Inside the exam room
1. You will talk with a mental-health examiner about your history and treatment. First exams and review exams differ. Give treatment dates. Say when a date is approximate.
2. You will be asked about sleep, concentration, mood, behavior, safety, and how long symptoms last. Give recent examples, including better and worse periods and whether treatment helps.
3. You will be asked how symptoms affect work, relationships, and daily tasks. Explain missed work, unfinished tasks, help you need, and what you can still do.
How VA rates PTSD
Explain how symptoms affect work, relationships, and everyday tasks, including better periods. VA looks at the whole record rather than assigning a percentage for one symptom. VA evaluates occupational and social impairment using the whole record, including how often symptoms happen, how severe they are, and how long they last, periods when symptoms improve, and what you can do during those periods. The examples in section 4.130 are not a one-symptom-to-percentage checklist. A diagnosis, suicidal thoughts, difficulty working, or a medication by itself does not establish a particular rating.
What each rating percentage means
Match the whole description with your exam and records. A single symptom or illustration does not decide your rating.
| Rating | What the rule requires |
|---|---|
| 0% | A diagnosed mental-health condition, with symptoms too mild to interfere with work or social life or to require ongoing medicine. |
| 10% | Mild or short-lived symptoms affect work and social life, with work becoming less efficient only during major stress; OR ongoing medicine controls symptoms. |
| 30% | Symptoms affect work and social life: you sometimes work less efficiently and sometimes cannot carry out work tasks, but generally manage daily routines, personal care, and normal conversation. |
| 50% | Symptoms affect work and social life, making you less reliable and reducing what you get done (reduced reliability and productivity). |
| 70% | Symptoms cause problems in most areas, such as work, school, family relationships, judgment, thinking, or mood (deficiencies in most areas). |
| 100% | Symptoms cause total loss of functioning in BOTH work and social life (total occupational AND social impairment). |
Check these details in your records
The examiner uses a condition form called a Disability Benefits Questionnaire (DBQ). Compare these items with your own records and explain what actually happens in daily life.
- A diagnosed mental-health condition, with symptoms too mild to interfere with work or social life or to require ongoing medicine.0%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- Mild or short-lived symptoms affect work and social life, with work becoming less efficient only during major stress; OR ongoing medicine controls symptoms.10%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- Symptoms affect work and social life: you sometimes work less efficiently and sometimes cannot carry out work tasks, but generally manage daily routines, personal care, and normal conversation.30%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- Symptoms affect work and social life, making you less reliable and reducing what you get done (reduced reliability and productivity).50%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- Symptoms cause problems in most areas, such as work, school, family relationships, judgment, thinking, or mood (deficiencies in most areas).70%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
- Symptoms cause total loss of functioning in BOTH work and social life (total occupational AND social impairment).100%Compare the whole description with your medical records. Choosing it here does not decide your VA rating.
What may happen in the exam room
- The examiner talks with you and reviews your mental-health records.
- Explain how symptoms affect work, relationships, treatment, and your safety.
What the measurements tell you
- How often symptoms happen, how hard they are to manage, and how long they last.
- Work, relationships, judgment, thinking, mood, and daily activities over time.
- Times when symptoms improve and what you can do then.
Questions the examiner may cover
- How do symptoms affect your work and relationships?
- How often do symptoms occur, how long do they last, and what changes during difficult periods?
- What treatment have you received, and how has it affected daily activities?
Questions to expect
How do symptoms affect your work and ability to finish tasks?
Explain: Describe actual missed shifts, mistakes, reduced output, conflict, accommodations or help required. Give frequency, duration and concrete recent examples, including periods you function better.
Rating connection: The 30% row describes occasional work disruption; 50% describes reduced reliability and productivity. The 70% and 100% rows require the broader impairment specified in their rating criteria.
What happens in relationships, judgment, thinking, mood and daily care?
Explain: Explain changes in family or social contact, decisions, concentration, personal care and independent routines. Identify what you still manage and what requires help.
Rating connection: VA assesses the overall pattern across work and social functioning. Deficiencies in most areas and total occupational AND social impairment are different standards, not a symptom-count checklist.
Which symptoms occur, how often, and how serious are they?
Explain: Describe sleep, panic, intrusive memories, avoidance, mood and any safety concerns that actually occur, plus treatment response. Do not wait for an exam to seek urgent help.
Rating connection: Symptoms, their frequency, severity and duration support the functional assessment. No single phrase or symptom automatically establishes a percentage.
Your answer outline
Over [time period], [symptom in your own words] has affected [work, relationship, or routine]. For example, [actual event and consequence]. This happens [frequency]. I still [activity or responsibility], and [treatment or support] has [actual effect].
Mark approximate dates and counts as estimates.
My notes: ________________________
Service connection records
1. How is this connected to your service?
For a direct claim, identify your current disability, what happened in service, and evidence linking them. Being on active duty or orders alone does not prove that link.
- Write the 5 Ws and how: who was there; what happened; when; where; why you were there; how the problem began. Add duty status, treatment, witnesses, and records. Mark uncertain dates as estimates.
- Guard or Reserve: find your orders, dates, duty type, and any line-of-duty records. Active duty, training, and drills have different rules.
- Secondary condition: it may start after service. Identify the service-connected condition and evidence that it caused or worsened this problem. A medical opinion may help explain the link.
- Started before service? Record what changed during service. Presumptive condition? Check the required diagnosis and service history; qualifying claims do not require separate proof of a link.
- Already service connected and seeking an increase? Focus on what has worsened and the records showing it.
If you do not know the cause, say so. Do not guess a medical connection.
Explain what changes in daily life
Describe both what you can do and what becomes difficult. Include how often it happens and how long it lasts.
- Describe actual examples from daily life, including both limitations and activities you can still do.
- Explain changes over time in your own words. Do not adopt symptoms from an example.
- Describe safety concerns honestly; their significance requires assessment by a qualified health care professional, not a checkbox score.
Common mistakes to avoid
- Assuming one symptom guarantees a percentage.
- Assuming that being unemployed alone means a total loss of ability to function at work and in social life.
- Minimizing or exaggerating symptoms to match a rating label.
Records to get ready before the exam
- Relevant treatment records and medication history.
- Statements from people who have seen changes in what you can do.
- Work attendance or accommodation records, if relevant and available.
Preparation notes
- Continue prescribed care unless your clinician advises otherwise.
- A C&P exam evaluates a claim; it is not a substitute for treatment.
Important context
Need immediate support? Contact the Veterans Crisis Line at 988, then press 1. Do not wait for a claim examination to seek help.
Official rating rule and code numbers
Use this source to check the full rule and its medical terms: 38 CFR 4.126 and 4.130, DC 9411. Source review recorded 2026-09-04.
Could one health problem have caused another?
A condition VA has already linked to your service may cause another health problem or make it worse. VA calls this secondary service connection. Having both conditions does not prove the link. Your records need to show a current diagnosis and explain how the first condition or its treatment affected the second.
- Start with your records. Find the current diagnosis, the condition VA already linked to service, and evidence from someone qualified to explain the connection.
- Ask about cause and worsening. Did the first condition or its treatment cause the new disability, or make an existing disability worse? These are different questions. The rules call them causation under 38 CFR § 3.310(a) and aggravation under § 3.310(b). If both are raised by your records, the medical opinion should address both; answering only the cause question may not be enough (El-Amin).
- If treatment may be involved, collect the dates. List the medicine or surgery prescribed for the condition VA linked to service, the side effect, and the new diagnosis. Bring pharmacy records and dates when treatment started or stopped. A provider must explain the connection in your case; taking a medicine alone does not prove it.
- If weight gain may be involved, ask how it fits. Weight gain or obesity can be a step between the first condition and another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself does not receive a VA disability rating.
- You do not need absolute certainty. VA uses the “at least as likely as not” standard and the reasonable-doubt rule under 38 CFR § 3.102. Ask a VA-accredited representative how the evidence applies to your claim.
- The same symptom cannot be counted twice. This is the rule against pyramiding in 38 CFR § 4.14. Mental-health diagnoses generally share one § 4.130 rating when they affect the same work and social abilities. Trouble sleeping may be a symptom rather than a separate disability.
- Check whether VA already assumes a link to service. Some conditions qualify based on where or when you served. These are called presumptive conditions. Examples can include chronic rhinitis, chronic sinusitis, hypertension after qualifying herbicide exposure, and type 2 diabetes. Sleep apnea (OSA) is not a PACT Act presumptive. Check eligibility before seeking a medical opinion about the link.
- An exam form and a medical opinion do different jobs. A Disability Benefits Questionnaire (DBQ) records the diagnosis and how severe it is. It may not explain why it is linked to service, often called a nexus. A VA-accredited veterans service organization (VSO) can help you file at no charge.
If another prescribed treatment may have caused a problem, ask your health care provider to record what happened and explain the connection in your case.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Other health problems to ask about
Use these notes to ask your provider about problems you already have. Your records must explain the connection. VA decides whether the condition is linked to service.
Sleep apnea (OSA) is not automatically linked to service. One possible chain is PTSD → prescribed psychiatric medication → weight gain or obesity → diagnosed OSA. Bring the treatment and weight records. A provider must explain each link in your case; having both conditions does not prove one caused the other.
If you have high blood pressure, ask your provider whether PTSD or its treatment caused it or made it worse. Also check whether it is linked directly to service or covered by a presumption, including qualifying herbicide exposure under 38 CFR § 3.309(e).
Bring your medicine list and treatment dates. A provider can check whether prescribed antidepressants (SSRIs or SNRIs), or another cause shown in your records, caused diagnosed GERD or made it worse.
If migraines are diagnosed, ask your provider whether the records show PTSD caused them or made them worse.
If IBS is diagnosed, ask your provider to explain any link. Symptoms alone, or a general link between conditions, do not prove the connection in your case.
Some prescribed mental-health medicines, including SSRIs, may be relevant. Bring pharmacy records and ask your provider to explain any link to diagnosed ED.
PTSD and depression can occur together. When they affect the same work and social abilities, VA generally uses one mental-health evaluation under 38 CFR § 4.130. A separate rating needs separate effects that are not already counted.
Weight gain after medicine may be a step between the treatment and another diagnosed disability under VAOPGCPREC 1-2017. This is called an intermediate step. Obesity itself does not receive a VA disability rating.
Allen v. Principi requires clear medical evidence that an alcohol-use disability is caused by, or is a symptom of, a condition VA linked to service. Benefits remain barred for primary alcohol or drug abuse during service. Ask an accredited representative to review the records.
Choose the related health problems you want to discuss. Your preparation packet will include the notes you select and the full condition guides available for them.