Post-Traumatic Stress Disorder (PTSD)
Mental health condition from experiencing or witnessing a traumatic event. Stressor verification required (except combat-related, which is presumed if consistent with circumstances of service).
Common symptoms
- Flashbacks
- Nightmares
- Avoidance
- Hypervigilance
- Sleep disturbance
- Anger/irritability
- Numbing
- Intrusive thoughts
VA rating criteria
| Rating | Criteria |
|---|---|
| 100% | Total occupational and social impairment. 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 own name, occupation, or names of close relatives. |
| 70% | Occupational and social impairment with deficiencies in most areas. Suicidal ideation; obsessional rituals; illogical/obscure/irrelevant speech; near-continuous panic or depression; impaired impulse control; spatial disorientation; neglect of personal hygiene; difficulty adapting to stressful circumstances; inability to establish/maintain effective relationships. |
| 50% | Occupational and social impairment with reduced reliability and productivity. Flattened affect; circumstantial/circumlocutory/stereotyped speech; panic attacks more than once weekly; difficulty understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation/mood; difficulty in establishing and maintaining effective work and social relationships. |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Depressed mood; anxiety; suspiciousness; panic attacks (weekly or less); chronic sleep impairment; mild memory loss. |
| 10% | Occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or symptoms controlled by continuous medication. |
| 0% | A mental condition has been formally diagnosed, but symptoms are not severe enough to interfere with occupational/social functioning or to require continuous medication. |
Pro tips
Common pitfalls
- Failing to verify non-combat stressor with buddy statements
- Inconsistent statements between 21-4138 and C&P exam
- Saying 'I'm fine' to the C&P examiner
Common secondaries from this condition
If Post-Traumatic Stress Disorder (PTSD) is service-connected, these are conditions worth investigating as secondaries (caused or aggravated by it).
Erectile Dysfunction
Almost always rated 0% — but unlocks SMC-K ($139.87/mo for life). Easiest path is secondary to mental health or diabetes.
Sleep Apnea (Obstructive/Central/Mixed)
Apneic episodes during sleep. CPAP-required = 50% rating (current rule; proposed changes have not been finalized). Hard to win directly post-service — much easier as secondary.
Gastroesophageal Reflux Disease (GERD)
Acid reflux. Cannot be combined with IBS — pyramiding rule.
Irritable Bowel Syndrome (IBS)
Functional GI disorder. Cannot be combined with GERD. Gulf War undiagnosed illness presumptive.
Hypertension
High blood pressure. PACT Act added for Vietnam veterans. Common as secondary to PTSD, sleep apnea, diabetes.
Migraine Headaches
Recurring debilitating headaches. The word 'prostrating' is key for higher ratings.
Insomnia Disorder
Difficulty falling/staying asleep. Often filed as secondary to PTSD, anxiety, depression, or chronic pain.
Alcohol Use Disorder
Cannot be directly service-connected (willful misconduct rule), BUT conditions secondary to alcohol use can be SC if alcoholism is secondary to a SC mental health condition (e.g., PTSD).
Filing this claim
This is typically filed as a direct service connection claim. You need a current diagnosis, evidence of in-service event or exposure, and a nexus letter linking them. Use the letter generators to draft your nexus letter and Statement in Support of Claim.
Step by step
- File an Intent to File (Form 21-0966) to lock your effective date.
- Confirm you have a current medical diagnosis in a medical record.
- Get a nexus letter — magic phrase: "at least as likely as not."
- Write a Statement in Support of Claim (21-4138).
- If applicable, gather buddy statements (21-10210).
- File the formal 21-526EZ.
Source: 38 CFR §4.130. For exact regulatory language, consult eCFR Title 38. This is general education — for your specific case, consult a VA-accredited representative.