How to Establish Service Connection for Bipolar Disorder

Establishing a service connection for bipolar disorder is mission critical for veterans seeking VA disability benefits.

This process involves proving that the bipolar disorder either developed during military service or was aggravated by it.

1. Medical Diagnosis of Bipolar:

• Obtain a formal diagnosis of bipolar disorder from a qualified healthcare professional.

• The diagnosis should adhere to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

2. Evidence of Symptom Onset or Exacerbation During Service:

Provide evidence that your bipolar disorder symptoms began or worsened during your military service.

This evidence can include:

• Service treatment records documenting symptoms or treatment for bipolar disorder.

• Personal statements detailing changes in behavior or mood during service.

• Statements from fellow service members, family, or friends who observed these changes.

3. Link Between Service and Bipolar Disorder:

Demonstrate a direct connection between your military service and the onset or aggravation of bipolar disorder.

This link can be established through:

• Documentation of traumatic events, extreme stress, or physical injuries (such as traumatic brain injuries) during service.

• Evidence showing that these experiences likely contributed to the development or worsening of bipolar disorder.

4. Nexus Letter:

If you’ve been out of the military for more than 12 months, obtain a Nexus Letter from a private healthcare provider.

This letter should:

• Clearly state that it is the provider’s medical opinion “at least as likely as not” that your bipolar disorder was caused or made worse by your military service.

• Include a detailed explanation of how your service likely caused or aggravated your condition, supported by a review of your medical history and service records along with appropriate medical research.

5. Continuity of Symptoms:

Demonstrate continuity of symptoms from service to the present.

This involves:

• Providing medical records showing ongoing treatment for bipolar disorder after discharge.

• Maintaining a consistent history of symptoms and treatment to support your claim.

What is the VA Rating for Bipolar?

The VA rates bipolar disorder under 38 CFR § 4.130, Schedule of Ratings for Mental Disorders, Diagnostic Code (DC) 9432 from 0% to 100% with breaks at 10%, 30%, 50%, and 70%.

The rating percentages are determined based on the level of social and occupational impairment caused by the disorder, as well as the frequency, severity, and duration of psychiatric symptoms.

Here is the VA bipolar rating criteria used by the VA Rater to assign a disability rating for bipolar disorder:

100% VA Rating for Bipolar

Total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, memory loss for names of close relatives, own occupation, or own name.

Detailed Explanation of the 100% VA Rating Criteria for Mental Health

1. Gross Impairment in Thought Processes or Communication

• Example: A veteran may have severely disorganized thinking, making it impossible to have coherent conversations or understand simple instructions. They might frequently lose track of conversations, jump from one topic to another without logical connection, or speak in a way that others cannot understand.

2. Persistent Delusions or Hallucinations

• Example: A veteran might experience constant auditory hallucinations (hearing voices) or visual hallucinations (seeing things that aren’t there). They may also hold firmly to delusional beliefs, such as thinking they are being watched or followed, despite evidence to the contrary.

3. Grossly Inappropriate Behavior

• Example: The veteran may exhibit behavior that is socially unacceptable and dangerous, such as undressing in public, shouting obscenities without provocation, or reacting violently to minor irritations.

4. Persistent Danger of Hurting Self or Others

• Example: A veteran might have frequent and severe suicidal thoughts or have made multiple suicide attempts. They could also pose a threat to others, exhibiting aggressive or violent behavior that puts family members, coworkers, or strangers at risk.

5. Intermittent Inability to Perform Activities of Daily Living (Including Maintenance of Minimal Personal Hygiene)

• Example: The veteran may go days or weeks without bathing, changing clothes, or grooming, leading to significant hygiene issues. They might also be unable to perform basic tasks like cooking, cleaning, or managing finances, requiring constant supervision or assistance.

6. Disorientation to Time or Place

• Example: The veteran may become frequently confused about the date, time, or their current location. They might get lost in familiar places or forget important information like their address or the names of their children.

7. Memory Loss for Names of Close Relatives, Own Occupation, or Own Name

• Example: Severe memory problems could cause the veteran to forget the names of their spouse or children, their own job or work history, or even their own name. This level of memory loss significantly impairs their ability to interact with others and manage their life independently.

70% VA Rating for Bipolar

Deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation, obsessive rituals which interfere with routine activities, near-continuous panic or depression affecting the ability to function independently, impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances (including work or a work-like setting), inability to establish and maintain effective relationships.

Detailed Explanation of the 70% VA Rating Criteria for Mental Health

1. Suicidal Ideation

• Example: A veteran frequently thinks about or plans suicide but may not have acted on these thoughts. They might talk about feeling hopeless and express a desire to end their life, which requires close monitoring and intervention.

2. Obsessive Rituals Which Interfere with Routine Activities

• Example: The veteran may engage in compulsive behaviors, such as repeatedly checking locks or washing hands for hours each day, which disrupt their ability to complete daily tasks and maintain a normal routine.

3. Near-Continuous Panic or Depression Affecting the Ability to Function Independently

• Example: The veteran experiences constant anxiety or depressive episodes that make it difficult to leave the house, go to work, or handle basic responsibilities. They might rely heavily on others for support and struggle with tasks that require independence.

4. Impaired Impulse Control

• Example: The veteran may have frequent outbursts of anger, act aggressively, or make rash decisions without considering the consequences. This can lead to conflicts with family members, coworkers, and others.

5. Spatial Disorientation

• Example: The veteran may become confused about their location, even in familiar settings. They might get lost while driving to routine destinations or have trouble navigating their own neighborhood.

6. Neglect of Personal Appearance and Hygiene

• Example: The veteran might neglect basic self-care, such as bathing, grooming, or changing clothes, leading to a disheveled appearance. This neglect can impact their health and social interactions.

7. Difficulty in Adapting to Stressful Circumstances (Including Work or a Work-Like Setting)

• Example: The veteran may have severe difficulty handling stress, whether it’s due to work demands, personal issues, or unexpected changes. They might experience panic attacks, shut down, or avoid stressful situations altogether.

8. Inability to Establish and Maintain Effective Relationships

• Example: The veteran may struggle to form or keep relationships with family, friends, and colleagues. They might withdraw socially, have frequent conflicts, or exhibit behavior that pushes others away, leading to isolation and loneliness.

50% VA Rating for Bipolar

Reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

Detailed Explanation of the 50% VA Rating Criteria for Mental Health

1. Flattened Affect

• Example: The veteran may display limited emotional expression, often appearing detached or unemotional in social interactions and at work. This lack of affect can make it difficult for others to read their emotional state and respond appropriately.

2. Circumstantial, Circumlocutory, or Stereotyped Speech

• Example: The veteran might speak in a roundabout way, taking a long time to get to the point, or use repetitive and stereotyped phrases. This speech pattern can make communication inefficient and frustrating for both the veteran and others.

3. Panic Attacks More Than Once a Week

• Example: The veteran experiences frequent panic attacks that cause intense fear, palpitations, sweating, and shortness of breath. These attacks occur multiple times a week, disrupting daily activities and requiring regular management and coping strategies.

4. Difficulty in Understanding Complex Commands

• Example: The veteran may struggle to follow multi-step instructions or understand detailed directives at work or in daily tasks. This difficulty can lead to mistakes, delays, and decreased productivity.

5. Impairment of Short- and Long-Term Memory

• Example: The veteran might have trouble remembering recent events, appointments, or tasks (short-term memory) and also struggle to recall significant past events or learned skills (long-term memory). This impairment can affect their ability to perform consistently at work and in personal life.

6. Impaired Judgment

• Example: The veteran may make poor decisions, such as spending money recklessly or engaging in risky behaviors, without fully considering the consequences. This impaired judgment can lead to negative outcomes in both professional and personal settings.

7. Impaired Abstract Thinking

• Example: The veteran might find it challenging to think abstractly, such as understanding metaphors, making connections between ideas, or solving problems that require creative thinking. This impairment can hinder their ability to perform tasks that require higher-level cognitive skills.

8. Disturbances of Motivation and Mood

• Example: The veteran may experience significant fluctuations in motivation and mood, leading to periods of low productivity and difficulty sustaining effort over time. They might struggle to start or complete tasks and feel persistently unmotivated.

9. Difficulty in Establishing and Maintaining Effective Work and Social Relationships

• Example: The veteran might have trouble forming and maintaining relationships with coworkers, friends, and family due to their mood instability, communication difficulties, and emotional detachment. This can result in social isolation and conflicts at work.

30% VA Rating for Bipolar

Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation) due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss.

Detailed Explanation of the 30% VA Rating Criteria for Mental Health

1. Depressed Mood

• Example: The veteran may experience periods of sadness or a low mood that affect their motivation and energy levels. While these episodes can reduce work efficiency and enthusiasm, the veteran typically manages to maintain daily responsibilities.

2. Anxiety

• Example: The veteran might frequently feel anxious or nervous, particularly in stressful situations. This anxiety can lead to occasional difficulties in focusing or completing tasks but does not consistently impair overall functioning.

3. Suspiciousness

• Example: The veteran may have a heightened sense of mistrust or suspicion towards others, impacting social interactions. This suspicion can cause tension in relationships but does not prevent the veteran from engaging in routine social activities.

4. Panic Attacks (Weekly or Less Often)

• Example: The veteran might experience panic attacks, characterized by sudden episodes of intense fear and physical symptoms like sweating and palpitations. These attacks occur infrequently (weekly or less often) and can temporarily hinder the veteran’s ability to work or socialize but are generally manageable.

5. Chronic Sleep Impairment

• Example: The veteran may struggle with insomnia or disturbed sleep patterns, leading to fatigue and reduced concentration during the day. Despite chronic sleep issues, the veteran manages to perform daily tasks and maintain a routine.

6. Mild Memory Loss

• Example: The veteran might have occasional forgetfulness, such as misplacing items or forgetting appointments. This mild memory loss can cause minor disruptions but does not significantly interfere with daily functioning.

10% VA Rating for Bipolar

Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

Detailed Explanation of the 10% VA Rating Criteria for Mental Health

1. Mild or Transient Symptoms

• Example: The veteran may experience occasional episodes of mild depression or anxiety that slightly affect their mood and productivity, particularly during times of high stress, such as a demanding project at work or personal issues. These symptoms are typically short-lived and do not significantly disrupt daily functioning.

2. Decreased Work Efficiency During Stress

• Example: During particularly stressful periods, the veteran might find it harder to concentrate, make decisions, or keep up with a high workload, leading to temporary decreases in work efficiency. However, outside of these stressful times, the veteran functions well and performs their job duties effectively.

3. Symptoms Controlled by Continuous Medication

• Example: The veteran may take medication to manage their bipolar symptoms, which effectively keeps their mood stable and prevents significant impairment. As long as they continue their prescribed treatment, they experience minimal impact on their occupational and social activities.

0% VA Rating for Bipolar

A mental condition has been formally diagnosed, but symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. Symptoms are controlled without a structured treatment plan and do not affect work efficiency or the ability to engage in social activities under normal circumstances.

Detailed Explanation of the 0% VA Rating Criteria for Mental Health

1. Formally Diagnosed Mental Condition

• Example: The veteran has received a formal diagnosis of bipolar disorder from a qualified healthcare provider, but the symptoms are mild and well-controlled.

2. Symptoms Not Interfering with Occupational and Social Functioning

• Example: The veteran experiences occasional mood swings or mild depressive episodes, but these do not significantly impact their ability to perform their job duties, interact with coworkers, or engage in social activities. They continue to maintain strong personal and professional relationships.

3. No Need for Continuous Medication

• Example: The veteran does not require ongoing medication to manage their symptoms. Their bipolar disorder is stable, and they can function effectively without the need for daily medication.

4. Symptoms Controlled Without a Structured Treatment Plan

• Example: The veteran’s symptoms are managed through lifestyle adjustments, such as regular exercise, a healthy diet, and good sleep hygiene, without the need for a structured treatment plan or frequent medical intervention. They maintain a normal routine and handle daily stressors well.

Two Important Rules for Bipolar VA Disability Ratings

A common misunderstanding among veterans is that to receive a specific VA rating for bipolar disorder, they must exhibit all the listed symptoms associated with that rating.

THIS IS NOT TRUE!

The Rating Veteran Service Representative (RVSR) assesses all available evidence and generally assigns the VA rating for bipolar disorder based on the “Preponderance of the Symptoms.”

This means that if a veteran displays a combination of symptoms from different rating levels, the RVSR will usually assign a rating that reflects the higher level of impairment, unless other evidence suggests otherwise.

For instance, if a veteran exhibits three symptoms from the 50% rating category for bipolar disorder and five from the 70% rating category, the VA will typically assign the 70% rating, assuming there is no contradictory evidence in the record.

Conversely, if a veteran shows five symptoms from the 30% rating category and three from the 50% rating category, the VA is likely to assign the lower 30% rating, unless other evidence supports a higher rating.

Under CFR 38, Part 4, Schedule for Rating Disabilities, Paragraph § 4.126, which governs the evaluation of disability from mental disorders, the RVSR (VA Rating Official) is instructed to adhere to two key rules:

• Rule #1: When assessing mental health symptoms for bipolar disorder, the VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. The VA must base the evaluation on all evidence that pertains to occupational and social impairment, not solely on the examiner’s assessment at the time of the examination.

• Rule #2: When determining the level of disability for bipolar disorder, the VA must take into account the extent of social impairment but should not base the evaluation solely on social impairment.

These guidelines ensure that the rating accurately reflects the veteran’s overall level of disability and the impact of bipolar disorder on their occupational and social functioning.

What is the Average VA Rating for Bipolar Disorder?

The most common VA rating for bipolar disorder is 70%.

The 70% rating criteria for bipolar means you have occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

You also have severe mental health symptoms including, but not limited to:

• Suicidal Thoughts: Thinking about or planning suicide.

• Obsessive Rituals: Repetitive actions that disrupt daily life.

• Panic or Depression: Constant anxiety or depression making it hard to function alone.

• Impulse Control: Difficulty managing anger or reactions.

• Disorientation: Getting confused about where you are.

• Neglecting Self-Care: Ignoring personal hygiene or appearance.

• Stress Management: Finding it hard to handle stress at work or in daily life.

• Relationships: Inability to form and keep healthy relationships.

Bipolar Disorder C&P Exam

After filing your VA claim for bipolar disorder, you’re likely going to get scheduled for a Compensation and Pension (C&P) exam for mental disorders.

On exam day, be uncomfortably vulnerable and don’t hold back!

You need to explain to the examiner how you are on your very worst days.

Here’s generally what to expect during a bipolar C&P exam:

• Medical History Review: The examiner will go over your medical records and ask about your bipolar diagnosis, treatment history, and any hospitalizations.

• Symptom Discussion: You’ll discuss your symptoms in detail, including their frequency, severity, and duration, and how they impact your work, life, and social functioning.

• Mental Health Evaluation: The examiner may perform psychological tests or assessments to evaluate your current mental state and functioning.

• Behavioral Observations: They’ll observe your behavior, mood, and appearance during the exam.

• Functioning Questions: Expect a variety of mental health C&P exam questions about your diagnosis, severity of symptoms, occupational and social impairment, and how your bipolar disorder negatively affects you.

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