38 CFR Part 4 Changes
Significant amendments to the VA Schedule for Rating Disabilities, organized by body system.
Why Rating-Schedule Changes Matter
38 CFR Part 4 is the rulebook VA uses to translate medical evidence into a percentage rating. When VA amends a section — whether a comprehensive overhaul (Mental Disorders 2025) or a single diagnostic code (sleep apnea) — every new claim is decided under the version in effect on the date of decision.
Key protection: existing ratings are generally protected from reduction following a schedule change under the stabilization rules at 38 C.F.R. § 3.951 and § 3.957. Changes typically benefit new filers and those with pending claims, not those already rated.
Sleep apnea — proposed tightening of CPAP-based ratings
What changed
VA proposed restructuring sleep apnea ratings so that the use of a CPAP machine would no longer automatically warrant a 50% evaluation. New criteria would require documented persistent symptoms despite treatment for higher tiers. Final rule has not been issued; existing ratings would be protected if and when finalized.
Who benefits
Veterans currently rated 50% for CPAP use are protected from reduction under stabilization rules. New filers should document residual symptoms (daytime hypersomnolence, cognitive impairment) regardless of CPAP use.
Comprehensive revision of the Mental Disorders rating schedule
What changed
VA replaced the General Rating Formula for Mental Disorders with a new evaluation framework based on five domains of functioning (cognition, interpersonal interactions, task performance, navigation, and self-care). Eliminated the 0% rating; minimum compensable evaluation is now 10%. Diagnostic codes consolidated and updated to align with DSM-5-TR.
Who benefits
Veterans with PTSD, depression, anxiety, and other mental health conditions get a more functionally-anchored evaluation. Reductions are restricted by stabilization-period rules — most existing ratings are protected.
Tinnitus reclassified as a symptom — proposed end of separate 10% rating
What changed
VA proposed to remove the standalone 10% evaluation for tinnitus under DC 6260 and instead treat tinnitus as a symptom of an underlying disease (e.g., Meniere's, hearing loss). Public outcry and Congressional pushback delayed implementation; existing ratings would be protected.
Who benefits
Existing tinnitus ratings remain protected. New filers should still claim tinnitus separately while the rule remains under review. Watch for finalization activity in the Federal Register.
PACT Act expanded presumptive conditions for toxic exposures
What changed
Honoring our PACT Act of 2022 added 23+ presumptive conditions for veterans exposed to burn pits and other airborne hazards in the Gulf War, post-9/11, and Vietnam eras. Includes hypertension as an Agent Orange presumptive and several rare cancers.
Who benefits
Post-9/11 veterans with burn pit exposure, Vietnam veterans with hypertension, and Gulf War veterans with newly recognized respiratory conditions and cancers.
Asthma and COPD — modernized pulmonary function testing criteria
What changed
VA updated the rating criteria for asthma (DC 6602) and chronic obstructive pulmonary disease (DC 6604) to reflect modern pulmonary function testing standards (FEV-1, FEV-1/FVC ratio) and current treatment regimens including biologic therapy.
Who benefits
Veterans on inhaled corticosteroids or biologics can now reach higher ratings without the older 'systemic steroid' requirement. PACT Act burn-pit asthma claims benefit directly.
Musculoskeletal system — updated joint and muscle injury criteria
What changed
VA modernized the musculoskeletal rating schedule to incorporate current clinical practice for joint replacement, muscle injury severity, and revised range-of-motion criteria. Includes updated diagnostic codes for shoulder, hip, and knee replacements.
Who benefits
Veterans with joint replacements (1-year post-op 100% rating retained) and those with documented functional loss now have clearer criteria for higher evaluations. Aligns with Correia and DeLuca exam requirements.
Hematologic and lymphatic systems — comprehensive revision
What changed
Added or revised diagnostic codes for sickle cell disease, multiple myeloma, polycythemia vera, primary myelofibrosis, and other rare blood disorders. Modernized treatment-response criteria.
Who benefits
Veterans with rare blood disorders, including those linked to Agent Orange and Camp Lejeune water contamination, now have explicit diagnostic codes rather than analogous ratings.
Skin disorders — updated criteria for scars and dermatologic conditions
What changed
VA revised diagnostic codes 7800-7833 to clarify scar measurement, treatment-frequency thresholds for chronic conditions like eczema and psoriasis, and added codes for newer conditions including hidradenitis suppurativa.
Who benefits
Veterans with chronic skin conditions on biologics or systemic therapy benefit from clearer 60% criteria. Burn-pit-related dermatologic claims benefit indirectly via PACT Act presumptives.
Visual impairment — updated criteria and table for visual acuity loss
What changed
Revised the table of ratings for impairment of central visual acuity and field of vision. Added or refined codes for diabetic retinopathy, glaucoma, and post-refractive surgery complications.
Who benefits
Veterans with diabetes-related retinopathy (often secondary to service-connected diabetes mellitus type 2) and those with traumatic brain injury–related visual deficits.
Endocrine system — diabetes, thyroid, and adrenal disorder updates
What changed
Modernized criteria for diabetes mellitus (DC 7913), hyperthyroidism, hypothyroidism, and adrenal disorders. Updated to current insulin-pump and continuous-glucose-monitoring practice.
Who benefits
Veterans with insulin-dependent diabetes (often Agent Orange or PACT Act presumptive) and those with thyroid conditions benefit from criteria that reflect modern care.
General education only
These summaries describe rule changes but are not a substitute for the official Federal Register text or the current Code of Federal Regulations. Rating-schedule applicability depends on the date of your claim and the date of the underlying decision. Oakridge Claims is a VA-accredited claims agent service and does not provide legal advice.