Long COVID (Post-Acute Sequelae of SARS-CoV-2) VA Rating Guide

Overview

Long COVID — formally Post-Acute Sequelae of SARS-CoV-2 (PASC) — is the cluster of symptoms persisting more than 12 weeks after a COVID-19 infection that cannot be explained by another diagnosis.

Common presentations include profound fatigue, post-exertional malaise, dyspnea on exertion, brain fog and memory loss, headaches, dysautonomia (POTS), anxiety/depression, sleep disturbance, and persistent loss of smell or taste.

VA does not maintain a Long COVID presumptive list. Service connection is decided on a direct basis: confirmed in-service infection, current diagnosis or persistent symptoms, and a medical nexus tying the two together.

How to Establish Service Connection

• Documentation of a COVID-19 infection during a qualifying period of service — positive PCR or antigen test, military hospital records, or contemporaneous quarantine orders.
• If no positive test is in the file, lay statements from chain of command and a clinician's retrospective opinion that the documented illness was clinically consistent with COVID-19 may support direct service connection.
• Current medical evaluation (within ~12 months) documenting each persistent symptom — pulmonologist, neurologist, cardiologist, mental health, or a dedicated post-COVID clinic.
• A nexus opinion stating the persistent symptoms are 'at least as likely as not' a sequela of the in-service COVID-19 infection.

Rating Criteria

Paraphrased from Rated by analogy across 38 CFR §§ 4.97, 4.124a, 4.130 (no single DC)

See what each percentage pays in 2026 and how it combines with your current rating →

Evidence Checklist

• Positive COVID-19 test result (PCR or antigen) from the in-service period, or service treatment record entries showing illness clinically consistent with COVID-19 during a known outbreak.
• Continuous treatment record from the acute infection through current symptoms — gaps weaken the nexus.
• Pulmonary function testing showing reduced DLCO or FVC.
• Cardiology workup including tilt-table testing if dysautonomia/POTS is suspected.
• Neurocognitive testing documenting brain fog or memory deficits.
• Mental health evaluation documenting anxiety, depression, or PTSD-spectrum response to severe illness.
• A nexus opinion from a treating clinician or independent medical reviewer.

Common pitfalls VA sees

• Filing without any documentation of the in-service infection. Locate the positive test or hospital admission first.
• Filing under a single 'Long COVID' label rather than each affected condition. File the diagnosed sequelae separately so each can be rated.
• Letting follow-up care lapse. Continuous treatment is the strongest evidence of persistent disability.

Common Secondary Conditions

Conditions frequently service-connected as secondary to Long COVID (Post-Acute Sequelae of SARS-CoV-2):

What the C&P Exam Documents

General information about how this condition is typically evaluated. This is not coaching on what to say and is not a substitute for medical or legal advice.

• →Long COVID exams may involve multiple specialists. Ask that each affected system be examined separately, with measurable findings (PFTs, tilt-table, neurocognitive testing).
• →Bring a daily symptom log showing post-exertional malaise — frequency, duration, and what activity triggered it.
• →If your worst days are very different from your average, say so explicitly. VA must consider flare-ups and additional functional loss under DeLuca and §§ 4.40 / 4.45.

Frequently Asked Questions