How VA rates PTSD
VA evaluates occupational and social impairment using the whole record, including symptom frequency, severity, duration, remissions, and functioning during remissions. 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.
Rating criteria from the tool data
| Rating | What VA looks for |
|---|---|
| 0% | A formally diagnosed mental condition without symptoms severe enough to interfere with occupational and social functioning or require continuous medication. |
| 10% | Occupational and social impairment from mild or transient symptoms decreasing work efficiency and task performance only during significant stress, OR symptoms controlled by continuous medication. |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, while generally functioning satisfactorily with routine behavior, self-care, and normal conversation. |
| 50% | Occupational and social impairment with reduced reliability and productivity. |
| 70% | Occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood. |
| 100% | Total occupational AND social impairment. |
DBQ and symptom topics to review
Review these topics against your own records and symptoms. Do not exaggerate or minimize; describe functional impact accurately.
- A formally diagnosed mental condition without symptoms severe enough to interfere with occupational and social functioning or require continuous medication.0%Compare the complete criterion with documented findings; not a personal rating.
- Occupational and social impairment from mild or transient symptoms decreasing work efficiency and task performance only during significant stress, OR symptoms controlled by continuous medication.10%Compare the complete criterion with documented findings; not a personal rating.
- Occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, while generally functioning satisfactorily with routine behavior, self-care, and normal conversation.30%Compare the complete criterion with documented findings; not a personal rating.
- Occupational and social impairment with reduced reliability and productivity.50%Compare the complete criterion with documented findings; not a personal rating.
- Occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood.70%Compare the complete criterion with documented findings; not a personal rating.
- Total occupational AND social impairment.100%Compare the complete criterion with documented findings; not a personal rating.
What may happen in the exam room
- Clinical interview and review of relevant mental-health records.
- Discussion of occupational and social functioning, symptoms, treatment, and safety concerns.
Measurements and findings to understand
- Frequency, severity, and duration of symptoms.
- Work, relationships, judgment, thinking, mood, and daily functioning over time.
- Periods of improvement and functioning during those periods.
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 functioning?
Functional-impact language to think through
Use plain, truthful wording that matches your records and daily limitations. These examples are prompts for accuracy, not scripts.
- 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 clinical assessment, not a checkbox score.
Common mistakes to avoid
- Assuming one symptom guarantees a percentage.
- Equating unemployment alone with total occupational and social impairment.
- Minimizing or exaggerating symptoms to match a rating label.
Evidence to organize before the exam
- Relevant treatment records and medication history.
- Statements describing observed functional changes.
- 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 source
38 CFR 4.126 and 4.130, DC 9411. Checked 2026-09-04. Educational preparation only; not a personal rating.
How secondary service connection works
A secondary condition is not automatic. The evidence must connect a current diagnosed disability to an already service-connected condition or its medically indicated treatment.
- Basic evidence: a current diagnosis, an already service-connected primary condition, and competent evidence linking the two.
- Two theories: the primary condition or its treatment caused the new disability under 38 CFR § 3.310(a), or aggravated a pre-existing non-service-connected disability under § 3.310(b). An opinion should address both when the record raises both; causation alone may be inadequate (El-Amin).
- Treatment pathway: service-connected condition → medically indicated medication or surgery → documented adverse effect → current diagnosis. Pharmacy records, start and stop dates, and a treating clinician’s reasoning matter; medication use alone does not establish the connection.
- Weight as an intermediate step: obesity or weight gain can be part of the causal chain under VAOPGCPREC 1-2017, but obesity itself is not a disability for a VA rating.
- Standard of proof: VA applies the “at least as likely as not” standard and reasonable-doubt rule under 38 CFR § 3.102. This guide identifies evidence questions; it does not tell you what to file.
- Avoid pyramiding: 38 CFR § 4.14 prohibits rating the same manifestation twice. Mental-health diagnoses generally use one § 4.130 evaluation for the same occupational and social impairment, and insomnia may be a symptom rather than a separate disability.
- Presumptives are different: qualifying service may make chronic rhinitis, chronic sinusitis, hypertension associated with herbicide exposure, or type 2 diabetes presumptive. OSA is not a PACT Act presumptive. Check current eligibility before seeking nexus evidence for a condition the law may already presume.
- DBQ is not a nexus: a DBQ documents diagnosis and severity; it does not necessarily establish service connection. A VA-accredited VSO can help with filing strategy at no charge.
Other medically indicated treatments for a service-connected condition may support a secondary theory when a clinician documents the adverse effect in this veteran.
Sources: 38 CFR § 3.310 · 38 CFR § 4.14 · VA-accredited representatives
Possible secondary conditions to discuss with a qualified reviewer
These are educational issue-spotting notes, not medical nexus opinions. VA decides service connection.
Not presumptive. One evidence path is service-connected PTSD → prescribed psychiatric medication → documented weight gain or obesity as an intermediate step → diagnosed OSA. A clinician must explain this veteran’s chain; association alone is not causation.
If hypertension is diagnosed, a clinician can address whether PTSD or its treatment caused or aggravated it. Also check direct and presumptive routes, including qualifying herbicide exposure under 38 CFR § 3.309(e).
Review medication records. A clinician may evaluate whether prescribed SSRI/SNRI treatment or another documented pathway caused or aggravated diagnosed GERD.
Review only when migraines are diagnosed and individualized medical evidence supports causation or aggravation.
Review only if IBS is diagnosed. Symptoms or general association do not establish a secondary nexus.
Prescribed psychiatric medications, including SSRIs, can be an evidence path when pharmacy history and a clinician connect treatment to diagnosed ED.
PTSD and depression may coexist, but overlapping symptoms generally receive one mental-health evaluation under 38 CFR § 4.130. Separate evaluation requires distinct, non-duplicative impairment.
Medication-related weight gain may be an intermediate step to another diagnosed disability under VAOPGCPREC 1-2017. Obesity itself is not a disability for a VA rating.