PTSD & Mental Health: VA Rating Criteria

Plain-language guide

What this rating actually turns on

VA does not rate PTSD on how bad the diagnosis sounds or how severe the trauma was. Every mental disorder — PTSD (DC 9411) included — is rated under one instrument, the General Rating Formula for Mental Disorders in 38 CFR 4.130, and its axis is occupational and social impairment: how much the condition degrades your ability to work and function, at the 0, 10, 30, 50, 70, or 100 percent level.

Two rules in 38 CFR 4.126 shape every decision. First, the rater must consider the frequency, severity, and duration of symptoms — and base the rating on all the evidence of record, not solely on how you presented during one examination. Second, social impairment alone cannot carry a rating; the occupational side has to be in the record too.

Before any percentage is assigned, service connection for PTSD requires three elements under 38 CFR 3.304(f): a diagnosis conforming to § 4.125(a) (DSM-5), a medical link between current symptoms and an in-service stressor, and credible supporting evidence the stressor occurred. The stressor burden is relaxed for combat, fear of hostile military or terrorist activity (when a VA psychiatrist or psychologist confirms it supports the diagnosis), former POWs, and in-service personal assault — where “marker” evidence like behavior changes, counseling records, or police reports can substitute for direct documentation.

If you are in crisis at any point — before, during, or after a claim — the Veterans Crisis Line is free and confidential: dial 988, then press 1, or text 838255 (va.gov).

What the C&P exam measures

Initial PTSD exams may only be performed by VHA staff or contract psychiatrists and psychologists; the Initial PTSD DBQ is not available for public use. On the Review PTSD DBQ, the examiner documents the DSM-5 diagnosis, checks a symptom list that mirrors the rating formula, and — critically — checks one box summarizing your level of occupational and social impairment, worded almost verbatim from the § 4.130 tiers. That single checkbox is heavily weighted in the decision, which is why your treatment records need to tell the same story the exam does.

What to have in your file

• A DSM-5-conforming diagnosis. Under § 4.125, a report that doesn’t conform or isn’t supported by findings gets returned to the examiner, not rated.
• VA Form 21-0781, the stressor statement, with dates, units, and locations as specific as you can make them.
• Ongoing mental health treatment records showing symptom frequency, severity, and duration over time — the § 4.126(a) evidence the rater must weigh beyond exam day.
• Lay statements from family, coworkers, or supervisors describing concrete changes in work performance and relationships.
• For personal-assault claims, marker evidence under § 3.304(f)(5): counseling visits, law-enforcement records, performance decline, transfer requests.

Common mistakes

• Treating the diagnosis as the rating. A confirmed PTSD diagnosis with mild functional impact rates low; the percentage follows impairment, not the label.
• Skipping the stressor element, or not invoking the relaxed paths in § 3.304(f) that fit your situation.
• A thin record. If nothing between exams documents your symptoms, the rater has little besides the exam snapshot. Describe your symptoms to your providers fully and honestly — including your worst stretches — so the record reflects reality.
• Relying on social withdrawal alone. § 4.126(b) bars ratings based solely on social impairment.

Worth knowing

The symptom lists in the formula are prefaced “due to such symptoms as” — they are examples, not checklists, in the regulation’s own wording. Also note the 10 percent tier explicitly covers symptoms “controlled by continuous medication” — being stabilized on medication does not zero out a rating. A VA-accredited representative or VSO can help at no cost for claims preparation.

Next steps

• Combine this rating with your others — VA math doesn't add ratings.
• How long are claims taking right now? Weekly VBA data.
• Browse other condition rating criteria.