Martinez-Bodon: Formal DSM-5 diagnosis required in order to be compensated for mental health disability

Martinez-Bodon v. McDonough, 28 F.4th 1241 (Fed. Cir. 2022)

HELD: VA REGULATIONS require a formal DSM-5 diagnosis in order to be compensated for a mental health disability.

Summary: Veteran had psychiatric symptoms, but no formal diagnosis. The Board denied service connection. Veteran argued that he didn’t need a diagnosis because Saunders v. Wilkie held that “pain that reaches the level of ‘functional impairment of earning capacity’ could constitute a ‘disability’ under 38 U.S.C. § 1110.”

The Court rejected this argument because the question in Saunders ”was whether conditions not on the rating schedule may still be considered for service connection purposes under § 1110.” VA regulations - 38 C.F.R. §§ 4.125, 4.130 - provide specific ratings for mental health conditions – so Saunders doesn’t apply. These regulations require a mental health diagnosis that conforms to the DSM-5.

Advocacy note: Make sure the record contains a formal DSM-5 diagnosis. Even if there are conflicting diagnoses. If the veteran doesn’t have a DSM-5 diagnosis, suggest that the veteran see a different practitioner. (You see 5 different psychologists, you’ll get 5 different diagnoses.)

Webb: Can a veteran get disability compensation for mental health symptoms absent a diagnosis that conforms with the DSM?

Webb v. Wilkie, docket no. 18-0966 (March 26, 2020)

HELD: Because the Court found that this case “presents factual disputes that should be resolved by the Board in the first instance,” which may ultimately moot the panel question, the Court declined to address whether a veteran can establish entitlement to disability benefits for symptoms of a mental health condition in the absence of a confirmed dignosis that conforms with the DSM.

SUMMARY: Veteran filed a claim for disability benefits for PTSD. He underwent several VA examinations that described mental health symptoms, but found that he did not have a diagnosis that conformed with the Diagnostic and Statistical Manual of Mental Disorders (DSM). His representative raised several arguments regarding the adequacy of the medical opinions, but the RO and the Board denied his claim based on the lack of a confirmed diagnosis.

At the Court, Mr. Webb argued that the Board “erred by failing to consider whether his lay statements are evidence of a psychiatric disability other than PTSD.” He asserted that his “symptoms caused functional impairment and … constitute a ‘current disability’ for purposes of establishing entitlement to disability compensation,” citing Saunders v. Wilkie, 886 F.23d 1356 (Fed. Cir. 2018).

The Secretary argued that “Saunders is limited to the facts of that case—that pain alone, absent a diagnosis, may be compensated if it causes functional loss.”

Unfortunately, the Court did not address this important question because it found that “the Board did not make any explicit findings regarding the adequacy of [the VA] examinations or explain which examinations it relied on to deny the appellant’s claim and, to the extent that it implicitly found either or both examinations adequate, its reasons are not readily apparent.” Because the Board did not make these “necessary factual findings in the first instance,” the Court declined to address the question that was the reason this case was sent to a panel.