Post-traumatic stress disorder is one of the most frequently claimed conditions in the VA system, and it is governed by a regulation written specifically for it. Understanding that regulation - 38 CFR 3.304(f) - explains most of what veterans find confusing about these claims, including why two veterans with the same diagnosis can receive very different decisions.
This guide is the overview for our mental health series. It walks through what the VA requires, how an in-service stressor is established, how severity is measured, and where an independent medical opinion does and does not matter. Companion guides go deeper on stressor evidence, rating levels, and the evidence a mental health claim rests on.
What the VA requires for service-connected PTSD
Under 38 CFR 3.304(f), service connection for PTSD requires three things:
- A medical diagnosis of PTSD conforming to the criteria in 38 CFR 4.125(a), which adopts the diagnostic manual the VA recognizes
- Credible supporting evidence that the claimed in-service stressor actually occurred
- A link, established by medical evidence, between the current symptoms and the in-service stressor
The third element is where a medical opinion lives. The first is a clinical question. The second is largely an evidentiary question - and it is the one that most often decides the claim.
How stressors are established
The regulation treats different stressors differently. If the claimed stressor is related to combat, or to fear of hostile military or terrorist activity, and a VA or VA-contracted psychiatrist or psychologist confirms that the stressor is adequate to support the diagnosis, the veteran's own testimony alone may establish the stressor - provided it is consistent with the places, types, and circumstances of service and the record contains no clear evidence to the contrary.
Stressors outside those categories generally require corroboration from another source. The regulation also contains specific provisions for stressors involving personal assault, including military sexual trauma, which recognize that these events are frequently unreported and allow alternative forms of evidence such as records from law enforcement, counseling, or a change in behavior documented after the event.
Because this element turns on records rather than medicine, it deserves its own treatment - see our guide to PTSD stressor evidence.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Individual Psychological Evaluation Package
A telehealth evaluation with a psychologist licensed in your state. It includes a one-on-one evaluation of your history, symptoms, and functional impact, a DBQ when clinically appropriate, and a nexus opinion section when the evaluation supports one. It starts with a free screening - you pay nothing unless a full evaluation appears clinically appropriate.
How the VA measures severity
Once a mental disorder is service connected, it is evaluated under the General Rating Formula for Mental Disorders in 38 CFR 4.130 at 0, 10, 30, 50, 70, or 100 percent. The formula measures occupational and social impairment - how much the condition interferes with work and relationships - rather than counting symptoms. The symptoms listed at each level are examples, not a checklist.
An important consequence: the VA assigns a single evaluation covering all service-connected mental health conditions together. A veteran with PTSD, depression, and anxiety does not receive three separate mental health ratings. Our PTSD ratings guide and our guide to anxiety and depression ratings explain what each level describes.
Rating criteria are amended from time to time. Always confirm the current text of 38 CFR 4.130 on the eCFR before relying on any summary, including this one.
Secondary mental health conditions
Not every mental health claim starts with a stressor. Under 38 CFR 3.310, a mental health condition that is caused or aggravated by an already service-connected disability can be service connected on a secondary basis - depression arising from chronic pain or from a disabling physical condition is a common example. Mental health conditions can also cause or aggravate physical conditions, which is the theory behind claims such as sleep apnea secondary to PTSD.
Our guide to depression and anxiety secondary to service-connected conditions covers that pathway in detail.
Where an independent medical opinion fits
A medical opinion addresses the nexus element: whether, in the reviewing clinician's judgment, the current condition is at least as likely as not related to service or to a service-connected disability. A useful opinion identifies the diagnosis and the criteria it meets, describes the evidence reviewed, applies recognized medical reasoning to that specific record, and addresses competing explanations rather than ignoring them.
It cannot manufacture a stressor, and it cannot promise a rating. If your records do not support a defensible opinion, the honest answer is to say so before anything is written. That is why we begin with a paid medical records review, and why our Individual Psychological Evaluation Package starts with a free screening.
Patriot NEXUS Letters provides independent medical evidence, not legal representation or claim filing. We do not guarantee that a medical professional will reach a favorable conclusion or that the VA will approve any claim.
Frequently asked questions
What are the three elements of a PTSD service connection claim?
Under 38 CFR 3.304(f): a medical diagnosis of PTSD, credible supporting evidence that the claimed in-service stressor occurred, and a link, established by medical evidence, between the current symptoms and the in-service stressor.
Do I need documentary proof of my stressor?
Not always. If the stressor is related to combat or to fear of hostile military or terrorist activity, and a psychologist or psychiatrist confirms the stressor is adequate to support the diagnosis, your own testimony may establish it - provided it is consistent with the places, types, and circumstances of your service and the record contains no clear and convincing evidence to the contrary.
Does PTSD automatically get a 100 percent rating?
No. PTSD is rated under the General Rating Formula for Mental Disorders at 0, 10, 30, 50, 70, or 100 percent based on how the condition affects occupational and social functioning. Our PTSD ratings guide explains each level.
Are PTSD, depression, and anxiety rated separately?
No. The VA assigns a single evaluation covering all service-connected mental health conditions together, measured under the same rating formula.