How the VA rates PTSD
PTSD is rated under 38 CFR § 4.130, diagnostic code 9411, using the General Rating Formula for Mental Disorders. The VA assigns one of five rating levels based on the degree of occupational and social impairment caused by your symptoms.
PTSD rating criteria by level
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily. Symptoms include depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss.
Occupational and social impairment with reduced reliability and productivity. Symptoms include flattened affect, circumstantial speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory, disturbances of motivation and mood, difficulty establishing and maintaining relationships.
Occupational and social impairment with deficiencies in most areas — work, school, family relations, judgment, thinking, or mood. Symptoms include suicidal ideation, obsessional rituals, near-continuous depression, impaired impulse control, spatial disorientation, neglect of personal appearance, intermittent inability to perform daily tasks.
Total occupational and social impairment. Symptoms include persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, disorientation to time or place, memory loss for names of close relatives, own occupation, or own name.
PTSD combined with other conditions
Many veterans have PTSD alongside other service-connected conditions — sleep apnea, tinnitus, back injuries, or TBI. The VA combines these using the efficiency formula in 38 CFR § 4.25. Ratings do not add up directly.
Secondary conditions to PTSD
Several conditions are commonly found secondary to PTSD and can be separately rated, increasing your combined percentage:
- Sleep apnea secondary to PTSD — frequently granted, commonly rated 50%
- Depression and anxiety as secondaries — if documented separately from PTSD
- Gastrointestinal conditions — GERD and IBS secondary to stress/PTSD medication
- Hypertension secondary to PTSD — elevated cortisol and stress response
- Erectile dysfunction secondary to PTSD or medications — rated separately
TDIU and PTSD
If your PTSD prevents you from maintaining substantially gainful employment, you may qualify for Total Disability based on Individual Unemployability (TDIU), which pays at the 100% rate even if your schedular rating is lower. To qualify, you generally need one condition rated at 60% or more, or a combined rating of 70% with at least one condition at 40%.
At 70% PTSD alone, you likely meet the single-condition threshold for TDIU if you cannot hold steady employment.
If your PTSD was denied or underrated
PTSD claims are frequently denied on nexus grounds (failing to establish the in-service event), or rated lower than the symptoms warrant. Common issues include:
- C&P examiner who did not review service records thoroughly
- Rating that used the wrong diagnostic code
- Failure to consider buddy statements or private medical evidence
- MST-related PTSD denied due to lack of service records (alternative evidence is available)
If your rating doesn't reflect your actual impairment, a VA-accredited attorney can review your C-file and identify grounds for an increased rating claim or appeal.
Frequently asked questions
Yes. The 70% rating is based on symptoms and impairment, not employment status. Veterans who are working can receive a 70% rating if their symptoms cause deficiencies in most areas of functioning. TDIU (unemployability) is a separate benefit that requires being unable to maintain gainful employment.
Generally yes, under the pyramiding rule (38 CFR § 4.14). The VA cannot rate the same disability under two different diagnostic codes. Depression, anxiety, and PTSD arising from the same stressor are typically rated under one code. However, if a separate in-service event caused the depression independently of the PTSD, separate ratings may be possible.
The VA schedules re-examinations when a condition is expected to improve. PTSD that has been rated for 5+ years without significant change is more likely to be considered stable and protected from reduction. After 10 years of continuous rating, the service connection itself cannot be severed (except for fraud).
A nexus letter is a medical opinion from a licensed professional stating that your PTSD is "at least as likely as not" caused by or connected to your military service. For PTSD, nexus is typically established through the stressor itself (combat exposure, MST, etc.) rather than a separate medical letter — but a letter from a private psychologist can strengthen a claim if the C&P exam was inadequate.