How the VA Rates PTSD

A mental health condition has been formally diagnosed, but symptoms are controlled by continuous medication with no occupational or social impairment.

Examples from this level’s criteria

• Confirmed diagnosis in medical records
• Currently prescribed psychiatric medication
• No current symptoms causing work or social problems

Occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.

Examples from this level’s criteria

• Mild anxiety or depressed mood
• Occasional sleep disturbance
• Symptoms worsen noticeably under stress
• Needs medication to function

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.

Examples from this level’s criteria

• Depressed mood, anxiety, suspiciousness
• Panic attacks more than once a week
• Chronic sleep impairment
• Mild memory loss (e.g., forgetting names, directions)
• Flattened affect
• Difficulty establishing and maintaining effective work and social relationships

Occupational and social impairment with reduced reliability and productivity due to symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment of short- and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

Examples from this level’s criteria

• Flat affect, emotional numbing
• Panic attacks more than weekly
• Short- and long-term memory problems
• Difficulty following complex instructions
• Impaired judgment or abstract thinking
• Significant difficulty in work relationships — write-ups, conflicts, reduced output
• Isolation from family and friends

Occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as: suicidal ideation; obsessional rituals interfering with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting ability to function independently; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; difficulty adapting to stressful circumstances; inability to establish and maintain effective relationships.

Examples from this level’s criteria

• Suicidal ideation (passive or active)
• Near-constant depression or anxiety
• Impulsive or self-destructive behavior
• Inability to maintain relationships — estrangement from family
• Difficulty functioning independently (needs reminders, supervision)
• Obsessive rituals interfering with daily tasks
• Poor personal hygiene or appearance on bad days
• Spatial disorientation
• Unemployed or on the verge of termination due to symptoms

Total occupational and social impairment due to symptoms such as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living; disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

Examples from this level’s criteria

• Unable to hold any job — complete occupational impairment
• Persistent hallucinations or delusions
• Danger to self (active suicidal ideation with plan or attempt)
• Inability to perform basic ADLs without help
• Gross thought disorganization
• Disorientation to time or place
• Memory loss for close relatives' names or own name