During their service, veterans may have experienced situations that went against what they felt was right – whether it was something they did, witnessed, or failed to prevent. That experience may have led to a concept called “moral injury.” While there is no moral injury VA rating, moral injury has been associated with anxiety, depression, and PTSD. Because the symptoms of moral injury overlap with the symptoms of other mental health conditions, veterans may still be eligible to receive benefits for moral injury through another related diagnosis.
If you’re wondering “what is a moral injury?” read on to learn more.
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In this article about the moral injury VA rating:
We all hold our own beliefs of what is right. These may be referred to as our moral beliefs, moral compass, moral code, values, or ethical code of conduct. These beliefs may evolve as we grow, learn, and consider other perspectives.
In 1994, military psychiatrist Dr. Jonathan Shay wrote about his observations working with Vietnam veterans. He believed that when soldiers experienced a situation that violated what they felt was right, it could lead to psychological damage or moral injury. Fifteen years later, a paper was published explaining the research on moral injury in veterans, and the topic began to receive more attention, prompting health officials to bring more awareness about this condition to the VA.
What is moral injury?
When we experience something that goes against what we feel is right – whether it was something we did, witnessed, or failed to prevent, we may suffer a moral injury. Though each person’s experiences may differ, moral injuries can have strong cognitive, emotional, psychological, social, behavioral, and spiritual impacts, many of which can be long-lasting. Some even call this injury a “soul wound” because of how deeply it can affect a person’s identity.
Symptoms of moral injury
Veterans experiencing moral injury may feel overwhelmed with persistent emotions. It may be difficult to stop thinking about the morally injuring experience, and self-forgiveness can feel impossible. Those with moral injuries report feeling remorse, guilt, shame, disgust, and anger. Depression is also a common diagnosis among those suffering from moral injury.
If you, or a veteran you know, is in crisis, you can contact the Veterans Crisis Line anytime, even if you are not receiving VA benefits.
What causes moral injury among veterans?
Moral injury can result from many situations in military service, especially in combat. For example, killing, witnessing human suffering, being unable to care for the injured or leaving someone behind, or having to make life-or-death decisions, can all cause moral injury.
“Without a doubt, as a veteran, you have been exposed to more trauma and extremely stressful experiences than most of us,” said VA disability lawyer Lori Underwood. “It should be recognized that these experiences leave scars, both mentally and physically.”
Some veterans may even change their beliefs about the justification for the war they fought in after their service. This can cause moral injury as they try to cope with being involved.
Everyone is different, so some things that will cause moral injury to one person may not cause it in another or result in different symptoms.
Moral injury evaluations
There are several different questionnaires available to assess moral injuries. Some checklists, such as the 9-item Moral Injury Events Scale and 20-item Moral Injury Questionnaire, ask veterans about their exposures to potentially morally injurious events.
In contrast, the Trauma-Related Guilt Inventory or Shame Inventory and the lengthier Moral Injury Symptoms Scale ask about symptoms. The Moral Injury Outcome Scale measures both the experiences of the veteran and the symptoms from those morally injurious events.
Moral injury vs. PTSD
A moral injury is different than post-traumatic stress disorder (PTSD). A veteran can have a moral injury but no PTSD, PTSD without moral injury, or both. PTSD occurs when veterans experience a severe traumatic stressor, while moral injury develops when a person’s beliefs or values are transgressed. These two concepts can and do overlap, but researchers have found that moral injury and PTSD involve different parts of the brain.
Though they are different, there is no question that moral injury and PTSD can be connected. Veterans exposed to morally injurious events are more likely to be diagnosed with PTSD or depression. In one study, researchers found at least one symptom of moral injury at high levels in 80% of active duty military with PTSD, and 52% reported at least four symptoms at high levels.
Even when a veteran has a moral injury and is experiencing symptoms of PTSD, such as feelings of anxiety, sadness, shame, guilt, or a loss of interest in things that they used to enjoy, it can be challenging to receive a diagnosis for PTSD.
“Oftentimes, the VA is looking to prove a stressor, which occurred in your line of duty through your service treatment records for them to accept that you have PTSD,” said VA disability lawyer Lori Underwood. “However, you may be one of the thousands of veterans who incurred a moral injury that will not be found in your service treatment records.”
Moral injury VA rating
While there is no diagnostic code or rating for moral injury because the VA does not consider it a medical diagnosis, the VA acknowledges that it’s something commonly experienced among veterans that should be taken seriously.
Veterans exposed to combat have an increased risk of mental disorders, and experiencing moral injury may play a part in that. For example, moral injury has been associated with anxiety, depression, and PTSD.
Because the symptoms of moral injury overlap with the symptoms of other mental health conditions, you may still be eligible to receive benefits for a moral injury if it leads to another condition, like under the diagnosis of PTSD. Therefore, while veterans won’t specifically get a moral injury VA rating, they can get a VA rating for mental conditions caused due to an in-service moral injury.
PTSD, anxiety, and depression are all rated using the General Rating Formula for Mental Disorders, summarized in the table below. The VA will also typically require C&P exams for veterans filing for mental health conditions. The results of that exam will be used to decide your rating and whether your condition is related to your service.
| Description | Rating |
|---|---|
| Total occupational and social impairment, which may include being a persistent danger of hurting self or others and the intermittent inability to perform activities of daily living | 100% |
| Occupational and social impairment, with deficiencies in most areas. May experience near-continuous panic or depression, affecting the ability to function independently. | 70% |
| Occupational and social impairment with reduced reliability and productivity. | 50% |
| Occupational and social impairment with occasional decrease in work efficiency due to symptoms such as depression, anxiety, suspiciousness, and panic attacks. | 30% |
| Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or symptoms controlled by continuous medication. | 10% |
| A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. | 0% |
VA unemployability for moral injury
You cannot receive a rating or TDIU for a moral injury, but it may lead to other service-connected conditions that make you eligible for unemployability.
Veterans who have received a rating for a mental health condition but whose condition is preventing them from keeping substantially gainful employment may be eligible to receive total disability based on individual unemployability (TDIU). TDIU pays the same rate as a 100% VA disability rating.
To be eligible, a veteran must have at least one service-connected disability (such as PTSD) rated at least 60% OR two or more service-connected disabilities with a combined rating of 70% or more, including one disability rated at 40% or more. If this concept feels confusing, you may watch our video below or call for a free case evaluation.
How Woods and Woods can help
The Woods and Woods team wants to ensure all veterans get the VA disability compensation they deserve. We’ve helped thousands of veterans nationwide with their claims. If you are interested in discussing your case, give us a call. We will never charge for help with an initial claim, and if we handle your appeal, you won’t pay unless we win.
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FREQUENTLY ASKED QUESTIONS
PTSD occurs when veterans experience a severe traumatic stressor, while moral injury develops when a person’s beliefs or values are transgressed. While the two can and do overlap, researchers have found that moral injury and PTSD involve different parts of the brain. Though they are different, there is no question that moral injury and PTSD can be connected. Veterans exposed to morally injurious events are more likely to be diagnosed with PTSD or depression.
While there is no diagnostic code or rating for moral injury because the VA does not consider it a medical diagnosis, veterans exposed to combat have an increased risk of mental disorders, and experiencing moral injury may play a part in that. For example, moral injury has been associated with anxiety, depression, and PTSD.
Neil Woods
VA disability attorney
Woods & Woods
Neil Woods is the firm’s owner and president. He received his law degree from Western Michigan University.
