VA PTSD Ratings: How the 0–100% Scale Actually Works

Of all the conditions VA rates, PTSD has the widest rating range — 0%, 10%, 30%, 50%, 70%, and 100% are all possible — and the most variable outcomes between claims with nearly identical symptoms. The reason is that VA rates mental health on a single Formula that asks one question: how much do the symptoms impair your work and social life? Understanding that question is the difference between a 30% rating and a 70%.

The General Rating Formula for Mental Disorders

PTSD, depression, anxiety disorders, bipolar disorder, schizophrenia, and most other psychiatric conditions are all rated on a single chart in 38 C.F.R. § 4.130. The chart lists six levels (0%, 10%, 30%, 50%, 70%, 100%), and each is anchored by a phrase that describes occupational and social impairment.

Plain English on the six anchors:

• 0% — Diagnosed condition that does not interfere with work or require medication.
• 10% — Mild symptoms, controlled by medication, transient occupational impairment during stress.
• 30% — Occasional decrease in work efficiency. Generally functioning satisfactorily.
• 50% — Reduced reliability and productivity at work. Symptoms like flattened affect, panic attacks more than weekly, impaired judgment, disturbances of mood.
• 70% — Deficiencies in most areas (work, school, family, mood, judgment, thinking). Symptoms like suicidal ideation, near-continuous panic or depression, neglect of personal hygiene at times.
• 100% — Total occupational and social impairment.

The hidden word in the Formula: "such as"

Each level lists a set of example symptoms preceded by the phrase "such as." The Federal Circuit ruled in Mauerhan v. Principi (2002) that those symptoms are examples, not requirements. VA cannot deny you a 70% rating because you don't have every single 70%-level symptom on the list. What controls is the overall picture of occupational and social impairment — the symptoms are just there to illustrate.

This matters because raters sometimes apply the list as a checklist. If your decision denies you the higher rating because "the veteran does not exhibit suicidal ideation, obsessional rituals, or near-continuous panic," that is the wrong legal standard, and it's appealable.

The C&P exam: what the examiner is measuring

The PTSD C&P uses the Initial PTSD DBQ or Review PTSD DBQ. The examiner walks through DSM-5 PTSD criteria (Criteria A through G), then assesses occupational and social impairment using the same six-tier language from the Formula. They will ask:

• Are you currently working? Full or part time? How many sick days? Conflicts with co-workers or supervisors?
• How is your relationship with your spouse, your children, your family? Friendships?
• Sleep — quality, hours, nightmares, awakenings?
• Concentration, memory, focus. Anger, irritability, hypervigilance.
• Self-care. Hygiene. Eating. Suicidal or homicidal ideation now or in the past.

What to say at the exam: describe a normal week, not a good day

The single biggest disservice veterans do themselves at PTSD exams is describing only their best moments. They feel better walking into the exam (a structured appointment, somewhere to be) and answer based on that morning rather than on the average week. The rating must reflect impairment across time, not a snapshot. 38 C.F.R. § 4.126 tells the rater to consider "the frequency, severity, and duration" of symptoms.

Describe a typical week honestly. How many nights of sleep are bad. How often you skip gatherings you used to enjoy. How many work hours you actually get done. If you have intrusive thoughts during the day, say how many times. If you isolate, say what that looks like — not leaving the house, leaving the room when family visits, not picking up the phone. Do not exaggerate. Do not script. Just describe the week.

Service connection: stressor verification

Combat-related stressors are conceded under 38 C.F.R. § 3.304(f)(2) when consistent with the circumstances of service. Fear of hostile military or terrorist activity is conceded under 38 C.F.R. § 3.304(f)(3). MST claims have a relaxed evidence standard under 38 C.F.R. § 3.304(f)(5) — see our separate article on MST. For non-combat, non-MST stressors, VA still requires verification, but lay statements, personnel records, and unit histories all count.

Common reasons PTSD claims under-rate

Working full-time at a stable job

Many raters interpret continued full-time employment as evidence against a 70% rating. But the Formula evaluates impairment, not whether you have managed to grind through it. If you are working but using all your leave on bad weeks, missing days, struggling with supervisors, having outbursts, or barely holding the job together, the picture is different from someone functioning satisfactorily.

Symptoms described as "in the past"

If a prior exam noted suicidal ideation and the current one says "denies current SI," raters often move you down a tier. But 38 C.F.R. § 4.126 specifies the rating should be assigned on the highest level of severity. If the symptoms have come and gone, that's still ongoing impairment.

Total Disability based on Individual Unemployability (TDIU)

If PTSD prevents you from securing or following a substantially gainful occupation, you may be eligible for TDIU under 38 C.F.R. § 4.16(a) — paid at the 100% rate even if your schedular rating is lower. This is a separate claim and requires its own evidence (vocational, medical, employment history). For veterans with severe PTSD who can no longer work, TDIU is often the right path even where the schedular rating sits at 50% or 70%.