Updated June 3, 2026
VA mental health evaluations consider occupational and social impairment under 38 C.F.R. § 4.130. This educational guide explains records, DBQs, medical opinions, and lay statements that may be relevant to a claim. It is not a diagnosis, medical opinion, or prediction of a VA decision.
PTSD, depression, and anxiety can affect people differently. An examination is one part of the record, so it can help to organize treatment history, symptom frequency, and specific examples of work, relationship, or daily-function impact.
Evidence to review: Relevant evidence may include clinical records, lay statements, and, when appropriate, a DBQ completed by a qualified clinician. The clinician must make an independent assessment, and only VA decides whether the evidence supports a particular rating.
A medical nexus opinion may be relevant when the connection between a current condition and military service is disputed or unclear. Whether an opinion is appropriate, who may prepare it, and whether a qualified clinician is available depend on the individual record and location. Any clinician must independently review the evidence and provide their own medical rationale; an opinion does not guarantee service connection.
Sleep apnea, migraine headaches, and TMJ or bruxism can coexist with PTSD, but they are not automatically caused or aggravated by it. A secondary-service-connection theory generally requires evidence of the additional condition and qualified medical evidence addressing causation or aggravation. If a head injury is also in the record, use the TBI residuals evidence checklist to distinguish overlapping symptoms. VA decides whether a condition is service connected and how any ratings are combined.
VA rates mental disorders under 38 C.F.R. section 4.130. The claim file needs more than a diagnosis: it should show work impairment, social impairment, symptom frequency, medication effects, safety concerns, treatment history, and how those facts appear in the DBQ and lay evidence.
Quick answers
VA rates PTSD and most mental health conditions by occupational and social impairment under 38 C.F.R. section 4.130. The file should connect symptoms to work impact, relationship impact, treatment history, medication effects, safety concerns, and the DBQ findings VA reviews.
Useful PTSD DBQ evidence can include diagnosis history, stressor information, therapy or medication records, panic or sleep frequency, missed-work examples, safety concerns, and buddy statements from people who observe daily function.
VA usually evaluates overlapping mental health symptoms together instead of assigning separate ratings for the same impairment. Use the VA pyramiding rule checklist when the record needs to separate distinct secondary physical conditions from overlapping mental health symptoms.
A witness should describe observable changes: isolation, panic episodes, missed work, sleep disruption, irritability, memory problems, unsafe behavior, relationship strain, or needing help with daily tasks. The statement should not try to diagnose the veteran.
Evidence reminder
Document symptom frequency, treatment history, and work and relationship impact. Only VA decides the rating and effective date.
Combat or non-combat stressors. If you are trying to prove worsening symptoms, start with the VA rating increase evidence checklist.
Often secondary to physical pain. See the chronic pain depression evidence checklist.
Service-connected stress. If tinnitus is part of the record, use the anxiety secondary to tinnitus checklist.
Evidence map
Use this page as the mental-health hub. The specific guides below carry the detail for the evidence paths Google is already surfacing: PTSD rating criteria, mental health DBQs, secondary anxiety or depression, chronic pain overlap, and statements that prove occupational and social impairment.
Organize occupational and social impairment, panic frequency, safety concerns, and missed-work facts.
Secondary depressionSeparate pain-driven mood symptoms, treatment history, nexus facts, and functional limits.
Secondary anxietyConnect tinnitus symptoms, sleep disruption, panic, concentration problems, and medical opinions.
Chronic symptomsKeep chronic physical symptoms, mental-health overlap, and DBQ evidence from getting blurred.
Lay evidenceWrite a direct statement that ties symptoms to work, relationships, safety, and daily function.
Witness evidenceUse spouse, coworker, supervisor, or roommate observations to show real-world impairment.