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Veterans Law

Permanent and Total VA Disability Ratings for PTSD

February 8, 2020

What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a mental health condition that develops in some people who have experienced a shocking, scary, or dangerous event.  While it is natural to experience a range of reactions after a traumatic incident, most people recover from initial symptoms naturally.  Those who continue to experience problems may be diagnosed with PTSD.  Symptoms of PTSD usually begin within three months of the traumatic incident, but sometimes they begin years afterwards.  In order to receive a diagnosis of PTSD, symptoms must last more than one month and be severe enough to interfere with relationships or work.  Specific diagnostic criteria for PTSD are divided into different types of symptoms, including the following:

  • Re-experiencing symptoms – includes flashbacks, nightmares, and intrusive thoughts
  • Avoidance symptoms – includes staying away from places, events, or objects that are reminders of the traumatic experience and avoiding thoughts or feelings related to the traumatic event
  • Arousal and reactivity symptoms – includes being easily startled, feeling tense or “on edge”, having difficulty sleeping, and having angry outbursts
  • Cognition and mood symptoms – includes trouble remembering key features of the traumatic event, negative thoughts about oneself or the world, distorted feelings like guilt or blame, and loss of interest in enjoyable activities

PTSD can either be short-term or chronic depending on the individual and the circumstances.  Regardless, the main treatments for people with PTSD are medications (e.g., antidepressants), psychotherapy (“talk” therapy), or both.

VA Disability Ratings for PTSD

To prove PTSD to VA and establish direct service connection, veterans must satisfy the following elements: (1) a current diagnosis of PTSD; (2) an in-service stressor (i.e., a traumatic event or incident that caused PTSD); and (3) a medical nexus linking the current, diagnosed PTSD to the in-service stressor.

After service connection for PTSD is established, VA will assign a disability rating.  To determine your disability rating, VA uses the General Rating Formula for Mental Disorders under 38 CFR § 4.130.  This rating scale ranges from 0 percent to 100 percent with in-between ratings of 10, 30, 50, and 70 percent.  In most cases, veterans’ disability ratings may be subject to change.  For example, if a veteran’s PTSD worsens over time, they can file for an increased rating.  On the other hand, if VA finds that a veteran’s PTSD has improved, there are certain situations in which their disability rating will be reduced.

Under limited circumstances, veterans may be assigned a permanent and total disability rating for PTSD.

What Are Permanent and Total VA Disability Ratings?

Permanent and total disability, or P&T, refers to veterans whose disabilities are total (rated 100 percent disabling by VA) and permanent (zero or close to zero chance of improvement).  Though “permanent and total” is often used as a single phrase, veterans can have a total disability that is temporary, or a permanent disability rated less than 100 percent.  Permanent and total ratings are protected from being reduced and may entitle you or your family to additional VA benefits.


VA deems a disability “permanent” when it is reasonably certain, based on medical evidence, that the level of impairment will continue for the rest of the veteran’s life.  For this reason, VA is allowed to take age into account when determining whether a disability is permanent and it can be more difficult for younger veterans to be considered permanently disabled.


Veterans’ conditions are rated based on VA’s Schedule of Rating Disabilities.  The rating levels for each type of disability are based on how much the residuals of said disability impair your ability to function in life and at work.  A 100 percent rating indicates that your disability is completely, or “totally,” disabling.

How Does This Apply to PTSD?

A PTSD disability rating may become permanent and total if VA determines that it meets the 100 percent criteria set forth by the rating schedule and there is zero chance of improvement.  The rating criteria for a total disability rating for PTSD are as follows:

  • 100% – “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.”

Therefore, if a veteran’s PTSD reflects the above-mentioned symptomology they may want to consider consulting a VA healthcare professional or private doctor to determine whether it is permanent.  It should also be noted that the above criteria is not all-inclusive, but rather is meant to provide examples.

VA should automatically consider whether a veteran’s PTSD qualifies for permanent and total status when adjudicating their claim.  If VA has awarded permanent and total status for PTSD it will most likely be indicated in the decision letter.  On some Rating Decisions, there is a Permanent and Total box that will be checked if your 100 percent PTSD rating is permanent.  On others, there may be language like “Eligibility to Dependents Chapter 35 DEA / CHAMPVA are established” or “no future exams are scheduled” – both of which indicate permanence.  The exact language may vary with different VA Regional Offices.