VA Is Rewriting Big Pieces of the Disability Rating Playbook

VA is in the middle of a multi-year effort to modernize the Veterans Affairs Schedule for Rating Disabilities, the regulatory framework that assigns percentage ratings intended to approximate average impairment post-service, as authorized by statute. 

What VA Says It Is Doing, and Where the Answers Live

VA has described the modernization effort as necessary to reflect advances in medical treatment, updated diagnostic standards, and technologies that did not exist when much of the schedule was last revised. 

The agency has stated that, once complete, this will represent the first comprehensive update of the rating schedule since its post-World War II restructuring in 1945, a claim reflected in VA’s own explanation of the project and echoed in oversight reporting by the Government Accountability Office.

When asked directly why VA is proposing changes to sleep apnea ratings and how those changes would affect veterans whose symptoms are controlled by CPAP therapy, VA Press Secretary Pete Kasperowicz declined to answer those questions in individualized terms. Instead, he pointed to the pending rulemaking and indicated the rationale for the changes is laid out in the Federal Register notice itself, while questions about how the proposal would work in practice remain under consideration as VA reviews public comments.

How Sleep Apnea Ratings Would Change Under the Proposal

Sleep apnea is currently rated under Diagnostic Code 6847, which assigns a 50% evaluation when a veteran requires the use of a breathing assistance device such as a CPAP machine. That structure makes the presence of a prescribed device the central determinant of the rating, rather than the degree of functional impairment that remains once treatment is in place.

VA’s proposed revision explicitly rejects that approach. In the notice, VA states the existing criteria evaluate sleep apnea based on the intensity of treatment rather than residual disability, and advances in therapy now allow many veterans to function with minimal impairment despite requiring ongoing treatment. 

VA explains that the proposal is intended to shift the focus toward how much impairment persists after treatment, rather than whether a device is prescribed, as described in the discussion accompanying the proposed rule.

Under the proposal, sleep apnea that is asymptomatic with or without treatment would generally be rated at 0%, while cases in which treatment provides only incomplete relief would fall at 10%. Higher ratings would be reserved for situations where treatment is ineffective, cannot be used, or where serious complications remain, with the most severe cases qualifying for a 100% evaluation.

This framework answers, at least in principle, why VA says it is pursuing the change: the agency views the current CPAP-driven model as overstating disability in cases where treatment restores function. 

What the notice does not provide is a veteran-facing estimate of how many existing claimants would see materially different outcomes under the new system, particularly those who currently receive 50% ratings solely because they use CPAP therapy.

What Happens to Tinnitus Under VA’s Plan

Tinnitus is currently compensated as a standalone condition under Diagnostic Code 6260, with a maximum schedular rating of 10% for recurrent tinnitus. VA’s proposal would eliminate that diagnostic code entirely.

The rationale offered in the notice is that tinnitus is not a disease in itself, but is instead a symptom associated with an underlying condition, such as hearing loss, vestibular disorders, or traumatic brain injury. VA states compensating tinnitus separately departs from medically supported practice and results in duplicative compensation when the underlying condition is already rated. 

Under the proposed framework, tinnitus would be evaluated as part of the underlying service-connected condition. VA proposes a narrow exception allowing a 10% evaluation when tinnitus accompanies noncompensable hearing loss, while prohibiting an additional tinnitus rating when hearing loss is already compensable. 

For veterans concerned about existing tinnitus ratings, VA points to the long-standing rule that a change in the rating schedule alone is not grounds for reducing a protected evaluation. The proposal itself reiterates that schedule changes do not automatically trigger reductions absent evidence of actual improvement.

How Mental Health Ratings Would Be Restructured

Mental health conditions are currently evaluated under the General Rating Formula for Mental Disorders, a framework VA acknowledges has remained largely unchanged since the mid-1990s. VA’s proposed mental health revisions are intended to align ratings more closely with DSM-5 diagnostic standards and contemporary clinical understanding of functional impairment.

The proposal replaces the current symptom-driven model with a system that evaluates impairment across multiple functional domains and then maps those findings onto percentage ratings. VA also proposes eliminating the noncompensable mental health rating, instead setting a minimum 10% evaluation for all service-connected mental disorders on the theory that a diagnosed mental condition necessarily produces some degree of functional limitation. 

VA cites internal analyses suggesting this revised mental health framework would, on average, result in higher evaluations for some veterans compared to the current system, although those findings appear within the proposal itself and remain subject to revision as part of the rulemaking process.

What “Grandfathering” Actually Protects, and What It Doesn’t

Veterans often assume that existing ratings are completely insulated from regulatory change. VA’s own regulations draw a narrower line. While a schedule readjustment cannot, by itself, justify a reduction, VA may still revisit a rating if evidence shows material improvement, subject to procedural safeguards. 

Additional protections apply depending on how long a rating has been in place. Ratings in effect for five years or more are subject to stabilization rules. Service connection itself is generally protected after ten years absent narrow exceptions such as fraud.

Veterans who hold a permanent and total disability designation occupy a slightly different position than those with schedular ratings alone. A finding of permanent and total disability reflects VA’s determination that the veteran’s service-connected conditions are both totally disabling and reasonably certain to continue for the rest of the veteran’s life. 

While a permanent and total designation does not create absolute immunity from review, VA regulations make clear that reductions require evidence of sustained material improvement under ordinary conditions of life, not merely a change in rating criteria or medical theory. That standard is reinforced by VA’s stabilization rules for long-standing ratings and by the protection afforded to service connection itself after ten years. 

As a practical matter, veterans with permanent and total status are far less likely to see disruption solely because VA rewrites diagnostic criteria, but the designation does not prevent VA from examining a condition if the veteran files a new claim, seeks an increase, or introduces evidence that places current severity back at issue.

None of those rules guarantees that a veteran who seeks an increased rating or files a new, related claim will be evaluated under legacy assumptions. The sleep apnea proposal, in particular, leaves unresolved how VA would apply the new criteria to veterans who already hold service-connected ratings but later reenter the system for reevaluation. 

When pressed on that point, VA declined to offer specifics and instead directed attention back to the notice, where the policy rationale is explicit, and the operational details remain largely unstated.