Commander Prep

What the examiner evaluates

• •Workload capacity in METs (metabolic equivalents) at which symptoms occur — dyspnea, fatigue, angina, dizziness, or syncope
• •Left ventricular ejection fraction (LVEF) from echocardiogram
• •Episodes of congestive heart failure
• •History of myocardial infarction, stent placement, or bypass surgery (CABG)
• •Whether continuous medication is required
• •Cardiac hypertrophy or dilatation on imaging

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Echocardiogram reports with ejection fraction values
• ✓Stress test results with METs achieved and symptoms at that workload
• ✓Cardiac catheterization reports showing vessel disease
• ✓Records of MI, stent placement, or bypass surgery with dates
• ✓Hospitalization records for any congestive heart failure episodes
• ✓Prescription records for all cardiac medications
• ✓For Agent Orange/PACT Act claims: service records establishing qualifying herbicide exposure

What to know for your exam

• 1.The rating is driven by METs capacity, ejection fraction, or CHF history — bring your most recent echo and stress test reports.
• 2.If you cannot complete a stress test, an interview-based METs estimate is used — describe accurately what activities bring on symptoms (walking pace and distance, stairs, yard work, carrying loads).
• 3.Report ALL exertional symptoms: shortness of breath, chest pain or pressure, unusual fatigue, dizziness — and at what activity level each appears.
• 4.Note that a 100% rating applies for three months following MI, and specific convalescent ratings follow bypass surgery — bring all dates.
• 5.Ischemic heart disease is presumptive for Agent Orange exposure — Vietnam-era veterans and others with qualifying herbicide exposure should confirm that history is documented.

What the examiner evaluates

• •Workload capacity in METs at which symptoms (dyspnea, fatigue, angina, dizziness, syncope) occur
• •Left ventricular ejection fraction
• •Evidence of cardiac hypertrophy or dilatation attributable to hypertension (echocardiogram, ECG, chest X-ray)
• •Episodes of congestive heart failure
• •Whether continuous medication is required
• •The relationship to the underlying hypertension — typically claimed secondary to service-connected hypertension (DC 7101)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Echocardiogram showing left ventricular hypertrophy, dilatation, or reduced ejection fraction
• ✓ECG reports noting LVH
• ✓Records establishing the hypertension diagnosis and its duration (the causal chain)
• ✓Stress test results with METs and symptoms
• ✓Hospitalization records for any heart failure episodes
• ✓Prescription records for cardiac and blood pressure medications

What to know for your exam

• 1.Hypertensive heart disease is rated separately from hypertension itself — DC 7007 (the heart) and DC 7101 (the blood pressure) are distinct ratable conditions.
• 2.Bring your echocardiogram report — documented cardiac hypertrophy or dilatation on imaging meets the 30% criterion even without exertional symptoms at that level.
• 3.Describe your exertional capacity precisely: what activities bring on shortness of breath, fatigue, or chest symptoms.
• 4.Report any heart failure symptoms: swelling in legs/ankles, orthopnea (needing pillows to breathe at night), sudden nighttime breathlessness.
• 5.If your hypertension is service-connected, hypertensive heart disease is commonly developed and claimed as secondary to it — confirm the records establish the progression.

What the examiner evaluates

• •The specific arrhythmia diagnosis: supraventricular (DC 7010) vs. ventricular (DC 7011)
• •Frequency of episodes per year, documented by ECG or Holter monitor
• •Whether the arrhythmia is paroxysmal (episodic) or permanent/chronic
• •For ventricular arrhythmias: METs capacity, ejection fraction, and CHF history (rated like other heart disease)
• •Treatment: rate/rhythm control medications, anticoagulation, cardioversion, ablation, pacemaker, or AICD
• •Symptoms during episodes: palpitations, lightheadedness, syncope, chest discomfort

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓ECG and Holter/event monitor reports documenting the arrhythmia and episode frequency — DOCUMENTED episodes are the rating criterion for DC 7010
• ✓Cardiology records establishing the specific diagnosis (afib, SVT, ventricular arrhythmia)
• ✓Records of cardioversions, ablation procedures, pacemaker or AICD placement with dates
• ✓Prescription records: rate/rhythm control medications, anticoagulants
• ✓Echocardiogram with ejection fraction if ventricular arrhythmia or structural disease is involved

What to know for your exam

• 1.For supraventricular arrhythmias, the rating depends on DOCUMENTED episodes per year — episodes captured on ECG or Holter monitor. If your episodes go uncaptured, ask your provider about event monitoring.
• 2.Report your episode frequency honestly, including episodes that were felt but not captured on a monitor — and describe the symptoms during each (palpitations, lightheadedness, near-fainting).
• 3.Bring all monitoring reports: ECGs, Holter results, event monitor data, and pacemaker/AICD interrogation reports.
• 4.If you have an AICD implanted, tell the examiner — AICD placement carries a 100% rating under the schedule.
• 5.Report all procedures and their outcomes: cardioversions, ablations, and whether episodes recurred afterward.

What the examiner evaluates

• •Blood pressure readings (multiple, at rest)
• •Current medications and whether BP is controlled
• •Diastolic pressure readings — the rating is based primarily on diastolic
• •Systolic pressure for isolated systolic hypertension
• •Presence of end-organ damage (heart, kidneys, eyes)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Blood pressure readings from multiple provider visits (showing trend over time)
• ✓Prescription records for antihypertensive medications
• ✓Cardiology records if applicable
• ✓Records of any end-organ complications (kidney disease, cardiac issues)

What to know for your exam

• 1.The examiner takes blood pressure readings — avoid caffeine, exercise, or stress immediately before the exam.
• 2.Bring a log of home blood pressure readings if you have them.
• 3.Report ALL blood pressure medications and dosages.
• 4.Describe any symptoms: headaches, vision changes, shortness of breath, chest pain.

What the examiner evaluates

• •Percentage of the entire body affected by the condition
• •Percentage of exposed areas (face, neck, hands) affected
• •Treatment requirements over the past 12 months: topical only vs. systemic therapy (corticosteroids or other immunosuppressive drugs)
• •Duration of systemic therapy: less than 6 weeks vs. 6 weeks or more vs. constant/near-constant
• •Flare pattern: whether the condition waxes and wanes — examined during an active phase if possible

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Dermatology records documenting diagnosis, affected areas, and severity over time
• ✓Photographs of the condition during flares — skin conditions wax and wane and the exam may fall during a quiet phase
• ✓Prescription records: topical steroids, and especially any systemic medications (oral steroids, immunosuppressives, biologics) with course durations
• ✓Records documenting body surface area estimates if a provider has assessed them

What to know for your exam

• 1.Skin conditions wax and wane — if your exam falls during a quiet phase, photographs of active flares are important evidence. Date-stamped photos showing the extent during flares document what the examiner cannot see.
• 2.The rating turns on body surface percentage OR systemic therapy duration — bring prescription records showing any oral steroid or immunosuppressive courses in the past 12 months with exact durations.
• 3.Point out every affected area during the exam, including areas covered by clothing.
• 4.Exposed areas (face, neck, hands) have their own percentage track — flag involvement there specifically.
• 5.Describe the functional and social impact: itching that disrupts sleep, clothing restrictions, work limitations.

What the examiner evaluates

• •Location: head/face/neck scars (DC 7800) are rated on disfigurement characteristics; other locations on area, pain, and instability
• •For head/face/neck: the eight characteristics of disfigurement (length ≥13cm, width ≥0.6cm, elevation/depression, adherence, hypo/hyperpigmentation, abnormal texture, missing soft tissue, induration/inflexibility)
• •For other scars: total area — deep and nonlinear (DC 7801) vs. superficial and nonlinear (DC 7802)
• •Whether scars are painful or unstable (DC 7804) — number of qualifying scars
• •Any limitation of function caused by the scar (DC 7805 — rated under the appropriate body system)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Surgical or injury records establishing the origin of each scar (the in-service or service-connected surgical event)
• ✓Photographs of all scars with a measurement reference
• ✓Records documenting scar pain, breakdown (instability), or treatment
• ✓For functional limitation: records documenting how the scar restricts motion or function

What to know for your exam

• 1.Identify EVERY scar from service-connected causes — surgical scars from service-connected condition surgeries count and are frequently overlooked.
• 2.Tell the examiner which scars are painful — even intermittent pain qualifies a scar under DC 7804, and the count of painful scars (1–2, 3–4, 5+) sets the level.
• 3.Report unstable scars: any that repeatedly break down, ulcerate, or lose skin covering.
• 4.If a scar limits motion or function (e.g., tightness restricting joint movement), report it — functional limitation is rated separately under the affected body system.
• 5.Painful-scar ratings (DC 7804) can be assigned IN ADDITION to area or disfigurement ratings for the same scars — make sure all pathways are documented.

What the examiner evaluates

• •Total body surface area of burn scarring, classified as deep (associated with underlying soft tissue damage) or superficial
• •Location — head/face/neck burn scars rated on the disfigurement characteristics (DC 7800)
• •Pain and instability of burn scar areas (DC 7804)
• •Functional limitations: contractures restricting joint motion, grip, or mobility (DC 7805 — rated under affected body system)
• •Associated residuals: heat/cold intolerance of grafted skin, loss of sweat glands, sensory changes in burned areas
• •Skin graft donor sites — also ratable scarring

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Service or treatment records documenting the burn event, depth classification, and total body surface area involved
• ✓Surgical records: debridement, skin grafts, reconstructive procedures, with donor site documentation
• ✓Photographs of all burned areas and graft donor sites with measurement reference
• ✓Records documenting contractures, restricted motion, or functional limitations
• ✓Records of temperature intolerance, sweating abnormalities, or sensory changes in burned areas

What to know for your exam

• 1.Burn residuals frequently warrant MULTIPLE ratings: area-based scar ratings, painful scar ratings, functional limitation ratings, and disfigurement ratings can all apply to the same injury — make sure each pathway is documented.
• 2.Include skin graft donor sites — donor site scarring is itself ratable and commonly forgotten.
• 3.Report functional consequences: contractures limiting joint motion are rated under the affected joint's criteria, separate from the scar rating.
• 4.Describe heat and cold intolerance, absent sweating, and sensory changes in burned and grafted areas.
• 5.Identify every painful area — the painful-scar count (1–2, 3–4, 5+) sets the DC 7804 level on top of area ratings.

What the examiner evaluates

• •Frequency and severity of symptoms: pyrosis (heartburn), regurgitation, dysphagia (difficulty swallowing)
• •Presence of substernal, arm, or shoulder pain accompanying reflux symptoms
• •Whether symptoms are persistently recurrent despite treatment
• •Complications: esophageal stricture, ulceration, Barrett's esophagus, anemia from blood loss
• •Overall impact on health: weight loss, malnutrition, hematemesis or melena
• •Whether the condition is claimed secondary (commonly to PTSD/anxiety medications or NSAIDs for musculoskeletal conditions)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Upper endoscopy (EGD) reports showing esophagitis, hiatal hernia, stricture, or Barrett's esophagus
• ✓GI or primary care records documenting diagnosis and symptom history
• ✓Prescription records: PPIs, H2 blockers, dosage escalations over time
• ✓Lab results if anemia or weight loss is claimed
• ✓If claimed secondary: records establishing the primary service-connected condition and the medication or mechanism linking them

What to know for your exam

• 1.Report the full symptom set the criteria describe: heartburn, regurgitation, difficulty swallowing, and any chest/arm/shoulder pain with episodes.
• 2.Describe symptom frequency despite medication — 'persistently recurrent' distress on treatment is the 30% threshold language.
• 3.Report any weight loss, vomiting episodes, or signs of GI bleeding (vomiting blood, black stools) — these define the 60% level.
• 4.Describe nighttime symptoms and any positional or dietary accommodations you must make.
• 5.If your GERD developed after starting medications for another service-connected condition (e.g., NSAIDs for joint conditions, psychiatric medications), make sure that history is documented.

What the examiner evaluates

• •Frequency and pattern of bowel disturbance: diarrhea, constipation, or alternating
• •Frequency and severity of abdominal distress episodes
• •Whether symptoms are mild (occasional episodes), moderate (frequent episodes), or severe (more or less constant)
• •Functional impact: bathroom urgency, accidents, dietary restrictions, work and travel limitations
• •Whether the condition qualifies as a Gulf War presumptive functional GI disorder under 38 CFR § 3.317
• •Whether claimed secondary to PTSD or other psychiatric conditions (gut-brain axis)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓GI records documenting IBS diagnosis (typically a diagnosis of exclusion — colonoscopy or workup ruling out other causes)
• ✓Treatment records: antispasmodics, dietary management, fiber therapy
• ✓A symptom log documenting episode frequency, bowel pattern, and abdominal distress
• ✓Records of work absences or accommodations related to symptoms
• ✓For Gulf War veterans: service records establishing qualifying Southwest Asia service
• ✓If claimed secondary to PTSD: psychiatric records establishing the service-connected condition

What to know for your exam

• 1.The rating distinctions are 'occasional' vs. 'frequent' vs. 'more or less constant' — describe your episode frequency per week and month with as much precision as you can.
• 2.Describe your bowel pattern: diarrhea-predominant, constipation-predominant, or alternating — the 30% criteria specifically reference diarrhea or alternating patterns.
• 3.Report functional consequences: urgency, bathroom mapping when leaving home, accidents or near-accidents, foods avoided, effect on work and travel.
• 4.For Gulf War veterans: functional GI disorders including IBS are presumptive under 38 CFR § 3.317 — confirm your qualifying service with the examiner.
• 5.If symptoms worsen with psychiatric symptom flares, describe that pattern — IBS is commonly claimed secondary to PTSD and anxiety disorders.

What the examiner evaluates

• •Whether hemorrhoids are internal, external, or both
• •Size and reducibility: mild/moderate vs. large or thrombotic, irreducible
• •Presence of excessive redundant tissue evidencing frequent recurrences
• •Persistent bleeding and whether secondary anemia has developed
• •Presence of anal fissures
• •Treatment history: banding, sclerotherapy, hemorrhoidectomy

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Colorectal, GI, or primary care records documenting diagnosis and severity
• ✓Procedure records: banding, sclerotherapy, or hemorrhoidectomy with dates
• ✓Lab results (CBC) if anemia from chronic bleeding is claimed
• ✓Records documenting recurrence frequency and thrombosed episodes
• ✓Records of any diagnosed anal fissures

What to know for your exam

• 1.Report recurrence frequency — 'evidencing frequent recurrences' is part of the 10% criteria.
• 2.Describe bleeding pattern: frequency, amount, and duration — persistent bleeding with anemia defines the 20% level.
• 3.Report any thrombosed episodes (acutely painful, hard lumps) and whether they required intervention.
• 4.If you have had lab work showing anemia, bring the results — anemia secondary to bleeding is a specific 20% criterion.
• 5.Even if rated 0%, service connection matters — it establishes the condition for any future worsening and potential secondary claims.

What the examiner evaluates

• •Treatment required: diet only, oral medications, or insulin
• •Whether insulin regulation requires restricted activities
• •Frequency of hospitalization or emergency treatment for diabetic episodes
• •Complications: neuropathy, retinopathy, nephropathy, cardiovascular disease

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Primary care records confirming diagnosis and treatment plan
• ✓Prescription records for all diabetes medications
• ✓Endocrinology records if applicable
• ✓Records of any hospitalizations for diabetic emergencies
• ✓Records of diabetes-related complications (nephropathy, neuropathy, retinopathy)

What to know for your exam

• 1.Describe your complete treatment regimen: all medications, injection frequency, dietary restrictions.
• 2.Report any hypoglycemic episodes, including those requiring assistance or emergency care.
• 3.Describe how diabetes-related activity restrictions affect your work or daily life.
• 4.Bring records of all complications — diabetic complications often qualify as separate ratable conditions.

What the examiner evaluates

• •Renal function: GFR (glomerular filtration rate), creatinine, and BUN values
• •Whether renal dysfunction is present: albuminuria, edema, or reduced GFR
• •Blood pressure relationship — hypertension at least 40% disabling under DC 7101 affects the rating
• •Whether dialysis is required (regular dialysis warrants 100%)
• •Symptoms: fatigue, edema, decreased appetite, restricted activities
• •Underlying cause — commonly claimed secondary to service-connected diabetes or hypertension

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Lab results over time: GFR, creatinine, BUN, urinalysis showing albuminuria/proteinuria
• ✓Nephrology records with CKD stage classification (Stage 1–5)
• ✓If secondary to diabetes or hypertension: records establishing the service-connected primary condition and the progression
• ✓Dialysis records if applicable
• ✓Records documenting edema, fatigue, weight changes, or activity restriction

What to know for your exam

• 1.The rating uses specific lab thresholds — bring your complete lab history showing GFR, creatinine, and BUN trends over time, not just the most recent values.
• 2.CKD is commonly claimed secondary to service-connected diabetes (diabetic nephropathy) or hypertension (hypertensive nephrosclerosis) — make sure the causal chain is documented in your records.
• 3.Report systemic symptoms: fatigue, weakness, poor appetite, weight loss, swelling — 'generalized poor health' is an explicit 80% criterion.
• 4.Describe activity limits: what exertion you can no longer tolerate.
• 5.Note that the renal rating interacts with the hypertension rating — the examiner should document both conditions fully.

What the examiner evaluates

• •Whether erectile dysfunction is present and its medical cause
• •Whether penile deformity accompanies the loss of erectile power (required for a compensable schedular rating under DC 7522)
• •The causal connection — commonly secondary to diabetes, hypertension medications, psychiatric medications, prostate treatment, or spinal conditions
• •Treatment history and response: oral medications, injections, devices, implants
• •Eligibility for Special Monthly Compensation (SMC-K) for loss of use of a creative organ

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Urology or primary care records documenting the ED diagnosis and its cause
• ✓Records establishing the service-connected primary condition if claimed secondary (diabetes, medication side effects, prostate treatment, spinal injury)
• ✓Medication records — both ED treatments and medications identified as causing ED (many antihypertensives, SSRIs, and other psychiatric medications)
• ✓Records of any penile deformity diagnosis (e.g., Peyronie's disease) if present

What to know for your exam

• 1.Most ED claims rate at 0% schedular — but the 0% rating still matters: it establishes service connection and triggers SMC-K, an additional monthly payment on top of your other compensation.
• 2.ED is most commonly granted secondary to another service-connected condition — diabetes, medication side effects (blood pressure and psychiatric medications are frequent causes), prostate cancer treatment, or spinal conditions. Make sure the causal chain is documented.
• 3.Tell the examiner when symptoms began relative to the primary condition or medication start — the temporal relationship is relevant evidence.
• 4.Report all treatments tried and their effectiveness.
• 5.This exam covers clinically necessary questions only — the examiner is documenting medical facts for the rating criteria, and the exam is typically interview-based.

What the examiner evaluates

• •Which rating pathway applies: urine leakage, urinary frequency, or obstructed voiding — rated under the predominant dysfunction
• •Urine leakage: whether absorbent materials are required and how often they must be changed per day
• •Urinary frequency: daytime voiding interval and number of nighttime awakenings to void
• •Obstructed voiding: hesitancy, weak stream, post-void residuals, catheterization requirements
• •Underlying cause: neurogenic bladder (commonly from TBI, spinal injury, or neurological disease), prostate treatment, or other

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Urology records documenting the diagnosis and the type of dysfunction (leakage, frequency, obstruction)
• ✓Urodynamic testing results if performed
• ✓Records or receipts documenting absorbent material use — pad/brief type and daily change frequency
• ✓A voiding diary documenting daytime intervals and nighttime awakenings
• ✓Records establishing the underlying cause if claimed secondary (TBI, spinal condition, prostate treatment)

What to know for your exam

• 1.The rating criteria are concrete and countable: how many times per day you change absorbent materials, your daytime voiding interval, and how many times you wake at night to void. Track these for a week before the exam.
• 2.Report absorbent material use accurately — pad/brief changes per day directly map to the 20/40/60% levels.
• 3.Describe nighttime frequency — nocturia counts are an explicit criterion.
• 4.If your incontinence stems from a service-connected condition (TBI, spinal injury, prostate treatment), confirm the causal records are in your file.
• 5.Voiding dysfunction is rated under the predominant symptom pathway — describe ALL your urinary symptoms so the examiner documents the complete picture.

What the examiner evaluates

• •The specific prostate diagnosis: BPH, chronic prostatitis, or post-treatment residuals of prostate cancer
• •Predominant dysfunction: voiding dysfunction, urinary frequency, obstructed voiding, or urinary tract infections — DC 7527 rates by the predominant residual
• •Obstructed voiding findings: weak stream, hesitancy, post-void residual volume, catheterization history
• •Urinary frequency: daytime intervals and nocturia counts
• •UTI frequency and treatment if infections are the predominant residual
• •Medication and treatment history: alpha blockers, 5-ARIs, procedures (TURP, etc.)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Urology records documenting the prostate diagnosis and treatment history
• ✓Uroflowmetry and post-void residual measurements if performed
• ✓Procedure records (TURP, laser therapy, biopsies) with dates
• ✓A voiding diary documenting daytime intervals and nighttime frequency
• ✓UTI treatment records if recurrent infections are part of the picture
• ✓For prostate cancer: oncology records — active malignancy rates 100% during treatment and for six months after

What to know for your exam

• 1.DC 7527 rates prostate conditions by the PREDOMINANT residual — voiding dysfunction, frequency, or infections. Describe all your urinary symptoms completely so the examiner identifies the right pathway.
• 2.Track your voiding pattern for a week before the exam: daytime intervals and nighttime awakenings map directly to the 20% and 40% frequency criteria.
• 3.Report stream quality changes: hesitancy, weak or interrupted stream, straining, feeling of incomplete emptying.
• 4.If you have had prostate cancer, the rules differ: 100% during active malignancy and for six months following treatment completion, then rated on residuals.
• 5.Report all medications and procedures, and whether symptoms persist despite them.

What the examiner evaluates

• •Subjective report of tinnitus (ringing, buzzing, hissing, or similar sound in ears or head)
• •Whether tinnitus is constant or recurring
• •In-service noise exposure history
• •Associated hearing loss

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Audiology evaluation confirming tinnitus
• ✓Service records documenting noise exposure (MOS, weapons qualification, aircraft/vehicle proximity)
• ✓Any prior VA or private audiological treatment records

What to know for your exam

• 1.Describe the nature of your tinnitus: constant or intermittent, high/low pitch, in one or both ears.
• 2.Explain how it affects sleep, concentration, and daily activities.
• 3.Report any aggravating factors (noise, stress, quiet environments).

What the examiner evaluates

• •Puretone audiometry results (thresholds at 1000, 2000, 3000, and 4000 Hz)
• •Maryland CNC speech discrimination score (word recognition)
• •Combined hearing level table (Tables VI and VIa, 38 CFR Part 4)
• •Whether hearing loss is bilateral or unilateral

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Audiology test results (most recent)
• ✓Service records showing noise exposure (MOS codes, aircraft, heavy weapons)
• ✓VA or private audiologist evaluation

What to know for your exam

• 1.The examiner conducts a full audiological evaluation — cooperate fully with all hearing tests.
• 2.Describe how your hearing loss affects communication: TV volume, phone calls, group conversations.
• 3.Mention use of hearing aids — and whether they fully correct your hearing.

What the examiner evaluates

• •Occupational and social impairment level
• •Frequency and severity of symptoms (nightmares, flashbacks, hypervigilance, avoidance)
• •Reliability in job performance and ability to maintain employment
• •Ability to maintain relationships with family, friends, and in social situations
• •Judgment, thinking, and memory
• •Whether symptoms are due to the military trauma (nexus)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Private therapy or psychiatry records (dates, diagnoses, treatment notes)
• ✓Service Treatment Records showing any mental health treatment or stressor documentation
• ✓Buddy/lay statements describing observed behavioral changes
• ✓Personal statement describing stressor event (if not already in records)
• ✓Employment records showing job changes, firings, or accommodation requests related to PTSD
• ✓Any crisis intervention or hospitalization records

What to know for your exam

• 1.The examiner is assessing how your symptoms affect your daily functioning — describe your worst weeks, not your best.
• 2.Answer questions about ALL time periods — how symptoms affect your work, family, and social life across a typical month.
• 3.If you have good days and bad days, tell the examiner both — the rating criteria consider the full range of your symptoms.
• 4.Don't minimize. If you've stopped doing activities, can't maintain relationships, or have had employment problems because of PTSD, those are relevant facts.
• 5.The examiner may ask about your stressor — you are not required to relive trauma in detail, but you should confirm the event occurred.

What the examiner evaluates

• •Occupational and social impairment level (same general rating scale as PTSD)
• •Depressed mood, anhedonia, and vegetative symptoms
• •Sleep disturbance, fatigue, appetite/weight changes
• •Concentration difficulties, decision-making impairment
• •Psychomotor agitation or retardation
• •Suicidal ideation or behavior

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Psychiatry/therapy treatment records with diagnosis and dates
• ✓Medication history (antidepressants, dosage changes)
• ✓Employment records showing impact on job performance
• ✓Buddy/lay statements from family or coworkers

What to know for your exam

• 1.Describe how depressive episodes affect your ability to work, maintain relationships, and manage daily tasks.
• 2.Mention if you've lost jobs, had attendance problems, or requested accommodations because of your symptoms.
• 3.Be honest about the frequency and severity — not just how you feel today.

What the examiner evaluates

• •Occupational and social impairment level (the general rating formula for mental disorders — same scale as PTSD)
• •Frequency and severity of anxiety symptoms: excessive worry, restlessness, muscle tension, irritability
• •Panic attacks — frequency, duration, and circumstances
• •Sleep disturbance and concentration difficulties
• •Impact on work performance, attendance, and ability to maintain employment
• •Impact on relationships and social functioning

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Mental health treatment records with diagnosis, dates, and treatment notes
• ✓Medication history (anxiolytics, SSRIs/SNRIs, beta blockers) with dosage changes over time
• ✓Records of panic attacks: ER visits, urgent care, or provider notes documenting episodes
• ✓Employment records showing missed work, performance issues, or accommodations
• ✓Buddy/lay statements describing observed anxiety behaviors and changes since service

What to know for your exam

• 1.Describe how anxiety affects your work, family life, and social functioning across a typical month — not just how you feel on exam day.
• 2.Report panic attack frequency precisely — the rating criteria distinguish 'once a week or less' from 'more than once a week.'
• 3.Describe avoidance behaviors: situations, places, or responsibilities you avoid because of anxiety.
• 4.Be honest about your worst periods, including any episodes where anxiety prevented you from working or leaving home.
• 5.Mention all physical manifestations: racing heart, sweating, GI distress, muscle tension, sleep loss.

What the examiner evaluates

• •Occupational and social impairment level (general rating formula for mental disorders)
• •Manic or hypomanic episodes: frequency, duration, severity, and consequences (spending, risk-taking, job loss)
• •Depressive episodes: frequency, duration, and severity
• •Mood stability between episodes and medication response
• •Hospitalizations or crisis interventions
• •Impact on employment continuity and relationships

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Psychiatric records confirming bipolar diagnosis (type I or II) with episode history
• ✓Hospitalization or crisis intervention records for manic or depressive episodes
• ✓Medication history: mood stabilizers, antipsychotics, dosage adjustments over time
• ✓Employment records showing job changes, terminations, or extended absences tied to mood episodes
• ✓Buddy/lay statements from family describing observed manic and depressive episodes

What to know for your exam

• 1.Describe both poles of your illness — manic/hypomanic episodes AND depressive episodes — with frequency and duration of each.
• 2.Report the consequences of manic episodes honestly: impulsive spending, risk-taking, conflicts, job losses — these reflect the impaired impulse control the criteria describe.
• 3.Describe your functioning between episodes — whether you return to baseline or have residual impairment.
• 4.Report any hospitalizations, crisis line contacts, or emergency interventions.
• 5.Describe medication side effects if they affect your daily functioning — sedation, tremor, and cognitive dulling are relevant to occupational impairment.

What the examiner evaluates

• •Occupational and social impairment level (general rating formula for mental disorders)
• •The identified stressor and whether symptoms developed in response to it
• •Whether the condition is acute or chronic (symptoms persisting beyond six months)
• •Predominant symptom pattern: depressed mood, anxiety, mixed, or disturbance of conduct
• •Impact on work performance and social functioning
• •Whether the diagnosis has evolved (adjustment disorder is frequently an early diagnosis later revised to PTSD, depression, or anxiety disorder)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Mental health records documenting the diagnosis, the identified stressor, and symptom duration
• ✓Service records documenting the in-service stressor or event if the connection is direct
• ✓Treatment history: therapy notes, medication records
• ✓Records showing whether the diagnosis was later revised (PTSD, MDD, GAD) — diagnostic evolution is common and relevant
• ✓Employment and lay statements describing functional changes since the stressor

What to know for your exam

• 1.Describe the stressor that triggered your symptoms and when symptoms began relative to it.
• 2.Report whether symptoms have persisted beyond six months — chronic adjustment disorder is rated the same as other mental disorders, on functional impairment.
• 3.If your diagnosis has changed over time (e.g., later diagnosed with PTSD or depression), tell the examiner the full diagnostic history.
• 4.Describe functional impact across work, family, and social life — the rating depends on impairment level, not the diagnostic label.
• 5.Be honest about your worst periods, not just your current state.

What the examiner evaluates

• •Range of motion (forward flexion, extension, lateral flexion, rotation) measured with a goniometer
• •Whether motion is painful before or at end range
• •Muscle spasm, guarding, or tenderness on palpation
• •Functional loss beyond measured range of motion (pain on use, fatigue, flare-ups)
• •Neurological deficits: weakness, reflex changes, sensation loss in legs
• •IVDS (intervertebral disc syndrome): incapacitating episodes — how many per year, how long each

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI or CT reports showing disc pathology, stenosis, or other findings
• ✓X-rays of the lumbar spine
• ✓Physical therapy records documenting functional limitations
• ✓Treatment records showing epidural injections, pain management, or surgical history
• ✓Records of incapacitating episodes (ER visits, work absences, bed rest) if claiming IVDS

What to know for your exam

• 1.The examiner will measure your range of motion — move through your full comfortable range and stop when it hurts. Do not push through pain.
• 2.Tell the examiner if your pain and limitation is worse during flare-ups than on examination day.
• 3.Report ALL symptoms: radiating pain down legs, numbness, weakness, incontinence, or balance issues.
• 4.Describe how your back affects daily activities: standing, sitting, lifting, driving, sleep.
• 5.Mention incapacitating episodes: days when you couldn't work or had to rest due to back pain.

What the examiner evaluates

• •Range of motion: forward flexion, extension, lateral flexion, rotation
• •Painful motion before or at end range
• •Muscle spasm, guarding, and tenderness
• •Neurological deficits: arm/hand weakness, reflex changes, numbness or tingling
• •Functional impact: driving, overhead work, sleeping

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI or CT of the cervical spine
• ✓EMG/nerve conduction study if radiculopathy is claimed
• ✓Physical therapy notes
• ✓Treatment records for injections or procedures

What to know for your exam

• 1.Report all symptoms: neck pain, headaches triggered by neck movement, arm/hand numbness or weakness.
• 2.Describe how your neck affects daily activities (looking over shoulder while driving, overhead work, computer use).
• 3.Tell the examiner about flare-up frequency and severity.

What the examiner evaluates

• •Range of motion: flexion and extension
• •Painful motion at what degree
• •Instability: lateral, anteroposterior (Lachman/drawer tests)
• •Recurrent subluxation or dislocation
• •Swelling/effusion, crepitation, locking
• •Muscle atrophy in thigh
• •Functional impact: stairs, walking distance, kneeling, standing time

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI of the knee showing any meniscus, ligament, or cartilage findings
• ✓X-rays showing joint space narrowing or arthritis
• ✓Surgical records if applicable (ACL repair, meniscectomy, etc.)
• ✓Physical therapy notes
• ✓Records of bracing, injections, or other treatment

What to know for your exam

• 1.Report all symptoms: pain location, swelling, instability/giving way, locking, crepitation (grinding/popping).
• 2.Describe functional limits: how far you can walk, whether you can climb stairs, kneel, or squat.
• 3.Tell the examiner if symptoms are worse on bad days vs. exam day — flare-up history matters.
• 4.If you wear a brace, tell the examiner — and describe your function both with and without it.

What the examiner evaluates

• •Range of motion: abduction, forward flexion, external/internal rotation
• •Painful motion and at what degree it begins
• •Muscle atrophy
• •Strength testing
• •Functional impact: overhead reach, lifting, sleep position

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI of the shoulder (rotator cuff tear, labral tear, etc.)
• ✓X-rays showing arthritis or AC joint pathology
• ✓Surgical records if applicable (rotator cuff repair, labral surgery)
• ✓Physical therapy notes

What to know for your exam

• 1.The examiner tests active and passive range of motion. Move through your comfortable range — stop when it hurts.
• 2.Describe activities you can no longer do: overhead reaching, lifting, sleeping on that shoulder.
• 3.Report any clicking, catching, or giving-way sensations.
• 4.Specify which shoulder is dominant (right or left-handed) — the dominant (major) arm is rated at higher percentages at several criteria levels.
• 5.If BOTH shoulders are affected, make sure each is examined and documented separately — each shoulder receives its own rating, and the bilateral factor applies on top.

What the examiner evaluates

• •Range of motion: dorsiflexion and plantar flexion
• •Painful motion and at what degree
• •Instability and history of giving way
• •Swelling, tenderness, and strength
• •Functional impact: walking distance, standing, stairs

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the ankle
• ✓MRI if soft tissue pathology claimed
• ✓Treatment records

What to know for your exam

• 1.Describe how ankle symptoms affect walking, standing, and daily activities.
• 2.Report any instability, history of giving way, or recurrent sprains.
• 3.Note if swelling is constant or worsens with activity.

What the examiner evaluates

• •Which nerve roots are affected (C5–C8/T1) and which arm is involved
• •Sensory deficits: numbness, tingling, or altered sensation in the arm, hand, or fingers
• •Motor deficits: weakness in specific muscle groups of the arm, forearm, or hand
• •Reflex changes: diminished or absent biceps, triceps, or brachioradialis reflexes
• •Degree of incomplete vs. complete paralysis of the affected nerve distribution
• •Whether the condition is claimed separately from the underlying cervical spine condition

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI of the cervical spine showing nerve root compression, foraminal stenosis, or disc herniation
• ✓EMG/nerve conduction study (NCS) — documents objective nerve involvement
• ✓Neurology or neurosurgery records documenting the specific nerve roots affected
• ✓Physical therapy or pain management treatment records
• ✓Service records documenting neck injury or onset of arm/hand symptoms in service

What to know for your exam

• 1.Describe BOTH your neck symptoms AND all arm/hand symptoms separately — cervical radiculopathy is rated as a distinct condition from the cervical spine condition causing it.
• 2.Tell the examiner which arm is affected and whether it is your dominant arm — rating criteria differ for dominant vs. non-dominant extremity.
• 3.Report all sensory symptoms with precision: where the numbness or tingling occurs (which fingers, forearm, upper arm), whether constant or intermittent, and what worsens it.
• 4.Describe motor symptoms: grip weakness, dropping objects, difficulty with fine motor tasks such as buttoning clothing or typing.
• 5.If you have an EMG report, bring it — objective nerve conduction data strengthens exam findings significantly.

What the examiner evaluates

• •Which nerve roots are affected (L4–S1 for sciatic; L2–L4 for femoral) and which leg is involved
• •Sensory deficits: numbness, tingling, or burning pain in the buttock, thigh, leg, or foot
• •Motor deficits: weakness in hip, knee, ankle, or foot muscles
• •Reflex changes: diminished patellar or Achilles reflex
• •Straight leg raise (SLR) test — positive result and at what degree
• •Degree of incomplete vs. complete paralysis of the affected nerve distribution

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓MRI of the lumbar spine showing nerve root compression, disc herniation, or foraminal stenosis
• ✓EMG/nerve conduction study documenting sciatic or nerve root involvement
• ✓Neurology or orthopedic records confirming diagnosis and specifying which nerve roots
• ✓Treatment records: epidural injections, physical therapy, pain management
• ✓Service records documenting onset of leg pain, numbness, or weakness

What to know for your exam

• 1.Describe BOTH your back symptoms AND all leg/foot symptoms separately — lumbar radiculopathy is rated as a distinct condition from the lumbar spine condition causing it.
• 2.Tell the examiner which leg is affected — rating criteria may differ by functional dominance.
• 3.Describe the precise location and nature of sensory symptoms: buttock pain, outer thigh numbness, calf tingling, foot burning or shooting pain.
• 4.Report all motor symptoms: weakness when walking, difficulty rising from a chair, foot drop, or toe drag.
• 5.Mention how symptoms change with position: worse sitting, standing, or walking — and describe your walking tolerance before pain stops you.

What the examiner evaluates

• •Range of motion: flexion and extension at the elbow joint
• •Forearm rotation: pronation and supination
• •Painful motion — at what degree pain begins in each plane
• •Grip strength and functional use of the forearm and hand
• •Whether the elbow is dominant (major) or non-dominant (minor)
• •Whether ankylosis (joint fusion) is present and in what position

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the elbow showing arthritis, structural deformity, or post-surgical changes
• ✓MRI if soft tissue pathology (ligament, tendon) is claimed
• ✓Surgical records for any elbow procedures (e.g., epicondyle release, elbow replacement)
• ✓Physical therapy records documenting range of motion measurements over time
• ✓Occupational health records if work-related or if occupational duties are affected

What to know for your exam

• 1.The examiner measures flexion/extension and forearm rotation — move through your full comfortable range and stop when pain begins.
• 2.Specify which arm is dominant — this affects the applicable rating criteria.
• 3.Describe functional impact: what daily tasks you cannot perform, such as lifting, reaching overhead, carrying, or gripping.
• 4.Report any pain, clicking, locking, or instability sensations at the elbow joint.
• 5.If you have had surgery, bring all operative notes and post-operative follow-up records.

What the examiner evaluates

• •Range of motion: dorsiflexion, palmar flexion, radial and ulnar deviation
• •Painful motion — at what degree in each plane
• •Grip strength (typically measured by dynamometer)
• •Whether ankylosis is present and in what position
• •Dominant vs. non-dominant wrist
• •Functional impact on hand use and fine motor tasks

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the wrist showing arthritis, fracture residuals, or deformity
• ✓MRI if TFCC tear, ligament injury, or tendon pathology is claimed
• ✓Surgical records for any wrist procedures (TFCC repair, carpal fracture fixation, fusion)
• ✓Physical therapy records with range of motion measurements
• ✓Occupational therapy records if hand function limitations were formally assessed

What to know for your exam

• 1.Identify which wrist is affected and whether it is your dominant side.
• 2.The examiner measures dorsiflexion, palmar flexion, and deviation in each direction — report pain at each endpoint.
• 3.Describe functional limitations: difficulty gripping, twisting (opening jars, turning door knobs), lifting, or using tools.
• 4.Report any instability, clicking, or locking in the wrist.
• 5.Describe whether symptoms worsen after activity or flare up periodically beyond the baseline.

What the examiner evaluates

• •Which specific fingers are affected and on which hand (dominant vs. non-dominant)
• •Range of motion for each affected finger: flexion and extension at the MCP, PIP, and DIP joints
• •Painful motion and degree of limitation at each joint
• •Whether ankylosis (joint fusion) is present and in what position (functional vs. non-functional)
• •Grip strength and pinch strength
• •Functional impact on daily tasks requiring hand dexterity

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the affected hand/fingers showing arthritis, deformity, or fracture residuals
• ✓MRI if tendon or ligament pathology (e.g., pulley injury, TFCC, collateral ligament) is claimed
• ✓Occupational therapy evaluation with range of motion measurements per joint
• ✓Surgical records (tendon repair, trigger finger release, Dupuytren's fasciotomy, finger fusion)
• ✓Records documenting job duties or daily tasks requiring hand dexterity that are affected

What to know for your exam

• 1.Specify which fingers are affected and whether the hand is dominant — rating criteria account for dominant/minor hand differences.
• 2.The examiner measures each affected finger joint individually — report pain at each motion endpoint.
• 3.Describe functional tasks you can no longer perform: gripping tools, writing, typing, buttoning clothing, turning keys.
• 4.If multiple fingers on the same hand are affected, they may be rated together under DC 5233 if the combined impairment is greater than separate ratings.
• 5.Report grip and pinch strength if formally measured — dynamometer results are objective evidence.

What the examiner evaluates

• •Range of motion: flexion, extension, abduction, adduction, and internal/external rotation
• •Painful motion — at what degree in each plane
• •Muscle strength and atrophy in the thigh
• •Whether total hip arthroplasty (replacement) has been performed and when
• •Gait — whether pain alters the walking pattern
• •Functional impact: walking distance, stairs, prolonged sitting, ability to rise from a chair

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the hip showing arthritis, deformity, or structural abnormality (weight-bearing views are most useful)
• ✓MRI if labral tear, AVN, or soft tissue pathology is claimed
• ✓Surgical records for hip replacement, labral repair, or other procedures
• ✓Physical therapy records with range of motion measurements
• ✓Orthopedic records confirming the diagnosis and treatment history

What to know for your exam

• 1.The examiner measures all hip motions — report pain with each movement and identify the degree at which pain begins.
• 2.Describe functional impact: walking distance before pain stops you, ability to climb stairs, rise from a seated position, or sleep without hip pain.
• 3.Report any history of falls, limp, or gait change caused by hip pain.
• 4.If you have had a total hip replacement, bring all surgical records — a 100% rating applies for the first year after surgery.
• 5.Mention any assistive devices used: cane, walker, or orthopedic shoe with lift.

What the examiner evaluates

• •Location and character of heel/arch pain and whether it is consistent with plantar fascia involvement
• •Tenderness on palpation of the medial calcaneal tubercle (heel bone insertion of the fascia)
• •Gait analysis — whether pain alters walking pattern or heel strike
• •Treatment history and response: orthotics, corticosteroid injections, physical therapy, ESWT
• •Functional impact: how long the veteran can stand or walk before pain requires stopping
• •Whether the condition is unilateral or bilateral

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the foot (may demonstrate calcaneal heel spur)
• ✓Ultrasound or MRI confirming plantar fascia thickening or partial tear
• ✓Podiatry or orthopedic records documenting diagnosis and treatment
• ✓Prescription for custom orthotics or orthopedic footwear
• ✓Records of corticosteroid injections or other procedural treatments

What to know for your exam

• 1.Describe the exact location of pain: bottom of the heel, arch, or both — and whether it is worst with the first steps after waking or after prolonged sitting (classic plantar fasciitis pattern).
• 2.Report standing and walking tolerance: how long before pain forces you to stop or alter activity.
• 3.Describe all treatments tried and their level of effectiveness.
• 4.Tell the examiner if both feet are affected — each foot is rated separately and the bilateral factor may apply.
• 5.Mention any gait changes: limping, avoiding heel strike, toe-walking, or use of a cane.

What the examiner evaluates

• •Degree of arch collapse: slight, moderate, or severe (obliterated arch)
• •Whether the condition is flexible (arch partially or fully reducible) or rigid (non-reducible)
• •Weight-bearing line: whether it falls over or medial to the great toe
• •Associated symptoms: plantar and submalleolar pain, heel pain, calluses
• •Achilles tendon alignment — whether inward bowing is present
• •Gait — whether pronation or arch collapse alters the walking pattern
• •Whether orthopedic footwear or custom orthotics are required

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the feet — weight-bearing views are critical for assessing arch collapse
• ✓Podiatry or orthopedic records documenting severity classification (mild/moderate/severe/pronounced)
• ✓Prescription for custom orthotics or orthopedic footwear
• ✓Records of any surgical procedures for flatfoot correction (osteotomy, tendon transfer)
• ✓Physical therapy records if conservative treatment was attempted

What to know for your exam

• 1.The examiner assesses arch height with weight-bearing — wear your standard footwear and bring your orthotics to the appointment.
• 2.Report whether the condition is bilateral — bilateral severe or pronounced flat feet are rated at a higher combined evaluation.
• 3.Describe pain location: arch, heel, ankle, inner knee — and whether pain radiates upward.
• 4.Tell the examiner whether orthotics or special footwear provide adequate relief or only partial relief.
• 5.If the arch cannot be manually reduced (rigid flatfoot), confirm this during examination — rigidity is a key criterion for the highest rating level.

What the examiner evaluates

• •Degree of angular deformity of the great toe — medial displacement of the first metatarsal head
• •Whether surgical correction has been performed (bunionectomy with or without metatarsal head resection)
• •Pain at the MTP joint on manipulation and during weight-bearing
• •Callus formation or skin breakdown over the bony prominence
• •Whether standard footwear is tolerated or orthopedic shoes are required
• •Functional impact: walking tolerance, standing, footwear restrictions

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓X-rays of the foot showing the degree of angular deformity (intermetatarsal angle, hallux valgus angle)
• ✓Surgical records if bunionectomy was performed — including operative technique (resection vs. osteotomy)
• ✓Podiatry records documenting clinical diagnosis and treatment
• ✓Prescription for orthopedic footwear or custom orthotics if required

What to know for your exam

• 1.Describe pain with weight-bearing, during shoe wear, and while walking — and whether any footwear modification provides adequate relief.
• 2.Report whether the condition is bilateral — each foot is rated separately.
• 3.If you have had surgery, bring all operative and post-operative records, including the specific surgical technique performed.
• 4.Describe any skin changes over the prominence: calluses, blisters, or wound history.
• 5.Mention how the condition affects your ability to wear required work footwear or perform sustained walking.

What the examiner evaluates

• •Whether ACR diagnostic criteria for fibromyalgia are met — widespread musculoskeletal pain plus tender point findings, or the 2010 ACR widespread pain index and symptom severity scale
• •Number and location of tender points (11 or more of 18 classic sites under the 1990 ACR criteria)
• •Associated symptoms: fatigue severity, non-restorative sleep, cognitive difficulties ('fibro fog'), mood symptoms
• •Whether symptoms are episodic (with periods of relative improvement) or constant and refractory to treatment
• •Functional impact on employment and daily activities

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Rheumatology records confirming fibromyalgia diagnosis with clinical criteria documented
• ✓Primary care records documenting widespread pain, sleep disturbance, and fatigue over time
• ✓Records of all treatment modalities tried and their outcomes: medications, physical therapy, sleep aids, cognitive behavioral therapy
• ✓Sleep study records if non-restorative sleep is a significant component
• ✓Functional or vocational assessment records if work capacity was formally evaluated

What to know for your exam

• 1.The key rating distinction is the proportion of time you are debilitated — describe what a typical week looks like versus a severe flare week, and how often severe flares occur.
• 2.Report ALL associated symptoms: widespread pain location, fatigue level, sleep quality, concentration difficulties, mood changes.
• 3.A symptom diary kept before the exam documenting frequency and severity of flare episodes directly maps to the rating criteria thresholds.
• 4.Describe what you can and cannot do during a bad week versus a relatively functional week.
• 5.List all treatments tried and their effectiveness — documenting that symptoms are refractory to multiple therapies supports the 40% criteria.

What the examiner evaluates

• •Whether the veteran is within six months of the vascular event (100% rating applies during this period)
• •All persistent residuals after six months — each rated separately under its own body system
• •Motor residuals: hemiparesis or hemiplegia, rated under the peripheral/cranial nerve codes for the affected extremities
• •Speech residuals: aphasia or dysarthria
• •Cognitive residuals: memory, attention, executive function impairment
• •Other residuals: visual field deficits, swallowing difficulty, emotional/behavioral changes, seizures
• •Underlying cause — commonly secondary to service-connected hypertension, diabetes, or cardiac disease

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Hospital records documenting the stroke: imaging (CT/MRI), type (ischemic vs. hemorrhagic), and date
• ✓Neurology follow-up records documenting all persistent residuals
• ✓Rehabilitation records: physical, occupational, and speech therapy notes documenting deficits and progress
• ✓Neuropsychological testing if cognitive residuals are claimed
• ✓Records establishing the service-connected primary condition if claimed secondary (hypertension, diabetes, cardiac disease)

What to know for your exam

• 1.Stroke residuals are rated individually — every persistent deficit is a separate rating. Inventory all of them before the exam: motor weakness, speech changes, memory problems, vision changes, swallowing difficulty, mood/behavior changes.
• 2.Describe motor deficits per extremity: weakness, coordination loss, gait changes — each affected limb is rated under its own nerve code.
• 3.Report cognitive changes concretely: missed appointments, inability to manage finances, difficulty following conversations or instructions.
• 4.If your stroke followed years of service-connected hypertension, diabetes, or heart disease, the causal chain supports a secondary connection — make sure those records are in your file.
• 5.The first six months after a stroke carry an automatic 100% rating — report your event date precisely.

What the examiner evaluates

• •Frequency of prostrating attacks (attacks severe enough that you must stop activity)
• •Duration of attacks
• •Whether attacks are characteristic (with prodrome, aura, or GI symptoms)
• •Whether attacks are economic in origin or otherwise
• •Response to treatment

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Neurology or primary care records confirming migraine diagnosis
• ✓Headache diary or log (frequency, severity, duration, functional impact)
• ✓Prescription records for migraine-specific medications (triptans, preventives)
• ✓Records of ER visits or urgent care for migraines
• ✓Work/employment records showing missed time due to migraines

What to know for your exam

• 1.The key rating factor is prostrating attacks — attacks where you cannot continue normal activities. Document frequency carefully.
• 2.A migraine diary helps establish frequency. Even a retrospective estimate is better than none.
• 3.Describe each phase of your attacks: prodrome, aura, headache phase, postdrome (recovery).
• 4.Report how migraines affect your employment: missed work days, inability to perform tasks, light/noise sensitivity.

What the examiner evaluates

• •Cognitive impairment: memory, concentration, executive function
• •Emotional/behavioral symptoms: irritability, depression, impulsivity
• •Headaches (rated separately under DC 8100)
• •Motor/sensory deficits
• •Visual disturbances
• •Sleep impairment
• •Vestibular symptoms (dizziness, balance)
• •Neurobehavioral effects

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Imaging: CT or MRI of the brain (even if negative — shows workup was done)
• ✓Neuropsychological testing results
• ✓Neurology treatment records
• ✓Records documenting the injury event (incident report, buddy statements, STRs)
• ✓Records of all TBI symptoms: cognitive, behavioral, physical

What to know for your exam

• 1.The TBI exam is extensive — cover every domain: memory, concentration, emotions, headaches, dizziness, sleep, vision, motor function.
• 2.Describe how each symptom affects your daily life: work performance, relationships, independent living.
• 3.TBI residuals span multiple body systems — each significant symptom may be ratable separately.
• 4.Bring a support person if allowed — they can confirm behavioral observations the veteran may not self-report.

What the examiner evaluates

• •Sensory deficits in the median nerve distribution: thumb, index, middle finger, and half of the ring finger
• •Motor deficits: weakness of thumb opposition and grip, thenar muscle atrophy
• •Provocative test results: Tinel's sign at the wrist, Phalen's maneuver
• •Whether symptoms are intermittent (e.g., nocturnal numbness) or constant
• •Severity of incomplete paralysis: mild, moderate, or severe
• •Which hand is affected and whether it is the dominant (major) hand

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓EMG/nerve conduction study confirming median nerve compression at the wrist — the key objective evidence
• ✓Neurology, orthopedic, or hand surgery records documenting diagnosis and severity classification
• ✓Surgical records if carpal tunnel release was performed, including post-operative outcome notes
• ✓Occupational records if repetitive hand use in service is part of the claimed connection
• ✓Records of splinting, injections, or other conservative treatment

What to know for your exam

• 1.Identify which hand is affected and whether it is your dominant hand — the rating percentages differ for major vs. minor hand at every level above 10%.
• 2.Describe the precise distribution of numbness: which fingers, how often, and whether it wakes you at night.
• 3.Report functional impact: dropping objects, difficulty with buttons or small objects, weakness opening jars, hand fatigue with use.
• 4.If you had carpal tunnel release surgery, describe your current residual symptoms — post-surgical residuals are what gets rated.
• 5.Bring your EMG report if you have one — nerve conduction data is the strongest objective evidence of severity.

What the examiner evaluates

• •Which nerves and extremities are affected — each affected extremity is evaluated separately
• •Sensory findings: light touch, pinprick, vibration, and position sense testing in a stocking/glove distribution
• •Motor findings: strength testing, muscle atrophy, deep tendon reflexes
• •Severity classification per nerve: mild, moderate, moderately severe, or severe incomplete paralysis
• •Underlying cause — commonly diabetes mellitus (secondary connection) or toxic exposure
• •Functional impact: balance, gait, fine motor tasks, tolerance for standing and walking

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓EMG/nerve conduction study documenting which nerves are involved and severity
• ✓Neurology records confirming diagnosis and classification (sensory vs. sensorimotor)
• ✓If secondary to diabetes: records establishing the diabetes diagnosis and its service connection
• ✓Records documenting balance problems, falls, or gait changes
• ✓Monofilament or vibration testing results from podiatry or primary care

What to know for your exam

• 1.Each affected extremity is rated separately — describe symptoms in each limb individually, not collectively.
• 2.Describe the precise character of symptoms: numbness, burning, electric shocks, pins-and-needles — and where each begins and ends on the limb.
• 3.Report functional impact: balance problems, falls or near-falls, inability to feel the floor, difficulty with stairs or uneven ground.
• 4.If your neuropathy is related to diabetes, make sure the examiner knows the diabetes history — diabetic peripheral neuropathy is commonly evaluated as secondary to service-connected diabetes.
• 5.Mention nighttime symptoms — burning feet that disrupt sleep are a frequent and relevant finding.

What the examiner evaluates

• •Which sinuses are involved (pansinusitis 6510, ethmoid 6511, frontal 6512, maxillary 6513, sphenoid 6514) — all use the same general rating formula
• •Number of incapacitating episodes per year requiring prolonged (4–6 weeks) antibiotic treatment
• •Number of non-incapacitating episodes per year characterized by headaches, pain, and purulent discharge or crusting
• •Whether sinus surgery has been performed (and whether radical surgery with chronic osteomyelitis)
• •Imaging findings: CT showing mucosal thickening, opacification, or obstruction

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓CT scan of the sinuses showing chronic changes
• ✓ENT records documenting diagnosis and episode history
• ✓Pharmacy records showing antibiotic courses — duration of each course matters (4–6 week courses define 'incapacitating episodes')
• ✓Surgical records for any sinus procedures (FESS, balloon sinuplasty, radical surgery)
• ✓Records or a log documenting episode frequency per year

What to know for your exam

• 1.The rating turns on episode counts per year — document how many sinus infections you have annually and how each was treated.
• 2.An 'incapacitating episode' has a specific regulatory definition: one requiring prolonged (4–6 weeks) antibiotic treatment. Identify which of your episodes met that definition.
• 3.Describe non-incapacitating episodes too: headaches, facial pain, and purulent discharge or crusting — count them per year.
• 4.Report all sinus surgeries and whether symptoms returned afterward.
• 5.If deployed near burn pits, mention exposure history — chronic sinusitis is a PACT Act presumptive condition for covered veterans.

What the examiner evaluates

• •Presence or absence of nasal polyps
• •Degree of nasal passage obstruction: percentage of obstruction on each side
• •Whether obstruction is greater than 50% on both sides, or complete on one side
• •Chronicity of symptoms and treatment response (antihistamines, nasal steroids, immunotherapy)
• •Exposure history if claimed as presumptive (burn pits, airborne hazards)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓ENT examination records documenting degree of nasal obstruction and presence/absence of polyps
• ✓Nasal endoscopy or imaging reports
• ✓Allergy testing results if allergic rhinitis is diagnosed
• ✓Treatment records: nasal steroids, antihistamines, immunotherapy
• ✓Service records documenting deployment locations if claiming presumptive exposure

What to know for your exam

• 1.The two rating criteria are specific physical findings: degree of obstruction and presence of polyps — the examiner assesses both during the exam.
• 2.Describe your obstruction pattern: one side or both, constant or alternating, and how it affects breathing, sleep, and exertion.
• 3.Report whether any provider has identified polyps — bring the records if so.
• 4.Describe treatment history and whether medications adequately control symptoms.
• 5.If deployed near burn pits, mention exposure history — chronic rhinitis is a PACT Act presumptive condition for covered veterans.

What the examiner evaluates

• •Pulmonary function testing: FEV-1 and FEV-1/FVC percentage of predicted values
• •Medication requirements: intermittent vs. daily inhalational therapy, systemic corticosteroids
• •Frequency of physician visits for required care of exacerbations
• •Frequency of asthma attacks and any episodes of respiratory failure
• •Exposure history if claimed as presumptive (burn pits, airborne hazards)

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Pulmonary function test (PFT) results — pre- and post-bronchodilator FEV-1 and FEV-1/FVC values
• ✓Pulmonology or primary care records confirming diagnosis
• ✓Prescription records for all asthma medications: rescue inhalers, daily controllers, oral steroids
• ✓Records of ER visits, urgent care, or hospitalizations for asthma exacerbations
• ✓Records of systemic corticosteroid courses (prednisone bursts) with dates

What to know for your exam

• 1.The rating is driven by PFT values OR medication requirements — whichever supports the higher level. Bring your most recent PFT results.
• 2.List every medication precisely: rescue inhaler frequency, daily controller inhalers, and any oral steroid courses in the past year with dates.
• 3.Report exacerbation history: how many flare-ups required physician visits, urgent care, or oral steroids in the last 12 months.
• 4.Describe functional limits: exertion tolerance, stairs, temperature/air-quality triggers, nighttime symptoms.
• 5.If deployed near burn pits, mention exposure history — asthma diagnosed after service is a PACT Act presumptive condition for covered veterans.

What the examiner evaluates

• •Pulmonary function testing: FEV-1, FEV-1/FVC, and DLCO (SB) percentage of predicted values
• •Exercise capacity: maximum oxygen consumption (ml/kg/min) if measured
• •Presence of cor pulmonale, right ventricular hypertrophy, or pulmonary hypertension
• •Whether outpatient oxygen therapy is required
• •Episodes of acute respiratory failure

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Complete pulmonary function tests including FEV-1, FEV-1/FVC, and DLCO
• ✓Pulmonology records confirming COPD diagnosis and severity staging (GOLD stage if assigned)
• ✓Prescription records: bronchodilators, inhaled steroids, oxygen prescription if applicable
• ✓Echocardiogram or right heart catheterization records if pulmonary hypertension or cor pulmonale is present
• ✓Hospitalization records for COPD exacerbations or respiratory failure
• ✓Service records documenting exposure history (burn pits, asbestos, chemicals, smoke)

What to know for your exam

• 1.The rating is driven primarily by PFT values — bring your most recent complete PFT report including DLCO.
• 2.If you use supplemental oxygen at any time (nighttime, exertion, continuous), tell the examiner — required outpatient oxygen therapy meets the 100% criterion.
• 3.Report any cardiac involvement: pulmonary hypertension or right heart strain diagnoses warrant the highest rating level.
• 4.Describe functional limits concretely: walking distance on flat ground, stairs tolerance, activities abandoned due to breathlessness.
• 5.Document your exposure history: deployment locations, burn pit proximity, occupational exposures in service.

What the examiner evaluates

• •Whether you use a CPAP, BiPAP, or other breathing assistance device
• •How often you use it and whether symptoms persist despite treatment
• •Daytime somnolence, fatigue, and cognitive impacts
• •Whether you've had any respiratory failure episodes
• •Related conditions: hypertension, cardiac issues, cognitive impairment

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Sleep study results (polysomnography showing AHI score)
• ✓CPAP/BiPAP prescription and compliance data (download from device if possible)
• ✓Records showing CPAP was prescribed and is being used
• ✓Any records showing symptoms persisting despite CPAP (follow-up sleep studies, provider notes)

What to know for your exam

• 1.Bring your CPAP machine prescription or a letter from your doctor confirming CPAP is required.
• 2.If you have a CPAP compliance report showing nightly use, bring it — it documents that you require the device.
• 3.Describe how sleep apnea affects your daytime functioning: fatigue, falling asleep, cognitive issues.
• 4.Report any symptoms that persist even with CPAP: morning headaches, excessive daytime sleepiness, etc.

What the examiner evaluates

• •Whether the diagnostic criteria for chronic fatigue syndrome are met: debilitating fatigue plus cognitive impairments or a combination of other signs and symptoms
• •Degree of routine daily activity restriction compared to pre-illness level
• •Frequency and duration of incapacitating episodes (symptoms requiring bed rest and treatment by a physician)
• •Whether symptoms wax and wane or are constant
• •For Gulf War veterans: whether the presentation qualifies as a medically unexplained chronic multisymptom illness (MUCMI) under 38 CFR § 3.317
• •Qualifying Southwest Asia service (August 2, 1990 to present) for presumptive eligibility

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓Service records establishing qualifying Southwest Asia theater service dates and locations
• ✓Medical records documenting the constellation of symptoms over time: fatigue, cognitive difficulties, musculoskeletal pain, GI symptoms, sleep disturbance
• ✓Records of physician-directed bed rest or incapacitating episodes with dates and durations
• ✓Records showing workup that excluded other diagnoses (the 'medically unexplained' element)
• ✓A symptom and activity log comparing current capacity to pre-illness functioning
• ✓Employment records documenting reduced hours, absences, or inability to maintain prior work level

What to know for your exam

• 1.The rating criteria compare your current activity level to your PRE-illness level — describe concretely what you could do before and what you can do now.
• 2.An 'incapacitating episode' under this code means symptoms requiring bed rest AND treatment by a physician — identify episodes that met both elements, with total weeks per year.
• 3.Report the full symptom constellation, not just fatigue: cognitive problems ('brain fog'), joint and muscle pain, headaches, GI symptoms, sleep disturbance, skin findings.
• 4.For Gulf War presumptive claims, the condition does not need a conventional diagnosis — a medically unexplained chronic multisymptom illness qualifies under 38 CFR § 3.317. Confirm your qualifying service dates and locations with the examiner.
• 5.Describe what a bad week looks like versus a relatively functional week, and how many of each you have per month.

What the examiner evaluates

• •Whether the diagnosis is a peripheral vestibular disorder (DC 6204) or Meniere's syndrome (DC 6205) — different rating formulas apply
• •Frequency of vertigo or dizziness episodes: occasional vs. weekly vs. more than weekly
• •Whether episodes include cerebellar gait (staggering) during attacks
• •For Meniere's: the triad of hearing impairment, tinnitus, and episodic vertigo
• •Objective vestibular testing: VNG/ENG, audiometry, rotary chair testing
• •Functional impact: driving restrictions, fall history, work limitations

Rating level criteria (38 CFR)

Documents to gather before your exam

• ✓ENT or neurotology records establishing the specific diagnosis (Meniere's vs. other vestibular disorder)
• ✓Vestibular testing results: VNG/ENG, rotary chair, VEMP
• ✓Audiometry results — hearing impairment is part of the Meniere's rating criteria
• ✓An episode log documenting vertigo attack frequency, duration, and whether staggering/falls occurred
• ✓Records of falls, ER visits, or injuries during vertigo episodes
• ✓Records of driving restrictions or work limitations imposed by providers

What to know for your exam

• 1.The rating formulas turn on episode frequency — keep a log of vertigo attacks (date, duration, severity, whether you staggered or fell) and bring it to the exam.
• 2.Distinguish true vertigo (the room spinning) from lightheadedness — describe exactly what your episodes feel like.
• 3.Report whether you stagger or cannot walk during attacks — 'cerebellar gait' during episodes is a specific criterion at the 60% and 100% Meniere's levels.
• 4.Describe associated symptoms during attacks: hearing changes, ear fullness, tinnitus, nausea or vomiting.
• 5.Report all functional consequences: falls, injuries, driving limitations, missed work, and activities you avoid for safety.