## Facts

- Albert F. Mauerhan, a Vietnam War combat veteran, sought VA disability compensation for service-connected posttraumatic stress disorder (PTSD).
- Medical evidence described symptoms including intense anxiety, hypervigilance, insomnia, nightmares, and social isolation.
- The record also reflected suicidal thoughts and that Mauerhan had attempted suicide three times.
- Despite significant symptoms, other evidence showed retained functioning, including a long-term relationship, continued contact with his children, and steady employment over a number of years, though with conflict with coworkers.
- VA assigned a 30% disability rating for PTSD under 38 C.F.R. § 4.130, Diagnostic Code 9411.
- Mauerhan sought a higher rating; VA continued the 30% evaluation.
- On appeal, the Board of Veterans’ Appeals (Board) denied an initial rating above 30%, finding that Mauerhan’s disability picture most closely matched the 30% level under the general rating formula for mental disorders.
- Mauerhan appealed to the United States Court of Appeals for Veterans Claims, arguing that the Board erred by relying on the regulatory rating categories instead of PTSD-specific criteria in the DSM-IV and by treating the regulation’s symptom lists as required elements.

## Issues

1. Whether VA must assign PTSD percentage ratings by applying DSM-IV PTSD symptom criteria, rather than the percentage criteria in 38 C.F.R. § 4.130, DC 9411.
2. Whether the Board erred by treating the symptoms listed in § 4.130’s rating levels as a checklist of required symptoms instead of nonexclusive examples tied to occupational and social impairment.
3. Whether the Board clearly erred in finding that Mauerhan’s PTSD more nearly approximated the 30% rating level.

## Decision

- The Court affirmed the Board’s denial of an initial rating higher than 30% for PTSD.
- The Court held that DSM-IV nomenclature informs psychiatric diagnosis and terminology, but it does not replace the rating schedule’s percentage criteria as the standard for assigning evaluations.
- The Court held that the symptoms listed in § 4.130’s general rating formula are examples, not an exhaustive or mandatory set of criteria for any particular rating.
- Applying the clearly-erroneous standard, the Court concluded the Board had a plausible basis in the record for determining that Mauerhan’s overall occupational and social impairment was consistent with a 30% evaluation.

## Legal Principles

- VA assigns percentage evaluations for mental disorders under 38 C.F.R. § 4.130’s general rating formula, which focuses on the level of occupational and social impairment.
- DSM-IV is referenced in § 4.130 for nomenclature and diagnostic context, but it is not an independent scoring tool that controls the assignment of disability percentages.
- The phrase “such symptoms as” in § 4.130 indicates that the listed symptoms at each evaluation level are illustrative examples of the type and degree of manifestations associated with that level of impairment.
- A claimant need not show all, most, or any particular listed symptoms to qualify for a given rating; the question is whether the veteran’s symptoms and resulting effects produce occupational and social impairment comparable to the level described in the rating criteria.
- Adjudicators must consider all symptoms that affect occupational and social functioning, including symptoms not specifically listed in § 4.130, and then determine which rating level the disability picture most nearly approximates.
- On judicial review, the Court does not reweigh evidence; it affirms the Board’s degree-of-disability finding if there is a plausible basis in the record and the finding is not clearly erroneous.

## Conclusion

Mauerhan v. Principi affirmed a 30% initial PTSD evaluation, explaining that VA rates mental disorders based on overall occupational and social impairment under § 4.130, that DSM-IV aids diagnosis but does not set the percentage rating, and that the regulation’s listed symptoms are examples rather than mandatory requirements for any rating level.


Mauerhan v. Principi, 16 Vet. App. 436 (2002)