How VA rates mental health conditions under 38 CFR 4.130, plus the proposed changes

Every mental health condition VA rates — PTSD, depression, generalized anxiety, panic disorder, conditions tied to military sexual trauma (MST), neurocognitive disorders, schizophrenia spectrum disorders, and chronic sleep impairment — is scored under the same rating rules. VA does not rate depression differently from PTSD or anxiety differently from MST-related conditions. It rates the degree of occupational and social impairment those symptoms cause, using one formula found at 38 CFR § 4.130. This page walks through that current formula, how VA applies it to specific diagnoses, a proposed rating-schedule overhaul that has not taken effect, and how to document a mental health claim.

How VA rates mental health conditions today: 38 CFR § 4.130

The General Rating Formula for Mental Disorders at 38 CFR § 4.130 assigns one of six percentages — 0%, 10%, 30%, 50%, 70%, or 100% — based on how much a veteran's psychiatric symptoms interfere with work and relationships. VA does not simply count symptoms; it weighs the overall level of impairment those symptoms cause, using the listed symptoms as examples rather than a checklist every veteran must match exactly.

The six impairment tiers, in plain language

• 0% — Diagnosed but not disabling. A mental health condition is documented, but symptoms are not severe enough to interfere with occupational or social functioning, or to require continuous medication.
• 10% — Mild or transient symptoms. Symptoms decrease work efficiency only during periods of significant stress, or are controlled by continuous medication.
• 30% — Occasional decrease in work efficiency. This tier covers symptoms such as depressed mood, anxiety, suspiciousness, panic attacks occurring weekly or less often, chronic sleep impairment, and mild memory loss (such as forgetting names, directions, or recent events).
• 50% — Reduced reliability and productivity. Symptoms at this level include flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; and impairment of short- and long-term memory.
• 70% — Deficiencies in most areas. This tier reflects impairment across work, school, family relations, judgment, thinking, or mood, evidenced by symptoms such as suicidal ideation, obsessional rituals, illogical or irrelevant speech, near-continuous panic or depression, impaired impulse control, neglect of personal hygiene, and an inability to establish or maintain effective relationships.
• 100% — Total occupational and social impairment. The most severe tier, marked by symptoms such as 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, and memory loss for names of close relatives, one's own occupation, or one's own name.

Two things trip veterans up about this formula. First, the symptom lists are examples ("such as"), not a mandatory checklist — a rater is supposed to look at overall impairment, and the Court of Appeals for Veterans Claims has repeatedly held that a veteran does not need every listed symptom at a tier to receive that rating. Second, this is a single formula that applies across diagnoses. VA does not have a separate rating scale for depression versus anxiety versus PTSD — the diagnostic code differs, but the rating criteria are identical.

How the formula applies to specific conditions

PTSD

PTSD (diagnostic code 9411) is rated under the exact formula above — there is no PTSD-specific rating table. What differs for PTSD is the evidence VA requires to service-connect it: a current diagnosis, an in-service stressor, and a medical nexus linking the two (with relaxed stressor-corroboration rules for combat, POW status, and personal/sexual assault claims). For a full breakdown of PTSD rating criteria, evidence, and the stressor statement process, see our dedicated PTSD disability rating guide.

Depression and anxiety disorders

Major depressive disorder, persistent depressive disorder (dysthymia), generalized anxiety disorder, panic disorder, and social anxiety disorder are all rated under 38 CFR § 4.130 using diagnostic codes in the 9400 and 9430 series. Because these conditions share so much symptom overlap with PTSD — sleep impairment, concentration problems, avoidance, irritability — VA examiners and raters are instructed to rate the combined psychiatric picture rather than parsing out which symptom belongs to which diagnosis when a veteran has more than one mental health condition. In practice this means:

• If a veteran has both PTSD and major depressive disorder, VA typically assigns one combined rating for the overall psychiatric impairment rather than two separate ratings, because symptoms like poor concentration, sleep disturbance, and social withdrawal cannot cleanly be separated by diagnosis.
• The rating hinges on functional impact, not diagnostic labels. A veteran with "only" generalized anxiety disorder who has near-continuous panic affecting their ability to function independently and appropriately can reach the 70% tier just as a veteran with PTSD can — the formula does not weight one diagnosis as inherently more severe than another.
• Secondary depression and anxiety are common. Chronic pain conditions, tinnitus, and other service-connected physical disabilities frequently cause or aggravate depression and anxiety; when a medical opinion links the two, the secondary mental health condition is rated under the same 4.130 formula as a primary claim.
• Sleep impairment is a listed symptom at the 30% tier ("chronic sleep impairment") but does not receive a separate rating on its own within a mental health claim — it is one factor VA weighs toward the overall percentage. A separately diagnosed sleep disorder such as insomnia disorder can, in some cases, be considered for its own rating, but VA generally avoids "pyramiding" (rating the same symptom twice under two diagnoses).

Conditions related to military sexual trauma (MST)

MST is not itself a diagnosis VA rates — it is the in-service stressor event. VA rates the mental health condition that resulted from it, most commonly PTSD, but also major depressive disorder, anxiety disorders, or a combination. The rating criteria are the same 38 CFR § 4.130 formula described above. What is different for MST claims is the evidence path: because assault-related incidents are frequently unreported through official channels, VA allows "markers" — secondary evidence such as changes in performance evaluations, requests for transfer, discipline, substance use, or health care visits after the incident — to help establish the in-service stressor without relying solely on official records.

Neurocognitive disorders and schizophrenia spectrum disorders

Mild and major neurocognitive disorders (including those secondary to traumatic brain injury) and schizophrenia spectrum/psychotic disorders are also rated under the 38 CFR § 4.130 general formula, using their own diagnostic codes. Because these conditions can involve memory loss, disorientation, or persistent delusions/hallucinations — symptoms explicitly listed at the 70% and 100% tiers — they are more likely, when severe, to reach the higher end of the scale than mood or anxiety disorders alone. TBI-related cognitive impairment may also be evaluated under the separate criteria at 38 CFR § 4.124a; VA applies whichever formula yields the higher evaluation, without duplicating credit for the same symptoms.

Proposed changes — not yet in effect

VA has proposed replacing the current 38 CFR § 4.130 formula with a different structure. As of 2026, this remains a proposed rule; it has not been finalized, has no effective date, and the current formula described above still governs every mental health claim VA decides today. Nothing changes for veterans filing or rated now unless and until VA publishes a final rule.

What the proposed rule would change

VA published the proposal in the Federal Register on February 15, 2022 (87 FR 8498, "Schedule for Rating Disabilities: Mental Disorders"), with a public comment period that closed April 18, 2022. Instead of the current single list of ascending symptoms, the proposal would score functioning across five domains:

• Cognition — understanding and communicating, covering memory, concentration, attention, planning, and problem-solving.
• Interpersonal interactions and relationships — the ability to engage with others in social and occupational settings.
• Task completion and life activities — managing vocational, educational, domestic, and caregiving demands.
• Navigating environments — getting around, including using transportation and functioning in unfamiliar or crowded settings.
• Self-care — hygiene, dressing, and nourishment.

Each domain would be scored on a 0–4 severity scale (none, mild, moderate, severe, total), with frequency thresholds attached to each level, and the domain scores would map to overall ratings of 10%, 30%, 50%, 70%, or 100% — rather than matching a single ascending symptom list the way the current formula works.

Other rating-schedule proposals in the pipeline

VA has floated related, separate proposed changes elsewhere in the rating schedule — most notably for sleep apnea (tying the rating more closely to how a veteran responds to treatment rather than a flat rating tied to a CPAP prescription) and for tinnitus (a proposal that could end tinnitus's current standalone compensable rating). Like the mental disorders proposal, these remain proposed and not in effect as of 2026 — VA has repeatedly pushed back projected timelines, and no final rule or effective date has been published for any of the three. Check the Federal Register and VA.gov directly for current status before assuming a change applies to your claim.

How to document a mental health claim

Because the rating hinges on functional impact rather than a diagnosis alone, the strongest claims give VA concrete, specific evidence of how symptoms affect work and daily life — not just that a diagnosis exists.

Buddy statements and lay evidence

Statements from spouses, family members, close friends, and former supervisors or coworkers (VA Form 21-4138) carry real weight because they describe changes a clinician never sees firsthand: irritability at home, withdrawal from social events, missed work, memory lapses, or changes in personal hygiene. Effective buddy statements are specific — dates, incidents, and before/after comparisons — rather than general characterizations like "he seems depressed."

Occupational and social impact evidence

Document concrete functional impact wherever it exists: performance reviews showing a decline, disciplinary actions, reduced hours or a demotion, jobs left or lost, gaps in employment, and any pattern of conflict or isolation from family and friends. For MST-related claims specifically, VA Form 21-0781 (the stressor statement, which also covers personal/sexual assault) is the standard vehicle for describing the in-service event and any secondary markers that corroborate it.

C&P exam tips

• Answer the examiner's questions completely and honestly — describe a bad day and a typical day, not just your best day.
• Bring specifics: how often panic attacks occur, how sleep is disrupted, how relationships and work have actually changed, not just "I have anxiety."
• Mention safety-relevant symptoms (suicidal ideation, impaired impulse control) if present — these map directly to specific listed criteria at the 70% and 100% tiers and are frequently underreported out of discomfort.
• Bring or reference supporting records (buddy statements, treatment notes, performance reviews) so the examiner's report reflects the same picture as the rest of the file.

This page describes rating criteria, not outcomes — VA determines the actual percentage assigned to any individual claim based on the full record. For guidance specific to your claim, a Veterans Service Organization (VSO) or accredited representative can review your evidence and help you prepare a stressor statement, buddy statements, or a Decision Ready Claim before you file.