That work follows a chain, from the claims file to a cited chronology, from each condition to its diagnostic code, and from the code to the rating threshold, with supporting and contradictory evidence sorted along the way. This guide walks through each link for attorneys, claims agents, and VSO representatives, with a worked PTSD example showing a chronology where every entry is tied to the criterion it meets.
The Evidence Chain at a Glance
| Link | Question it answers | Where the rule lives |
|---|---|---|
| C-file | What evidence is already of record? | VA Form 20-10206; 38 CFR 1.600–1.603 |
| Cited chronology | What does the record say, in date order, and on which page? | 38 CFR 4.2, 4.6 |
| Diagnostic code | Which schedule entry governs the rating? | 38 CFR 4.14, 4.20, 4.27 |
| Rating threshold | Which level does the evidence most nearly approximate? | 38 CFR 4.7, 4.21 |
| Supporting and contradictory evidence | How is a conflict resolved? | 38 CFR 3.102, 4.126 |
Start With the C-File
The C-file holds everything submitted and developed for a veteran's claims: service treatment records, the DD 214, C&P exams, rating decisions and code sheets, VA and private treatment records, DBQs, and lay statements. A representative can request a copy on VA Form 20-10206 with a valid power of attorney of record, or apply for read-only VBMS access under 38 CFR 1.600–1.603.
Files for veterans with long treatment histories regularly run into the thousands of pages. Index these first, because every later step depends on them:
- Rating decisions and code sheets, with dates and assigned diagnostic codes
- C&P exams and DBQs
- Service treatment records showing in-service events or symptoms
- Intent to file forms, claims, and decision notices, which fix effective dates and review deadlines
- Any Automated Review Summary Document
What VA's Automation Has Already Pulled From the File
For a growing list of conditions, VA's Automated Decision Support tool reads the claims file before a rater does and produces an Automated Review Summary Document (ARSD). It orders diagnoses, symptoms, medications, and lab results by date, lists page numbers, and links to the rating criteria. It does not suggest an evaluation, and three limits matter:
- It covers only automation-eligible contentions. Under M21-1 IV.i.2.A, any other contention is listed in the ARSD's "Contentions Not Processed by ADS" table with the reason it was not automated.
- It lists what it could not read under "Relevant Documents Unavailable for Automated Review."
- It shapes the exam. Under M21-1 IV.i.2.A, automated exam requests point examiners to the ARSD to find relevant evidence, so an entry the ARSD misses may never reach the examiner.
Representatives with VBMS access can view it. They should check it: at an April 2026 House hearing, VBA reported issue-level accuracy over 94 percent but claim-based accuracy of 83.31 percent, meaning roughly one claim in six had at least one error. A representative's own cited chronology covers every condition claimed, including the documents automation skipped.
From Condition to Diagnostic Code
Every rated disability sits under a four-digit diagnostic code, grouped by body system from 5000 to 9999 (38 CFR 4.27). An unlisted condition is rated by analogy under 38 CFR 4.20, with a code ending in "99."
Two checks belong in every review. First, confirm the assigned code matches both the diagnosis and the evidence, since a condition coded under criteria the record cannot meet stays at a low rating however disabling it is. Second, watch for pyramiding: under 38 CFR 4.14, "the evaluation of the same disability under various diagnoses is to be avoided."
From Diagnostic Code to Rating Threshold
Three general rules govern how criteria are applied. The higher rating goes to the evidence that "more nearly approximates the criteria required for that rating" (38 CFR 4.7). Not every listed finding has to appear (38 CFR 4.21). And reports are read "in the light of the whole recorded history" (38 CFR 4.2).
Mental disorders, including PTSD at DC 9411, are rated under the General Rating Formula in 38 CFR 4.130. Most increase claims are decided across these three levels:
| Rating | Level of impairment (regulation text) | Example symptoms listed |
|---|---|---|
| 30% | "Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks" | depressed mood, anxiety, panic attacks (weekly or less often), chronic sleep impairment |
| 50% | "Occupational and social impairment with reduced reliability and productivity" | panic attacks more than once a week; difficulty in understanding complex commands; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships |
| 70% | "Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood" | suicidal ideation; near-continuous panic or depression; impaired impulse control; inability to establish and maintain effective relationships |
The symptom lists are examples. Under Mauerhan v. Principi, 16 Vet. App. 436 (2002), and Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), a rating does not require every listed symptom, but the symptoms must cause the level of impairment described. A chronology built for this formula records both for each entry: the symptom and its effect on work or social functioning.
This formula is still in force. VA proposed a five-domain replacement in February 2022 (87 FR 8498), but no final rule had been published as of September 2026.
Worked Example: PTSD at the 50 Percent Level
A veteran is rated 30 percent under DC 9411, and the representative is testing whether the record supports 50 percent.
Illustrative example. All records, dates, and page numbers are fictional.
| Date | Source (page) | Record entry | Criterion language matched | Level | Effect |
|---|---|---|---|---|---|
| 03/04/2025 | VA mental health note (p. 212) | "Reports panic attacks 3–4 times per week, most often at work." | "panic attacks more than once a week" | 50% | Supports |
| 03/04/2025 | VA mental health note (p. 213) | "Missed 6 shifts in the last two months. Supervisor issued a written warning." | "reduced reliability and productivity" | 50% | Supports |
| 05/19/2025 | Private therapist letter (p. 340) | "Has difficulty following multi-step instructions at work and relies on written lists." | "difficulty in understanding complex commands" | 50% | Supports |
| 06/10/2025 | VA primary care note (p. 377) | "Mood stable on sertraline. Sleeping 6–7 hours." | Symptoms "controlled by continuous medication" | 10% | Cuts against |
| 08/22/2025 | C&P examination, DBQ (p. 402) | Examiner selects "occasional decrease in work efficiency" | 30% impairment language | 30% | Cuts against |
| 09/15/2025 | Lay statement, spouse (p. 455) | "He stopped going to our kids' games. He says crowds set off his panic." | "difficulty in establishing and maintaining effective work and social relationships" | 50% | Supports |
On its own, the C&P exam supports 30 percent. Against the whole record, four entries from three sources describe the 50 percent picture, and 38 CFR 4.126(a) requires an evaluation "based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." The two unfavorable entries stay in the chronology so the representative can address them first: the primary care note says nothing about work, and the exam captured one day.
Handling Contradictory Evidence
- Reasonable doubt goes to the veteran, within limits. Under 38 CFR 3.102, doubt from "an approximate balance of positive and negative evidence" is resolved for the claimant, but the rule "is not a means of reconciling actual conflict or a contradiction in the evidence."
- Lay evidence counts for what a layperson can observe (38 CFR 3.159(a)). A spouse can describe withdrawal. A diagnosis needs a clinician.
- Inadequate exams go back. Under 38 CFR 4.2, a report without sufficient detail must be returned "as inadequate for evaluation purposes."
Medication is unsettled. VA amended 38 CFR 4.10 in February 2026 after Ingram v. Collins, 38 Vet. App. 130 (2025), then rescinded the change ten days later. Tag entries that describe medication effects so the point can be argued under whatever rule applies.
Evidence for Service Connection
On an original claim, the condition must be service connected before it is rated. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004), requires a present disability, an in-service incurrence or aggravation, and a causal link between them.
| Theory | Rule | What the chronology should tag |
|---|---|---|
| Direct | 38 CFR 3.303 | Current diagnosis; in-service event in STRs; medical opinion on the link |
| PTSD | 38 CFR 3.304(f) | DSM-5 diagnosis; medical link to a stressor; credible evidence the stressor occurred |
| Secondary | 38 CFR 3.310 | Service-connected primary condition; evidence the new condition is caused or aggravated by it, with a baseline for aggravation |
| Presumptive | 38 CFR 3.307, 3.309, PACT Act rules | Qualifying service; diagnosis of a listed condition |
Secondary claims are where file reviews most often find unclaimed value, such as a back condition from an altered gait or sleep problems alongside service-connected PTSD.
The Entries That Set the Effective Date
| Situation | Rule | Entry to surface |
|---|---|---|
| Claim within one year of separation | 3.400(b)(2)(i): day after separation | Separation date; evidence the condition existed at discharge |
| Claim for increase | 3.400(o)(2): earliest date the increase is "factually ascertainable," if the claim follows within one year | First entry in the prior year documenting the worsening |
| Intent to file | 3.155: claim dated to the intent to file if completed within one year | Intent-to-file and claim dates |
| Continuous pursuit | 3.2500(h): original date kept if each review is filed within one year | Every decision and filing date, in order |
The increase rule is most often missed. A treatment note documenting the worsening eight months before the claim can move the effective date back to that note.
Matching the Evidence to the Review Lane
| Lane | New evidence allowed? | What the chronology should highlight |
|---|---|---|
| Supplemental claim (3.2501) | Yes, if "new and relevant" | Entries added since the last decision; new theories |
| Higher-Level Review (3.2601) | No, record closed at the prior decision | Favorable entries the decision overlooked; code errors |
| Board, direct review (20.202) | No | Errors on the existing record |
| Board, evidence or hearing docket | Yes, within 90 days | New evidence tied to the criterion in dispute |
For a Higher-Level Review, a cited chronology of the file as it stood at decision is the core exhibit.
Rating Schedule Changes to Track (as of September 2026)
| Change | Status |
|---|---|
| Digestive system | Final, effective May 19, 2024 |
| Mental disorders, five-domain model | Proposed February 2022, not final |
| ENT and respiratory, including sleep apnea (DC 6847) | Proposed, not final; agenda target April 2027 |
| Impact of medication (38 CFR 4.10) | Issued and rescinded, February 2026 |
| Genitourinary cancers and leukemias/multiple myelomas (38 CFR 3.320a, 3.320b) | Interim final rules in effect since January 2025 |
Check the Federal Register before relying on any proposed change.
Where Superinsight Fits in the Chain
| Category | What it produces | Maps entries to diagnostic codes and rating criteria? |
|---|---|---|
| General medical chronology software | Date-ordered summary of medical events | No |
| VA medical evidence services | Nexus letters, DBQs, and medical opinions | Per condition, as an opinion |
| VA-native record analysis | Cited chronology tied to codes and criteria | Yes |
Superinsight works in the third group. It reads the full claims file and produces a chronology in which every entry quotes the record, links to its source page, and is tagged to the diagnostic code and rating level it supports. It flags missing records and treatment gaps, and makes worsening that postdates the last rating visible. One nonprofit veterans organization with 12,000 to 15,000 open cases replaced three RNs and two nurse practitioners after adopting it. See the veteran disability page for details.
Frequently Asked Questions
What medical evidence does VA need to rate a disability claim?
A current diagnosis, evidence of severity measured against the criteria for its diagnostic code, and, on an original claim, evidence linking it to service. The rating level turns on whether the specific findings in the criteria are documented.
What is a VA C-file, and how does an accredited representative get it?
It is VA's claims file for a veteran. Representatives can request it on VA Form 20-10206 with a power of attorney of record, or apply for read-only VBMS access.
What is a VA medical record review?
It can mean VA deciding a claim on the records already on file without an exam, or a representative's review of the C-file for evidence that supports or undermines the claim. Either way, the question is whether the record documents the criteria for the rating sought.
Are there keywords VA raters look for in medical records?
Raters look for evidence matching the rating criteria's language, such as "reduced reliability and productivity." That language only carries weight when it describes documented symptoms, and coached phrasing the rest of the record does not support tends to lower credibility.
Does medication lower a VA disability rating?
Some criteria address medication directly, such as the 10 percent mental health level. For others, the question is in litigation after VA issued and rescinded a February 2026 rule on it.
What happens when a C&P exam conflicts with the treatment records?
The rater must weigh all the evidence, and for mental disorders the evaluation cannot rest solely on the exam. A representative can cite the conflicting entries by page and, if the exam lacks detail, argue it is inadequate.
Does VA use AI or automation to review disability claims?
Yes, as decision support. For eligible conditions, VA's automation produces an Automated Review Summary Document indexing relevant evidence, and VA states that a trained employee decides every claim.
Is VA's proposed mental health rating change in effect?
No. As of September 2026, mental health conditions are still rated under the General Rating Formula in 38 CFR 4.130.
How long does it take Superinsight to review a C-file and build a chronology?
About an hour for a first pass on a full file, even at five or six thousand pages. Once the chronology exists, new records fold into it in minutes.
How do you verify an AI-built chronology of a C-file?
Check each entry against the page it cites. A reliable chronology quotes the record verbatim, links every entry to its source, and keeps contradictory evidence in view.
Does Superinsight tag chronology entries to VA diagnostic codes and rating criteria?
Yes. Each entry is tied to the condition, diagnostic code, and rating level it supports, with its source page.
Sources
- 38 CFR Part 4, Schedule for Rating Disabilities (eCFR)
- 38 CFR 4.130, General Rating Formula for Mental Disorders
- 38 CFR 3.102, Reasonable doubt
- 38 CFR 3.400, Effective dates (eCFR)
- Schedule for Rating Disabilities: Mental Disorders, proposed rule, 87 FR 8498
- Evaluative Rating: Impact of Medication, 91 FR 7118, and rescission, 91 FR 9712
- VBA Automated Decision Support VSO Toolkit, fact sheet (Dec. 2022)
- Nextgov, AI helping VA speed claims processing (April 2026)
- VA Form 20-10206
- VA decision reviews