Golden: PTSD and GAF Scores

Golden v. Shulkin, Case Number 16-1208, decided February 23, 2018 considers the Board’s reference to GAF scores when setting a PTSD rating.  The Court strictly determines GAF scores should not be considered. 

As said by the Court:

The "Global Assessment of Functioning" scale was a scale ranging from 0 to 100, that was created to reflect "psychological, social, and occupational functioning on a hypothetical continuum of mental health illness." See DSM-IV at 32. In other words, a GAF score was a numerical summary on a standardized scale reflecting the presence and severity of psychological symptoms and their effects.

Id. at *4.

GAF scores were long considered by the VA in setting a PTSD rating.  However, in August 2014 the VA amended its regulations to replace references to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) with references to DSM-V.  The DSM-V had done away with references to GAF scores because the American Psychiatric Association found them lacking in clarity and usefulness.  Id. at *5.

In this case, the Board did discuss the veteran’s GAF scores and stated: “While the Veteran's GAF scores have fluctuated over time, his lowest score assigned – 40 in May 2010 – is consistent with no greater impairment than that contemplated by the assigned 70 percent rating. In fact, the Veteran has also received GAF scores that would indicate only serious or moderate symptomatology.”  Id. at *3. 

The Appellant argued the Board erred in but argued the GAF scores were relevant, but the scores must be addressed within a context of noting they were methodologically flawed and particularly unreliable when applied to PTSD.  Id. at *3.  The Secretary also argued reference to GAF scores was required because the Board had to consider all pertinent evidence and any error was non-prejudicial.  Id. at *3-4.

The Court rejected both arguments, stating: “Given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Court holds that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies.”  Id. at *5.  The Court also stated

The Board's rating analysis for psychiatric disorders has always been "symptom driven,"

meaning that "symptom[s] should be the fact finder's primary focus when deciding entitlement to a given disability rating." The Court simply clarifies that, to the extent that the Board may have been tempted to use numerical GAF scores as a shortcut for gauging psychiatric impairment, such use would be error. 

Id. at *6 (internal citations omitted).

The Court further addressed the Secretary’s argument that reference to the GAF scores was non-prejudicial error.  It stated:

Although it is possible that the Board may have analyzed the appellant's GAF scores in response to his argument that his low GAF score of 40 entitled him to a higher rating the Board did not provide this explanation, and the Court is unable to conclude that the Board's decision would have been the same had the discussion of GAF scores been removed. The Court does not hold that the Board commits prejudicial error every time the Board references GAF scores in a decision, but in this case, it is unclear whether the Board's discussion of the GAF scores was prejudicial.

Id. at *7.

While the GAF score was an easy shorthand way of generating a rating, it was unreliable and it is probably better the Court simply forbade reference to it than preserving it as a piece of evidence to be analyzed.  This case will be grounds for many appeals dealing with mental health issues as the Board and some advocates have continued to reference GAF scores in their arguments.

Decision by Judge Greenberg, joined in by Judges Pietsch and Allen.