PTSD VA Rating: How the 38 CFR § 4.130 Criteria Actually Work (0% to 100%)

PTSD is the most consequential rating in the VA system — not because it is the most common (tinnitus holds that title), but because the difference between the tiers is enormous. In 2026, the gap between a 30% and a 70% PTSD rating is over $1,250 a month, tax-free — and the 70% tier is the gateway to TDIU, which pays at the 100% rate. Yet most veterans walk into their C&P exam with no idea how the rating formula actually works.

This article breaks down the exact criteria the rater uses — the General Rating Formula for Mental Disorders at 38 CFR § 4.130 — tier by tier, in plain English, with the case law that keeps the VA honest and the evidence that moves a rating.

How the General Rating Formula works (DC 9411)

PTSD is rated under Diagnostic Code 9411, but the criteria are shared by nearly every mental-health condition — depression, anxiety, panic disorder — through the General Rating Formula at § 4.130. Two structural rules matter before we get to the tiers:

• The symptom lists are examples, not checklists. The formula says “due to such symptoms as” — and the Federal Circuit in Mauerhan v. Principi held that the listed symptoms are illustrative. The Veterans Court in Vazquez-Claudio added that what controls is the level of impairment the symptoms cause.
• The benefit of the doubt goes to you. Under 38 CFR § 4.7, when your disability picture sits between two tiers, the VA must assign the higher one. Veterans straddling 50/70 belong at 70 when deficiencies show up in most areas.

The six tiers, translated

Here is each tier of § 4.130, what the regulation says, and what it looks like in real life — with the 2026 monthly rate for a single veteran with no dependents.

• 0% — diagnosed, not impairing. A formal diagnosis exists but symptoms are not severe enough to interfere with work or social functioning or to require continuous medication. No payment, but service connection is established — which preserves the effective-date trail for a future increase.
• 10% ($180.42/mo) — mild, intermittent. Occupational and social impairment due to mild or transient symptoms that decrease work efficiency only during periods of significant stress, or symptoms controlled by continuous medication.
• 30% ($552.47/mo) — occasional decrease in efficiency. Intermittent periods of inability to perform occupational tasks, with symptoms like depressed mood, anxiety, suspiciousness, weekly (or less frequent) panic attacks, chronic sleep impairment, and mild memory loss. You generally function, with bad stretches.
• 50% ($1,132.90/mo) — reduced reliability and productivity. Symptoms like flattened affect, panic attacks more than once a week, difficulty understanding complex commands, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships.
• 70% ($1,808.45/mo) — deficiencies in most areas. Work, school, family relations, judgment, thinking, or mood. Example symptoms: suicidal ideation; obsessional rituals; intermittently illogical speech; near-continuous panic or depression affecting the ability to function independently; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty adapting to stressful circumstances (including work); inability to establish and maintain effective relationships.
• 100% ($3,938.58/mo) — total occupational and social impairment. Gross impairment in thought processes or communication; 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.

The most under-reported symptom that changes the tier

Suicidal ideation is a 70%-tier example symptom. Passive thoughts — “sometimes I think everyone would be better off without me” — count. The Veterans Court in Bankhead v. Shulkin held that suicidal ideation alone can support the 70% tier; it does not require a plan, an attempt, or hospitalization. Veterans minimize this at C&P exams constantly — out of pride, fear, or habit — and get rated 50% when the regulation places them at 70%. Tell the examiner the truth, in plain words, including frequency.

The evidence that moves a PTSD rating

1. The C&P exam is the main event. The examiner fills out the mental-disorders DBQ, and the boxes they check map directly onto the tiers above. Walk in prepared: describe your worst weeks, not your best day, and lead with how symptoms affect work and relationships. The full playbook is in the C&P exam guide and the PTSD DBQ field guide.
2. Lay statements fill the record. A spouse's statement describing the nightmares, the isolation, the anger, the missed family events is competent evidence the rater must weigh. See buddy statements: the free evidence that wins claims.
3. Work records corroborate occupational impairment. Write-ups, accommodations, job changes, firings, and gaps in employment are exactly what “deficiencies in work” looks like on paper.
4. Treatment notes matter — but absence of treatment is not absence of disability. Consistent therapy notes help, but the VA cannot deny a tier solely because you toughed it out without treatment.

The secondaries that stack on PTSD

A PTSD rating is rarely the end of the claim — it is the anchor for a chain of secondary conditions under 38 CFR § 3.310:

• Obstructive sleep apnea — the 50% CPAP rating, on a documented physiologic pathway. Full breakdown: sleep apnea secondary to PTSD.
• GERD — via stress physiology or psychiatric medications.
• Migraines — tension and sleep-deprivation pathways; up to 50% under DC 8100.
• Hypertension — emerging medical literature supports the link.
• Erectile dysfunction — commonly from SSRIs; rated 0% but unlocks SMC-K (an extra monthly payment).

The Claim Coach secondaries track maps these chains from your existing ratings and builds the evidence list for each link.

The five mistakes that cost PTSD tiers

1. Performing wellness at the exam. Showering, dressing sharp, and saying “I'm fine” describes your one good day. Rate-able impairment lives in your worst weeks — describe those.
2. Hiding suicidal ideation. It is a 70%-tier symptom and the most under-reported one. Honesty here is not weakness; it is accuracy.
3. No collateral statements. The people who live with you see what you minimize. One spouse statement can outweigh a guarded interview.
4. Quitting the claim at 50%. If deficiencies show in most areas — work, family, mood, judgment — the regulation places you at 70%, and § 4.7 breaks ties upward. The appeal lanes are mapped in HLR vs Supplemental vs Board.
5. Ignoring TDIU. If PTSD keeps you from working, file VA Form 21-8940. At 70%, the schedular gateway is already met.

Quick answers

Built by a veteran. The condition guides are free, forever.

→ Sign up to use the Claim Coach, save your claim tracker, and get the Secondary Conditions Checklist

Educational content only. This is not legal, medical, or financial advice. Always consult an accredited VSO or VA-accredited attorney for claim-specific guidance. CFR citations: 38 CFR § 4.130 (General Rating Formula for Mental Disorders, Diagnostic Code 9411), § 4.7 (higher of two evaluations), § 4.126 (evaluation of mental disorders), § 4.16 (TDIU), § 3.310 (secondary service connection). Case law: Mauerhan v. Principi, 16 Vet. App. 436 (2002); Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Bankhead v. Shulkin, 29 Vet. App. 10 (2017). 2026 rates reflect the 2.5% COLA effective December 1, 2025. If you are in crisis, call or text 988 and press 1 for the Veterans Crisis Line.