DSM-IV and DSM-5 in Terms of PTSD and Its Effects on VA Disability Ratings

Updated: July 2025

The shift from DSM-IV to DSM-5 altered how Post-Traumatic Stress Disorder (PTSD) is diagnosed, and this has had implications—though sometimes misunderstood—for VA disability claims.

What Is the DSM?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published by the American Psychiatric Association and provides standardized criteria for mental health diagnoses. It is widely used in both clinical and legal settings, including by the Department of Veterans Affairs (VA).

Key Differences Between DSM-IV and DSM-5

• DSM-IV: Classified PTSD as an anxiety disorder, with three symptom clusters:
  • Re-experiencing
  • Avoidance
  • Hyperarousal
• DSM-5: Reclassified PTSD under a new category: Trauma- and Stressor-Related Disorders. It added a fourth symptom cluster:
  • Negative alterations in mood and cognition

DSM-5 also introduced more specific diagnostic criteria, including exposure types and symptoms for children under 6.

Does the VA Use DSM-5?

Yes. Since August 4, 2014, the VA has officially adopted DSM-5 for all C&P exams and disability evaluations related to mental health conditions.

This means that:

• Your C&P examiner will use DSM-5 criteria to determine whether you meet the diagnostic threshold for PTSD.
• However, your actual VA rating is still based on the VA’s mental health rating schedule, which uses a General Rating Formula based on the level of occupational and social impairment.

Impact on Veterans Filing PTSD Claims

Here’s how the DSM-5 shift may affect your case:

• Wording differences: If an older diagnosis (under DSM-IV) doesn’t meet all DSM-5 criteria, you might need an updated exam.
• Functional impairment matters more than symptom labels. The VA looks at how PTSD affects work, relationships, and daily functioning—not just the diagnostic label.

What If You Were Diagnosed Under DSM-IV?

If you were diagnosed with PTSD before 2014 using DSM-IV, your diagnosis is still valid—but for any new claims or re-evaluations, the VA may require an updated C&P exam under DSM-5.

This does not mean you’ll lose your rating. But you should ensure your medical records include current language that maps to DSM-5 criteria.

Tips for Veterans

• Ask your provider if your diagnosis meets DSM-5 criteria.
• Ensure your C&P exam addresses functional impact—not just symptom checklists.
• Review your rating decision and appeal if the VA overlooked key symptoms or impairments.

Conclusion

While the DSM is critical in establishing a PTSD diagnosis, your VA disability rating will depend on how that condition affects your ability to work and maintain relationships. The DSM-V provides more clarity, but understanding the difference between diagnosis and rating is essential to winning your claim.

If you’re unsure how DSM changes affect your claim, speak with a VA-accredited representative or mental health professional familiar with VA claims.