The VA rates mental disorders primarily based on a list of symptoms found in 38 CFR 4.130. Most of them are self-explanatory (e.g. “chronic sleep impairment”), but some of them are terms used by mental health professionals (e.g. “flat affect”). Their meaning is not evident to a layperson, but understanding them can be helpful when sitting for a C&P exam. Below is a list of some of those symptoms with a short description of each.
The individual expresses little to no expression. Their body language looks possibly slouched, they have poor posture, and perhaps a low hanging head. They express a lack of motivation to do things that they used to do or enjoyed. They withdraw from others and from activities. For example, a woman used to go out with her friends to dinner and movies. She used to enjoy reading. Now, she finds that when a friend calls her, she either says that she cannot go out with the friend or she does not answer the phone. The individual might eat more than usual or less than usual. Often times, the individual will express a change of sleep, either sleeping too much, having insomnia, or not being able to fall asleep. They also might have thoughts of suicide either passive or intentional.
A panic attack is an intense feeling of anxiety or feeling very nervous. An attack can appear to come on suddenly, but often times there are warning signs, such as an increase in body temperature or feeling uneasy. People who experience panic attacks might have physical symptoms that include increased sweating, heart racing, chest pain/pressure, dizziness, shortness of breath, trembling, tingling, feel chilled, feeling as if one is choking, feeling ill/abdominal pain or discomfort, fear of dying, or feeling as if things are not real. To be diagnosed with a panic disorder, one has to have at least four or more of these symptoms during a panic attack. At least one of the attacks must be followed by intense worry for at least a month and cannot caused by another physical medical issue or substance use.
The individual does not express any emotion. They might sound monotone in their speech. They might not feel they are aware of anything else around them. Often times, a flattened affect is a trait in people with depression or schizophrenia.
Circumstantial speech: A person takes a long time to get to the point. He/She might talk about other details before answering a question or getting to the important part. Circumlocutory Speech: A person might talk about something else and take a while (but will eventually) to get to the point. Stereotyped speech: is speech that is repetitive in thought process. The individual repeats themselves.
Someone with impaired judgment might take actions that do not make logical sense to others and/or engage in risky behavior. For example, someone with bipolar disorder might take risks that could do themselves harm or others. A person with impaired judgment might also have other cognitive deficits, such as an inability to pay attention, process information quickly, remember and recall information, think critically, and initiate speech.
Impaired Abstract Thinking
Is a difficulty in thinking about something that is not physically present. For example, recognizing the symbolism of an object, such as the American flag symbolizing freedom. An inability to understand metaphors is another example. When someone is under a lot of stress, for example experiencing a flashback, they will not be able to think critically and constructively. This is because their brain is functioning using only the primal part of the brain instead of the frontal lobe, which is the logical part of the brain.
Speech Intermittently Illogical, Obscure or Irrelevant
Speech which seems nonsensical to others. For example, if someone asks if a chair will fit through the doorway and the individual’s response is “of course it will because the chair is brown.”