Martinez-Bodon: In order to be a "disability" for VA benefits purposes, a mental health condition must have a DSM-5 diagnosis
/Martinez-Bodon v. Wilkie, docket no. 18-3721 (August 11, 2020)
HELD: “The definition of ‘disability’ in section 1110 includes any condition that results in ‘functional impairment of earning capacity’” and this definition applies to psychiatric conditions. However, VA regulation “requires a DSM-5 diagnosis to compensate a psychiatric disability” – and while the Court can interpret the meaning of VA’s regulations within the rating schedule, it “lack[s] jurisdiction to determine whether the regulations are consistent with section 1110.”
SUMMARY: Veteran filed a claim for disability benefits for diabetes and a mental health condition related to the diabetes. A VA examiner determined that he did not have a diagnosis that “met the criteria for a mental condition per DSM-5.” The RO granted service connection for diabetes, but denied the mental health claim. The veteran appealed to the Board and the Board confirmed the RO’s denial.
On appeal to the Court, the veteran argued that the Board’s requirement of a diagnosis is inconsistent with Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), in which the Federal Circuit held that “pain alone, without a specific diagnosis or otherwise identified disease or injury, may constitute a disability under 38 U.S.C. § 1110.” He argued that as long as his mental health symptoms “‘caused impairment of earning capacity,’ they constitute a disability for service-connection purposes.” In the alternative, he argued that he should receive separate ratings for his anxiety and sleep problems – secondary to his service-connected diabetes – because those symptoms are not reflected in the rating for diabetes.
The Court first found that the Federal Circuit in Saunders “defined ‘disability’ as ‘functional impairment of earning capacity’” and that it “gave no indication that it was defining that term differently for pain than it would have for any other condition.” The Court thus held that “Saunders is not limited to pain” and that “the definition of ‘disability’ in section 1110 includes any condition that results in ‘functional impairment of earning capacity’ . . . including the psychiatric condition at issue here.”
The Court then turned to 38 C.F.R. §§ 4.125 and 4.130, which appear to require a formal diagnosis consistent with the DSM-5 – and examined these regulations in light of Saunders and in the context of an undiagnosed mental health condition. The Court first acknowledged that it cannot “review” the rating schedule – but found that this “jurisdictional limitation does not prevent” the Court from interpreting these regulations. The Court held that these regulations “require[] a DSM-5 diagnosis to compensate a psychiatric disability” and that “the Saunders definition of a ‘disability’ is constrained as relevant to this appeal by VA’s decision to limit the psychiatric disabilities it would compensate.”
The Court stated that it “lacks jurisdiction to question what the Secretary decides constitutes a disability, including whether the Secretary’s definition of certain disabilities complies with section 1110” – and reiterated that it lacked “jurisdiction to review the Secretary’s regulations concerning mental health conditions contained in the rating schedule to determine whether they are consistent with section 1110.”
The Court rejected the veteran’s alternative argument regarding separately rating his mental health symptoms related to his diabetes – repeating that “VA’s rating schedule requires a DSM-5 diagnosis as a precondition for compensating veterans for psychiatric disabilities.”
