PTSD VA rating criteria: the six tiers explained

By BilateralFactor Editorial Team · Published June 9, 2026

The short answer

VA rates PTSD under Diagnostic Code 9411 using the General Rating Formula for Mental Disorders in 38 CFR §4.130. The rating is not based on a diagnosis alone. It is based on the level of occupational and social impairment the condition causes. The six tiers are 0%, 10%, 30%, 50%, 70%, and 100%.

A PTSD diagnosis is required to establish service connection. The rating percentage is determined separately, based on documented functional impact.

The six rating tiers

The following criteria are from 38 CFR §4.130, verified 2026-06-09. DC 9411 uses this formula directly; it does not have separate criteria.

100%: Total occupational and social impairment

“Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others…”

In plain terms: the veteran cannot function in work or social settings. Symptoms are severe and persistent. This tier also covers cases where the condition is so debilitating that daily functioning is severely compromised across all areas.

70%: Deficiencies in most areas

“Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities…”

The 70% tier describes someone who may be marginally employed or unemployed, has significant difficulty maintaining family relationships, and whose mood or thinking is impaired in most aspects of daily life. The symptom list at 70% includes suicidal ideation, near-continuous panic or depression affecting independent function, and impaired impulse control.

50%: Reduced reliability and productivity

“Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week…”

At 50%, the veteran is typically still functioning but inconsistently. Work performance suffers. Attendance is unreliable. Social interactions are impaired but the veteran can manage basic daily tasks. Panic attacks occurring more than once per week are a listed symptom at this tier.

30%: Occasional decrease in efficiency

“Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks…due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often)…”

At 30%, the veteran functions satisfactorily most of the time. Symptoms intermittently reduce efficiency or cause missed work but do not dominate daily functioning. Panic attacks weekly or less often are listed at this tier (compare: more than once per week at 50%).

10%: Mild or stress-limited symptoms

“Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.”

The 10% tier recognizes a formally diagnosed condition being treated, whose impact on work and social life is minimal and usually stress-triggered or medication-controlled.

0%: Diagnosed but not currently symptomatic

“A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.”

A 0% rating is assigned when service connection exists but current symptoms do not yet meet the 10% threshold. This establishes the service-connected record, which matters for future increased-rating claims.

What §4.126 requires of the evaluator

38 CFR §4.126 governs how raters must approach mental health evaluations. Three points are directly relevant to PTSD claims:

1. Longitudinal view. The evaluator must consider the frequency, severity, and duration of symptoms, plus the length of remissions, across all available evidence. A single exam snapshot is not sufficient.

2. Social impairment alone is not enough. The regulation states that a rating cannot be assigned solely on the basis of social impairment. The evaluation must reflect both occupational and social functioning.

3. Fluctuating symptoms. If your symptoms vary over time, the rating should reflect the overall picture rather than the best day or worst day at the exam.

Practically: if you are having a calm day at your C&P exam but typically struggle with employment and relationships, that history must be documented in your medical records and lay statements for the examiner to consider it.

Combined ratings: PTSD with other service-connected conditions

PTSD ratings combine with other service-connected conditions using the §4.25 efficiency formula. The bilateral factor does not apply to mental health conditions.

Example: PTSD 50% + tinnitus 10% + right knee 20%

Sort by severity: 50, 20, 10

1. Combine 50 and 20: 50 + (20 × 50/100) = 50 + 10 = 60
2. Combine 60 and 10: 60 + (10 × 40/100) = 60 + 4 = 64
3. Round to nearest 10: 60%

The combined raw value is 64%, which rounds to 60%. A three-condition claim at 50/20/10 produces a final rating of 60%.

If the combined rating in your decision letter is lower than this math shows, see what to do after a VA decision you disagree with.

Run your own numbers with the VA Combined Ratings Calculator.

The C&P exam for PTSD

The C&P examiner uses the PTSD DBQ (Disability Benefits Questionnaire) to rate occupational and social impairment. The exam covers:

• Symptom frequency and intensity (nightmares, flashbacks, hypervigilance, avoidance)
• Effect on work attendance, performance, and ability to maintain employment
• Quality of family and social relationships
• Judgment, impulse control, and safety
• Treatment history and medication

Bring documentation: employment records showing missed days or reduced hours, treatment notes from mental health providers, and a personal statement describing your functional limitations on typical days. The examiner matches your overall picture to one of the six tiers.

No bilateral factor for mental health

The bilateral factor under 38 CFR §4.26 applies only to paired extremities and skeletal muscles. A PTSD rating does not qualify. It enters the combined-rating calculation as any other single-condition rating.

Common evidence issues in PTSD claims

The in-service stressor. Service connection for PTSD requires a verified in-service stressor event. For combat veterans, VA generally accepts lay statements about combat stressors without corroborating records. For non-combat stressors, the veteran typically needs corroborating evidence that the event occurred. The required evidence standard differs based on the stressor type and service record.

The nexus. A Compensation and Pension examiner provides an opinion connecting the current PTSD diagnosis to the in-service stressor. If the examiner concludes the nexus is not at least as likely as not, the claim is denied on that basis. A private nexus opinion can rebut an unfavorable VA opinion.

Symptom documentation between exams. The longitudinal record matters under §4.126. If your mental health treatment notes from the year before the C&P exam document severe functional impairment, those notes are evidence of the severity level. A calm presentation at a single exam does not override a consistent record of significant impairment.

Requesting an adequate exam. If a C&P examiner issues an inadequate opinion (one that does not address the specific stressor, the full symptom picture, or the functional domains in the General Rating Formula) you can request a new exam or submit a rebuttal through the appeals process. The adequacy of the examination is a separately reviewable issue.

How PTSD interacts with secondary conditions

PTSD frequently generates secondary service-connected conditions, each of which adds to the combined rating. Common secondary claims include:

Sleep apnea secondary to PTSD. Disrupted sleep architecture from PTSD has been linked to obstructive sleep apnea in some medical literature. A secondary claim requires a nexus opinion from a provider who can address the physiological connection. See the sleep apnea VA rating article for the DC 6847 tiers.

Tinnitus. Tinnitus is occasionally claimed secondary to PTSD-related hyperacusis or auditory sensitivity, though the more common claim is direct service connection from noise exposure. Whether secondary to PTSD or direct, tinnitus rates at 10% maximum under DC 6260.

Cardiovascular conditions. Chronic stress and PTSD have established associations with hypertension and other cardiovascular conditions in medical literature. These claims require specific medical nexus evidence and are evaluated on their own merits.

Secondary conditions increase the combined rating through the §4.25 formula. Each additional service-connected condition adds to the combined value, though with diminishing returns as the combined value rises.

Related articles

• How VA combined ratings work
• Tinnitus VA rating: commonly paired with PTSD
• Sleep apnea VA rating: secondary to PTSD is a common claim path
• VA Combined Ratings Calculator

The rating criteria above come directly from 38 CFR §4.130, retrieved 2026-06-09. Individual outcomes depend on the evidence in your specific claim file. This page is informational math and regulation reference only. See our disclaimer.