How VA Rates Mental Disorders: The 38 CFR 4.130 Ladder, Tier by Tier

Most veterans assume the mental health rating depends on the diagnosis, or on matching the symptoms VA lists at each level. Neither is true: nearly every mental disorder is rated on one ladder, the level turns on occupational and social impairment, and the listed symptoms are examples, not requirements.

One formula, many diagnoses

VA rates almost every mental disorder using the same regulation: the General Rating Formula for Mental Disorders at 38 CFR 4.130. PTSD, MDD, persistent depressive disorder, generalized anxiety, panic disorder, agoraphobia, OCD, bipolar I and II, schizoaffective disorder, schizophrenia, and others all use the same ladder. Eating disorders have a separate but parallel formula (also in 4.130). TBI residuals with cognitive impairment have their own formula at 4.124a, DC 8045.

The diagnostic code at the front of the claim (9411 for PTSD, 9434 for MDD, 9400 for GAD, etc.) is for record-keeping. The actual rating turns on the General Rating Formula.

The six tiers, in the regulation's own words

0 percent

"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."

This tier exists, and it is more common than people think. A 0 percent rating still establishes service connection. That matters because a worsening later opens the door to an increase under the same diagnosis without having to re-prove service connection.

10 percent

"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."

Someone is functioning well on a daily basis but has periods of stress that knock down performance. Or they are functioning well because they take psychiatric medication every day.

30 percent

"Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)."

Day-to-day life still works, but stress events cause periods where work drops off. Sleep problems and mild memory issues are typical.

50 percent

"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; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships."

Reliability and productivity are reduced. Panic attacks are weekly or more. Memory and judgment are slipping.

70 percent

"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; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships."

Most areas of life have deficiencies. Suicidal ideation, impaired impulse control, near-continuous panic or depression, neglected hygiene, and inability to keep relationships are all common at this tier.

100 percent

"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; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name."

This is a total functional disability rating, not the same as TDIU. The veteran cannot maintain employment AND cannot maintain social relationships.

The Mauerhan rule (examples are not a checklist)

Many veterans (and even some C&P examiners) read 4.130 as if a veteran has to hit every symptom listed at a particular tier to qualify. That is wrong, and the Court of Appeals for Veterans Claims said so in Mauerhan v. Principi, 16 Vet. App. 436 (2002):

"The symptoms listed at each level of 38 CFR 4.130 are not requirements but rather examples of the type and degree of symptoms or their effects that would warrant a particular rating. The Board need not find the presence of all, most, or even some, of the enumerated symptoms to assign a particular rating."

In everyday terms: the rater must look at the overall functional impairment. If the veteran's symptoms produce the same level of impairment as the examples at a given tier, the rater grants that tier even if the specific symptoms listed do not match.

How the formula gets misapplied (and how to fix it)

Three mistakes show up over and over:

Symptom checklist thinking. A rating decision lists which 50-percent symptoms the veteran has and concludes "some but not all, so 30 percent." That is Mauerhan error. Argue overall functional impairment.
Treating GAF as the rating. GAF scores are not in 38 CFR 4.130 anymore (DSM-5 removed them in 2013). They are background context, not a substitute for the regulation.
Ignoring the "or, ..." structure of the regulation. The General Rating Formula uses "or" between symptoms. A veteran can be rated at 50 percent because of weekly panic attacks alone, even if their memory and speech are fine.

If any of those happened in your rating decision, a Higher Level Review or Supplemental Claim with a competent expert opinion is the right play. Reference 38 CFR 4.130 and Mauerhan by name.

Eating disorders, TBI cognitive residuals, and sleep disorders

38 CFR 4.130 also contains separate formulas for anorexia nervosa and bulimia (DC 9520, 9521) that turn on body-weight measures and the need for inpatient or outpatient care. For TBI cognitive residuals, the rating is under 38 CFR 4.124a, DC 8045, which uses a ten-facet table (memory, attention, executive function, etc.). For sleep disorders, the rating is under DC 6847 if obstructive sleep apnea is diagnosed; sleep disorders formally diagnosed as mental disorders under DSM-5 that do not have a separate diagnostic code (such as nightmare disorder or hypersomnolence disorder, as well as pure insomnia) are rated under the General Rating Formula in 4.130.

The TDIU and SMC interactions

A 70 percent mental health rating alone meets the TDIU schedular threshold under 38 CFR 4.16. See the TDIU calculator.
A 100 percent mental health rating alone does not automatically qualify for SMC-S (housebound), but two paths can lead there: the schedular path requires a 100 percent rating plus a separate 60 percent disability, and the housebound-in-fact path allows SMC-S when the veteran is actually confined to the home due to disability, regardless of combined percentages.
A 100 percent mental health rating does not bar TDIU on other disabilities. Bradley v. Peake established that a veteran with a 100 percent rating for one condition can still receive TDIU for a different condition if the latter alone would meet the criteria, opening the door to SMC-S.

Where this comes from

[38 CFR 4.130](https://www.ecfr.gov/current/title-38/chapter-I/part-4/subpart-B/section-4.130), General Rating Formula for Mental Disorders
[Mauerhan v. Principi, 16 Vet. App. 436 (2002)](https://www.courtlistener.com/opinion/816894/mauerhan-v-principi/)
38 CFR 4.16, TDIU
38 CFR 4.124a, DC 8045 (TBI cognitive residuals)

This page is educational and does not promise a specific rating.

The nuances most veterans miss

The controlling phrase is occupational and social impairment, not a symptom checklist. VA sets the level by how much your condition disrupts work and relationships; the listed symptoms are only examples (the Mauerhan principle).
The line between 70 and 100 percent is total vs near-total. A 100 percent rating requires total occupational and social impairment, while 70 percent is deficiencies in most areas. Most 100 percent denials turn on whether the impairment is total.
One evaluation covers all your mental conditions. PTSD plus depression are rated together under a single evaluation; VA does not stack two mental ratings, because that would be pyramiding.
GAF scores are gone. VA uses the DSM-5 and the impairment language, not a numeric GAF, so an old GAF number does not control your rating.
Describe a bad week, not a good hour. Symptoms come and go, and the rating reflects the overall picture, so a provider's note and your own account of your worst stretches matter.

Related on this site

Common questions

Do all mental health conditions use the same VA rating criteria?

Nearly all of them. PTSD, depression, anxiety, panic disorder, OCD, bipolar disorder, and schizophrenia are all rated under the General Rating Formula for Mental Disorders at 38 CFR 4.130, on the same six tiers: 0, 10, 30, 50, 70, and 100 percent. Eating disorders have a separate parallel formula, and TBI cognitive residuals are rated under their own ten facet framework at diagnostic code 8045.

What is the Mauerhan rule?

In Mauerhan v. Principi, the Court of Appeals for Veterans Claims held that the symptoms listed at each level of 38 CFR 4.130 are examples, not requirements. The Board need not find all, most, or even some of the listed symptoms to assign a rating. If your symptoms produce the same level of occupational and social impairment as a tier's examples, that tier applies even when the specific symptoms differ.

What separates a 70 percent from a 100 percent mental health rating?

The difference between deficiencies in most areas and total impairment. Seventy percent covers deficiencies in most areas such as work, family relations, judgment, thinking, or mood. One hundred percent requires total occupational and social impairment: the veteran can neither maintain employment nor social relationships. Most 100 percent denials turn on whether the impairment is total.

Can I get separate ratings for PTSD and depression?

No. VA assigns one evaluation covering all of a veteran's mental conditions together, because rating the same impairment twice would be pyramiding. PTSD plus depression are rated as a single evaluation under the General Rating Formula.

Do GAF scores still affect a VA mental health rating?

No. GAF scores were removed when the DSM-5 replaced them in 2013, and they are no longer part of 38 CFR 4.130. They are background context at most, not a substitute for the regulation's impairment language, so an old GAF number does not control your rating.