Review mental health guidance around documented diagnosis, occupational and social impairment level, symptom patterns, functional impact, and unsupported symptom-only routes.
Condition Overview & Clinical Scope
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VA generally uses one General Rating Formula for many mental disorders, including PTSD, anxiety disorders, depressive disorders, and adjustment disorder. The formula focuses on the overall level of occupational and social impairment shown by the complete record, not the diagnosis name or a symptom count by itself.
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Common Questions & FAQs
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What are you trying to understand about mental health?
VA generally uses one General Rating Formula for many mental disorders, including PTSD, anxiety disorders, depressive disorders, and adjustment disorder. The formula focuses on the overall level of occupational and social impairment shown by the complete record, not the diagnosis name or a symptom count by itself.
Regulatory authority: 38 CFR 4.125, 4.126, and 4.130, General Rating Formula for Mental Disorders
This hub explains the published schedule and common record language. It does not diagnose a condition, determine service connection, estimate an outcome, or replace clinical care. This hub's holistic, not-a-checklist framing is grounded in real, binding case law: the listed symptoms are illustrative examples, not an exhaustive checklist (Mauerhan v. Principi, 16 Vet.App. 436, 442 (2002)); but they must still translate into demonstrated occupational and social impairment of similar severity, frequency, and duration to the regulation's own examples, not merely be present in the abstract (Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013)); and a single sufficiently severe symptom can by itself establish a higher level's impairment, since VA must conduct a holistic analysis rather than impose a requirement -- such as hospitalization -- that the regulation itself does not state (Bankhead v. Shulkin, 29 Vet.App. 10, 19, 22 (2017)). A pending VA rulemaking (RIN 2900-AQ82) may eventually replace this formula; RatingScope does not assume how or whether it will apply. RatingScope does not ask for crisis details. If you are in crisis, call 988 and press 1 for the Veterans Crisis Line.
Percentage Guides
Understanding Your Percentage
Select a pathway to see what the published criteria ask about, what records may clarify it, and what should not be assumed.
0%
Next: 10%
A mental condition is formally diagnosed, but the documented symptoms are not severe enough to interfere with occupational and social functioning or require continuous medication.
What separates the next level: The 10% level begins when mild or transient symptoms reduce work efficiency during significant stress, or when symptoms are controlled by continuous medication.
Review CFR criteria, examples, and evidence
Official CFR language
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.
Qualification explanation
The diagnosis is documented, while the record describes no qualifying occupational or social interference and no continuous-medication requirement. Missing impairment information should not be treated as proof of this pathway.
Examples
A clinician documents a diagnosis but no current interference with work or social functioning.; The record does not describe a need for continuous medication.; Enough information is present to distinguish no documented impairment from missing detail.
Medical evidence
Mental Disorders DBQ or PTSD review DBQ; Diagnostic and treatment records; Clinician description of occupational and social functioning
Functional impact examples
The record describes stable functioning without qualifying interference.; A diagnosis can exist even when the current documented impairment is noncompensable.
Common misconceptions
A 0% pathway is not a statement that the condition is unimportant.; Missing records are not evidence that impairment is absent.; A diagnosis alone does not identify a compensable percentage.
Related topics
formal diagnosis; occupational impairment; social impairment; continuous medication
Source context
38 CFR 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
10%
Next: 30%
The 10% level describes mild or transient symptoms that reduce work efficiency and the ability to perform occupational tasks only during significant stress, or symptoms controlled by continuous medication.
What separates the next level: The 30% level describes occasional decreases in work efficiency and intermittent periods when occupational tasks cannot be performed, even though routine functioning is generally satisfactory.
Review CFR criteria, examples, and evidence
Official CFR language
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.
Qualification explanation
This level can be described by the significant-stress pathway or the continuous-medication-control pathway. The record should identify the actual impairment description rather than relying on a diagnosis label alone.
Examples
Symptoms affect work efficiency during periods of significant stress.; Continuous medication controls the documented symptoms.; The record describes mild or transient functional effects rather than recurring periods of inability to perform tasks.
Medical evidence
DBQ occupational and social impairment selection; Medication history and treatment notes; Clinical history describing functioning during stress
Functional impact examples
Reduced efficiency during unusually stressful periods; Symptoms remain controlled with continuous medication; Generally preserved routine functioning
Common misconceptions
Taking medication does not automatically explain every percentage level.; A single mild symptom is not a substitute for the overall impairment description.; The diagnosis name does not separate 10% from 30%.
Related topics
significant stress; continuous medication; mild or transient symptoms; work efficiency
Source context
38 CFR 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
30%
Next: 50%
The 30% level describes occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks, while routine behavior, self-care, and conversation are generally satisfactory.
What separates the next level: The 50% level describes reduced reliability and productivity rather than occasional decreases with generally satisfactory routine functioning.
Review CFR criteria, examples, and evidence
Official CFR language
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation.
Qualification explanation
The published symptom examples help illustrate this level, but the central question is the documented pattern of occupational and social impairment across the record.
Examples
The record describes recurring but intermittent difficulty completing occupational tasks.; Routine behavior and self-care remain generally satisfactory.; Symptoms such as depressed mood, anxiety, chronic sleep impairment, or mild memory loss are documented with the broader functional picture.
Medical evidence
DBQ impairment summary and symptom section; Treatment notes describing frequency, severity, and duration; Occupational and social history
Functional impact examples
Occasional reduction in work efficiency; Intermittent periods when occupational tasks cannot be performed; Generally satisfactory routine behavior and self-care
Common misconceptions
The listed symptoms are examples, not a required checklist.; One symptom associated with a higher level does not automatically establish that level.; Social difficulty alone should not be used as the sole basis for an evaluation.
Related topics
occasional decrease in work efficiency; intermittent inability; generally satisfactory functioning; symptom examples
Source context
38 CFR 4.126 and 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
50%
Next: 70%
The 50% level describes occupational and social impairment with reduced reliability and productivity.
What separates the next level: The 70% level requires a broader pattern of deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.
Review CFR criteria, examples, and evidence
Official CFR language
Occupational and social impairment with reduced reliability and productivity.
Qualification explanation
The record should show how symptoms affect reliability, productivity, work, and relationships. Symptom examples provide context, but the overall impairment level remains the organizing standard.
Examples
The record describes recurring reliability or productivity problems at work.; Difficulty maintaining effective work and social relationships is documented.; Clinical findings such as impaired judgment, disturbances of motivation and mood, or memory impairment are connected to the overall functional pattern.
Medical evidence
DBQ impairment selection and symptom findings; Longitudinal treatment records; Documented work and relationship effects
Functional impact examples
Reduced reliability across recurring responsibilities; Reduced productivity rather than only occasional inefficiency; Difficulty establishing or maintaining effective relationships
Common misconceptions
The presence of one listed symptom does not create an automatic percentage.; Employment does not by itself rule out this pathway.; The record is evaluated as a whole rather than by counting symptoms.
Related topics
reduced reliability; reduced productivity; work relationships; social relationships
Source context
38 CFR 4.126 and 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
70%
Next: 100%
The 70% level describes occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.
What separates the next level: The 100% level requires total occupational and social impairment. Serious symptoms alone do not replace the need to understand the overall documented level.
Review CFR criteria, examples, and evidence
Official CFR language
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.
Qualification explanation
This level concerns the breadth and severity of impairment across most major areas of life. The evidence should connect symptoms and observations to that wider functional pattern.
Examples
The record describes deficiencies across work, family relations, judgment, thinking, or mood.; Difficulty adapting to stressful circumstances is documented as part of a broader impairment pattern.; The clinician connects symptom severity to deficiencies in most areas.
Medical evidence
DBQ overall impairment selection; Treatment and examination records describing multiple affected areas; Occupational, educational, family, and social history
Functional impact examples
Deficiencies across most major areas rather than one isolated setting; Significant difficulty adapting to work or work-like stress; Substantial impairment in relationships, thinking, judgment, or mood
Common misconceptions
A veteran does not need to show every symptom example in the schedule.; Working does not automatically exclude a 70% pathway; the documented impairment still controls.; A serious symptom should be understood in the context of the entire record.
Related topics
deficiencies in most areas; difficulty adapting to stress; occupational impairment; social impairment
Source context
38 CFR 4.126 and 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
100%
Highest listed pathway
The 100% level describes total occupational and social impairment.
What separates the next level: The 70% level describes deficiencies in most areas. The 100% level uses the distinct standard of total occupational and social impairment.
Review CFR criteria, examples, and evidence
Official CFR language
Total occupational and social impairment.
Qualification explanation
The record must support total impairment in both occupational and social functioning. The schedule provides serious symptom examples, but RatingScope does not infer total impairment from a diagnosis or single symptom.
Examples
The examiner documents total occupational and social impairment.; The longitudinal record supports pervasive inability to function in occupational and social settings.; Severe clinical findings are explained in relation to total functional impairment.
Medical evidence
DBQ overall impairment selection; Longitudinal clinical and treatment records; Detailed occupational and social functioning history
Functional impact examples
Total occupational impairment; Total social impairment; Pervasive functional effects documented across the record
Common misconceptions
A diagnosis alone does not establish total impairment.; One serious symptom does not automatically establish the 100% pathway.; The standard is total occupational and social impairment, not simply unemployment.
Related topics
total occupational impairment; total social impairment; longitudinal evidence; overall impairment
Source context
38 CFR 4.126 and 4.130; General Rating Formula for Mental Disorders; Current General Rating Formula educational pathway.
Learn
Understand the details behind the criteria
Use these short guides to connect published terms with the records and observations that may clarify them.
A pending rulemaking may eventually replace this formula (not yet finalized)
RIN 2900-AQ82 is a proposed VA rulemaking that would eliminate the 0 percent tier, add a 10 percent minimum evaluation for any diagnosed, service-connected mental disorder, and replace the current symptom-example General Rating Formula with a new functional-domain framework. RatingScope does not assume whether or when this rule will take effect.
The proposed rule was published in the Federal Register on February 15, 2022 (87 FR 8498) and remains at the proposed/final rule stage in VA's Unified Agenda as of this hub's current sourcing -- it has not been finalized.
If finalized, the rule would restructure the current 0/10/30/50/70/100 percent tiers described on this hub into a 10/30/50/70/100 percent structure, with no percentage below 10 percent for a diagnosed, service-connected mental disorder.
As of this hub's current sourcing, the live regulation is unchanged: the General Rating Formula described throughout this hub remains the operative standard for every current rating decision. RatingScope will revisit this disclosure if the rule is finalized, rather than guessing its eventual scope now.
Records to review: Federal Register rulemaking history.
Evidence
Evidence that may clarify the published criteria
Mental Disorders or PTSD DBQ
Organizes diagnosis, symptom differentiation, occupational and social impairment, history, symptoms, behavioral observations, and relevant overlap such as TBI.
A DBQ can organize relevant findings, but RatingScope does not decide what evidence VA must accept or whether an examination is sufficient.
Mental health treatment records
May show diagnosis, symptom frequency and severity, treatment response, medication, clinician observations, and changes in functioning over time.
Treatment frequency alone does not determine a percentage pathway.
Occupational and educational history
May clarify reliability, productivity, attendance, task completion, stress tolerance, accommodations, school functioning, or periods of inability to perform tasks.
Employment status by itself does not identify the level of occupational impairment.
Firsthand descriptions of daily functioning
May describe observable changes in routines, relationships, communication, stress tolerance, task completion, and social participation.
A lay statement can describe firsthand observations but does not create a diagnosis or clinical finding.
Medication history
May show continuous medication, treatment response, changes, and side effects that add context to functioning.
Medication use does not create a hidden score or automatically establish a particular percentage.
C&P examination and clinician observations
May document the overall impairment selection, symptom examples, behavior, history, and how findings affect occupational and social functioning.
VA evaluates the complete record; RatingScope does not treat one examination moment as the entire history.
Official VA Forms & DBQs
Downloadable DBQs & Supporting Claim Forms
Take the public DBQ to your private physician or review it prior to your C&P examination.
Terminology
Plain-English terms
TDIU
A veteran whose service-connected mental health condition causes unemployability may qualify for compensation at the 100 percent rate through TDIU, even if their schedular mental-health rating does not itself reach the 100 percent 'total occupational and social impairment' standard under DC 4.130.
A lower schedular percentage does not by itself foreclose TDIU eligibility -- this hub computes only the schedular DC 4.130 percentage and does not determine TDIU eligibility.
How documented symptoms affect reliability, productivity, attendance, task completion, judgment, stress tolerance, or the ability to perform occupational tasks.
The General Rating Formula repeatedly pairs occupational and social impairment. Employment status alone does not answer the question.
occupational history; DBQ; treatment notes; work efficiency; reliability; productivity
How documented symptoms affect family relationships, friendships, communication, participation, isolation, conflict, or the ability to establish and maintain effective relationships.
Social impairment is considered with occupational impairment and should not be the sole basis for an evaluation.
social history; lay statements; DBQ; relationships; isolation; communication
Being employed, unemployed, retired, or in school is context. The important question is what the record says about functioning, reliability, productivity, stress, and task performance.
A job title or employment status does not automatically prove or disprove a percentage pathway.
occupational history; educational history; occupational impairment; work efficiency
The listed symptoms help explain the kind and degree of impairment described at each level. They are not a rigid checklist or point system.
VA considers frequency, severity, duration, and functional effects across the complete record rather than simply counting symptoms. Courts have confirmed this directly: the symptom list is illustrative, not exhaustive (Mauerhan v. Principi, 16 Vet.App. 436, 442 (2002)); symptoms must still add up to demonstrated impairment of similar severity, frequency, and duration to the regulation's examples (Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013)); and a single sufficiently severe symptom can be enough by itself (Bankhead v. Shulkin, 29 Vet.App. 10, 19 (2017)).
If my schedular mental-health rating is below 100%, can I still be compensated at the 100% rate?
Possibly, through TDIU (Total Disability rating based on Individual Unemployability, 38 CFR 4.16) -- a separate pathway to 100 percent compensation based on unemployability, independent of whether the schedular DC 4.130 rating itself reaches 100 percent. This hub computes only the schedular percentage and does not determine TDIU eligibility.
How is mental health rated?
VA generally applies the General Rating Formula for Mental Disorders. It looks at the overall occupational and social impairment supported by the complete record. Diagnosis names and symptom examples provide context, but neither operates as a point system.
What evidence commonly helps explain a mental health percentage?
A Mental Disorders or PTSD DBQ, treatment records, diagnosis records, medication history, clinician observations, and occupational or social history may help explain the documented impairment level. No single document automatically controls every case.
What is occupational impairment?
Occupational impairment describes how symptoms affect work-like or school functioning, including reliability, productivity, attendance, task completion, judgment, and stress tolerance. Employment status alone does not identify the level.
What is social impairment?
Social impairment describes effects on relationships, communication, participation, isolation, or conflict. Under 38 CFR 4.126, social impairment is considered, but an evaluation should not be based on social impairment alone.
Can I work and still have a compensable mental health evaluation?
Employment does not automatically establish or exclude a percentage pathway. The schedule focuses on the documented level of occupational and social impairment, including how reliably and effectively the veteran functions.
What is pyramiding?
Pyramiding means compensating the same manifestation more than once under different diagnoses. Multiple diagnosis names do not automatically create separate percentages when symptoms overlap. RatingScope does not make case-specific pyramiding decisions.
Are the symptoms listed at each percentage a checklist?
No. The listed symptoms are examples that help describe the type and degree of impairment. The complete record, including frequency, severity, duration, and functional effects, matters more than a simple symptom count. This is confirmed by real case law, not just RatingScope's own reading: the symptom list is illustrative, not exhaustive (Mauerhan v. Principi, 16 Vet.App. 436 (2002)); symptoms still must add up to demonstrated impairment of similar severity, frequency, and duration to the regulation's own examples (Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013)); and one sufficiently severe symptom can be enough by itself, without needing many symptoms or a requirement like hospitalization that the regulation doesn't state (Bankhead v. Shulkin, 29 Vet.App. 10 (2017)).
Can PTSD, anxiety, and depression receive separate percentages?
These diagnoses commonly use the same General Rating Formula. Separate diagnosis names do not automatically mean separate evaluations, especially when manifestations overlap. Distinguishable manifestations and other rules require case-specific review.
What happens during a mental health C&P exam?
The examiner may review diagnosis, symptom differentiation, history, symptoms, behavioral observations, and the overall occupational and social impairment selection. The examination gathers information for VA; the examiner does not issue the final benefits decision.
How does VA evaluate severity over time?
Under 38 CFR 4.126, VA considers the frequency, severity, and duration of symptoms, periods of remission, and the capacity for adjustment. The evaluation should use the evidence of record rather than only the examiner's assessment at one moment.
What separates the 0% rating from adjacent levels?
The 10% level begins when mild or transient symptoms reduce work efficiency during significant stress, or when symptoms are controlled by continuous medication.
What separates the 10% rating from adjacent levels?
The 30% level describes occasional decreases in work efficiency and intermittent periods when occupational tasks cannot be performed, even though routine functioning is generally satisfactory.
What separates the 30% rating from adjacent levels?
The 50% level describes reduced reliability and productivity rather than occasional decreases with generally satisfactory routine functioning.
What separates the 50% rating from adjacent levels?
The 70% level requires a broader pattern of deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.
What separates the 70% rating from adjacent levels?
The 100% level requires total occupational and social impairment. Serious symptoms alone do not replace the need to understand the overall documented level.
What separates the 100% rating from adjacent levels?
The 70% level describes deficiencies in most areas. The 100% level uses the distinct standard of total occupational and social impairment.
These diagnosis families generally share one occupational-and-social-impairment framework.
Ready when you are
Compare documented mental health findings
Use the impairment language already documented in a DBQ, examination, or clinician record. Do not enter crisis details, treatment narratives, Social Security numbers, claim numbers, or other sensitive identifiers. RatingScope does not infer an impairment level from symptom descriptions.
Informational guidance only. RatingScope does not predict, decide, or guarantee VA outcomes.
38 CFR 4.16 - Total disability ratings for compensation based on unemployability (TDIU)
Official source for TDIU, a separate pathway to 100 percent compensation based on unemployability, independent of the schedular DC 4.130 percentage. This hub does not determine TDIU eligibility.
DC 5025's qualifying condition lists depression and anxiety as symptoms that may accompany fibromyalgia. RatingScope discloses this as a pyramiding consideration (38 CFR 4.14) -- different diagnosis names do not automatically create separate percentages when the same symptoms overlap -- not a computed dispatch rule between the two hubs. Under 38 CFR 4.126(d), when a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency evaluates it using the diagnostic code representing the dominant, more disabling aspect of the condition (see 4.14) -- RatingScope discloses this standard but does not determine which aspect dominates in any specific case.
38 CFR 4.126 - Evaluation of disability from mental disorders
Official eCFR source for frequency, severity, duration, remission, adjustment, and social-impairment principles, paragraph (c)'s neurocognitive-disorder/TBI combination mechanic, and paragraph (d)'s dominant-aspect standard for physical-plus-mental overlap.
Official VA form showing diagnosis, differentiation, impairment, history, symptom, and observation fields. Initial PTSD uses a separate examination process.
RatingScope plain-language guide to the nexus-letter legal standard, relevant when a mental health condition is claimed secondary to another condition. Does not assess whether this or any specific case needs one.
RatingScope plain-language guide to how insomnia is rated under this hub's own General Rating Formula for Mental Disorders, often as a condition secondary to PTSD or another mental health diagnosis.
This reflects regulatory and clinical relationships already explained elsewhere on this site. It is not a diagnosis, not a prediction that you have or will develop a connected condition, and not personalized medical or legal advice.
Regulatory relationship
Mental Health Fibromyalgia
DC 5025's own qualifying-condition text lists depression and anxiety as symptoms that may accompany fibromyalgia.
Mental health conditions like depression and anxiety are frequently secondary to chronic Tinnitus due to constant ringing impacting sleep and quality of life.
Commonly discussed as a secondary condition in VA claims practice: Sleep problems may appear in mental-health histories, but diagnosed sleep apnea follows a separate respiratory criteria pathway. This distinction is described in RatingScope's own guidance as an informal note, not a regulatory citation.
Commonly discussed as a secondary condition in VA claims practice: Mental-health and TBI symptoms can be difficult to tell apart in a documented history. RatingScope's guidance notes this as a diagnostic differentiation point, not a formal cross-condition rule.