Mental Health Symptom Language Decoded — VA §4.130 Plain English

How the §4.130 rating formula actually works

The General Rating Formula for Mental Disorders assigns one rating (0, 10, 30, 50, 70, or 100 percent) that reflects the veteran's overall occupational and social impairment. The bullet-list symptoms under each percentage are examples, not checklists. VA must consider the totality of the veteran's symptoms and the resulting functional impact, even if a particular symptom does not appear on the list. This was clarified by the Federal Circuit in Mauerhan v. Principi (2002) and reinforced in Vazquez-Claudio v. Shinseki (2013).

Reading your decision becomes much easier once you understand that the examiner is using these phrases as shorthand for observed behavior — not assigning points. The phrases below are paraphrased from the rating schedule and DBQ language; refer to 38 CFR §4.130 for the controlling text.

30% level — common symptom phrases

• Depressed mood — a persistent low mood most days, not just situational sadness.
• Anxiety — recurrent, distressing worry that goes beyond ordinary nerves.
• Suspiciousness — a baseline of distrust toward others without a specific reason.
• Panic attacks (weekly or less often) — brief episodes of intense fear with physical symptoms (racing heart, sweating, shortness of breath).
• Chronic sleep impairment — trouble falling asleep, staying asleep, or non-restorative sleep, occurring most nights.
• Mild memory loss — forgetting names, directions, or recent conversations more than peers of the same age.

50% level — common symptom phrases

• Flattened affect — visibly reduced emotional expression; the face and voice don't change much regardless of topic.
• Circumstantial, circumlocutory, or stereotyped speech — circumstantial means giving excessive unnecessary detail before getting to the point; circumlocutory means talking around a topic; stereotyped means repetitive, rigid phrasing.
• Panic attacks more than once a week — frequent enough to interfere with routines.
• Difficulty in understanding complex commands — trouble following multi-step instructions at work or in conversation.
• Impaired judgment — making decisions that others would recognize as risky, impulsive, or against self-interest.
• Impaired abstract thinking — trouble interpreting proverbs, metaphors, or generalizing from examples.
• Disturbances of motivation and mood — lack of drive to start tasks, persistent irritability, or rapid mood shifts.
• Difficulty in establishing and maintaining effective work and social relationships — losing jobs, isolating from friends, or strained marriage.

70% level — common symptom phrases

• Suicidal ideation — thoughts of suicide, with or without a plan. Important: any suicidal ideation can support a 70% rating even when no other 70% symptoms are present (Bankhead v. Shulkin, CAVC 2017).
• Obsessional rituals which interfere with routine activities — compulsive behaviors (checking, counting, washing) that take significant time or block normal tasks.
• Speech intermittently illogical, obscure, or irrelevant — speech that loses topical coherence at times.
• Near-continuous panic or depression affecting the ability to function independently — symptoms present most of the day, most days, that materially limit independent functioning.
• Impaired impulse control (such as unprovoked irritability with periods of violence) — anger outbursts that exceed the trigger or cause property damage or fights.
• Spatial disorientation — getting lost in familiar places.
• Neglect of personal appearance and hygiene — showering, shaving, or laundry consistently skipped.
• Difficulty in adapting to stressful circumstances (including work or worklike setting) — common workplace stressors trigger disproportionate responses.
• Inability to establish and maintain effective relationships — no current meaningful relationships beyond immediate family.

100% level — common symptom phrases

• Gross impairment in thought processes or communication — speech is so disorganized others cannot follow it; thinking is markedly distorted.
• Persistent delusions or hallucinations — fixed false beliefs or sensory experiences (voices, visions) that persist over time.
• Grossly inappropriate behavior — behavior far outside social norms regardless of setting.
• Persistent danger of hurting self or others — ongoing risk that is not episodic.
• Intermittent inability to perform activities of daily living (ADLs), including maintenance of minimal personal hygiene — at times unable to bathe, dress, feed self, or use the toilet without help.
• Disorientation to time or place — does not know the date, season, or location.
• Memory loss for names of close relatives, own occupation, or own name — severe memory disturbance.

Words examiners use that are not in the formula

DBQs often add observational shorthand that is not in §4.130 itself. Examples: 'anhedonia' (loss of pleasure in activities normally enjoyed); 'hypervigilance' (constant scanning for threats); 'avoidance' (going out of one's way to bypass reminders of trauma); 'emotional numbing' (reduced range of feeling); 'dissociation' (a sense of detachment from self or surroundings); 'psychomotor agitation' or 'retardation' (sped-up or slowed-down movement); 'guarded' (giving short, defensive answers); 'restricted affect' (a narrower-than-normal emotional range, less severe than 'flattened').

These terms describe what the examiner observed and influence which §4.130 bullets they think apply. They are evidence, not ratings.

How to read your own DBQ

Match each symptom the examiner checked against the bullets above. If the examiner checked symptoms from the 70% bullet list but the decision granted 50%, the decision is worth a closer look — either a Higher-Level Review (no new evidence) or a supplemental claim with additional evidence may be appropriate. Bankhead and Mauerhan are particularly useful authority when the examiner noted suicidal ideation or symptoms not on the bullet list.

The DBQ also asks the examiner to characterize overall occupational and social impairment with one of five phrases ('occasional decrease,' 'reduced reliability and productivity,' 'deficiencies in most areas,' 'total occupational and social impairment,' etc.). That summary often drives the rating more than any individual symptom checkbox.

Frequently Asked Questions