How the VA rates PTSD and other mental health conditions
Every mental health condition in the schedule, PTSD, depression, anxiety, bipolar disorder, is rated on the same six-tier formula. The formula is not about your diagnosis. It is about how much the condition gets in the way of work and relationships.
PTSD has its own diagnostic code, DC 9411, but the code is only a label. The actual rating comes from the General Rating Formula for Mental Disorders in 38 CFR § 4.130, which applies to nearly every psychiatric diagnosis the VA recognizes. Understanding the formula matters more than understanding your diagnosis, because the formula is what the rater is reading.
The six tiers
Each tier opens with a phrase describing the overall level of occupational and social impairment, followed by a list of symptoms offered as examples of that level. The phrase is the rating. The symptoms are illustrations.
| Rating | Level of impairment | Example symptoms the schedule lists |
|---|---|---|
| 0% | Diagnosed, but symptoms are not severe enough to interfere with work or social functioning, or to require continuous medication. | None listed. |
| 10% | Mild or transient symptoms that decrease work efficiency only during periods of significant stress, or symptoms controlled by continuous medication. | None listed beyond the description. |
| 30% | Occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, generally functioning satisfactorily. | Depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss. |
| 50% | Reduced reliability and productivity. | Flattened affect, circumstantial speech, panic attacks more than once a week, difficulty understanding complex commands, impaired short- and long-term memory, impaired judgment and abstract thinking, disturbances of motivation and mood, difficulty maintaining effective work and social relationships. |
| 70% | Deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. | Suicidal ideation, obsessional rituals, illogical or obscure speech, near-continuous panic or depression affecting independent function, impaired impulse control with unprovoked irritability and violence, spatial disorientation, neglect of personal appearance, inability to establish and maintain effective relationships. |
| 100% | Total occupational and social impairment. | Gross impairment in thought or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, inability to perform activities of daily living, disorientation to time or place, memory loss for names of close relatives or own name. |
The Federal Circuit held in Vazquez-Claudio v. Shinseki (2013) that the symptoms in each tier are examples, not requirements, and that the question is whether your symptoms are of the same frequency, severity, and duration as those listed, producing that tier's level of impairment. You do not need every symptom in the 70% row to be rated 70%. You need symptoms like them, producing deficiencies in most areas. The earlier case Mauerhan v. Principi (2002) said the same about symptoms not on the list at all: they count too, if they cause the same level of impairment.
What the tiers mean in real life
The abstract language hides a fairly concrete picture:
- 30% describes someone who holds a job and has relationships, but has bad weeks. Sleep is a problem, mood is a problem, there are panic attacks now and then.
- 50% describes someone whose work product and attendance are genuinely unreliable because of the condition, whose relationships are strained, and who may be on a second or third job in a few years.
- 70% describes someone for whom most of life is going wrong at once: work, family, judgment, mood. Suicidal ideation sits in this tier, and the Veterans Court held in Bankhead v. Shulkin (2017) that ideation alone, without a plan or intent, is still the 70% symptom the schedule names.
- 100% is rare and describes someone who cannot function in society or at work at all.
A veteran who works full time can still be rated 70%. Work is one area among several, and the schedule asks about deficiencies in most areas, not all. Do not let anyone tell you a job caps you at 50%.
Service connection for PTSD: the stressor
PTSD is the only condition with its own service-connection regulation, 38 CFR § 3.304(f). It requires a diagnosis, a link between the symptoms and an in-service stressor, and credible supporting evidence that the stressor occurred. That third element is where claims used to die, and the rules have been relaxed in three ways:
- Combat. If you engaged in combat and the stressor is related to it, your own statement is enough, if consistent with the circumstances of your service.
- Fear of hostile military or terrorist activity. Since 2010, a stressor involving fear of hostile activity, being mortared, IED threats, convoys, does not need independent corroboration if a VA psychiatrist or psychologist confirms it is adequate to support the diagnosis and your symptoms are related to it. This is § 3.304(f)(3), and it covers most post-9/11 deployments.
- Military sexual trauma. Under § 3.304(f)(5), evidence from outside service records can corroborate an MST stressor: behavioral changes, requests for transfer, performance drops, statements from people you told at the time. Form 21-0781 has a dedicated section.
The stressor statement is VA Form 21-0781. Fill it in with dates, locations, unit, and names where you have them. Vague statements get vague corroboration.
One mental health rating, not several
If you have PTSD and depression and anxiety, you get one rating under § 4.130, not three. The regulation rates the combined occupational and social impairment from all psychiatric symptoms together, because the symptoms overlap and rating them separately would be pyramiding under § 4.14. The practical consequence is that adding a second mental health diagnosis does not add a second rating, but it can push the single rating up a tier if the combined picture is worse.
Physical conditions that grow out of a mental health condition are a different story. Sleep apnea, GERD, hypertension, and migraines are all commonly claimed as secondary to PTSD, and each of those gets its own rating. See how the VA rates sleep apnea and the secondary conditions guide.
The evidence that moves a mental health rating
- Treatment records over time. A rater weighs a year of therapy notes far more than one exam. If you are not in treatment, the absence is read as mildness. The VA's own mental health care is free for most veterans, and Vet Centers do not require a rating at all.
- A symptom log. Panic attacks, nights of broken sleep, days missed, arguments, the week you did not shower. Frequency is what the tiers measure, and nobody remembers frequency accurately in an exam six months later.
- Lay statements. A spouse, a supervisor, a friend from the unit, describing specific changes they saw. These are evidence of social and occupational impairment, which is the actual question, and they are the single most under-used tool in mental health claims.
- Employment records. Write-ups, job changes, accommodations, terminations. Occupational impairment is half the formula.
- A DBQ or opinion from your own treating provider, if the C&P exam comes back low. A provider who has seen you forty times outweighs one who saw you for forty minutes, when the rater is told why.
Mental health C&P exams are short and the examiner writes down what you say. Veterans trained to answer "I'm fine" get rated as fine. Describe your worst weeks, not your best, and say what you have stopped doing: the crowds you avoid, the jobs you left, the relationships that ended. Preparing for a C&P exam covers this in detail.
When the rating is not enough
A veteran rated 70% for PTSD who cannot hold a job has a strong case for TDIU, which pays the 100% rate without a 100% rating. The 70% single-rating threshold is already met. Read TDIU explained before you assume the next step is an appeal.
READY214 holds a daily symptom and mood log, tracks the evidence buckets for each condition, and maps the physical conditions commonly claimed as secondary to a mental health rating. Free, no account needed to look.