On this page
- Dementia VA rating criteria (38 CFR § 4.130)
- How the formula reads for memory loss and confusion
- Dementia and a TBI rating: one rating or two
- Competency, fiduciaries and aid and attendance
- How much VA pays for dementia
- How to prove dementia is service connected
- The C&P exam and the Mental Disorders DBQ
- Why VA denies dementia claims
- Questions veterans ask about dementia
- What is the VA rating for dementia?
- Is dementia a presumptive condition for veterans with a TBI?
- What if my TBI was mild or my dementia started more than 15 years later?
- Can dementia be secondary to PTSD?
- Can VA rate my TBI and my dementia separately?
- Will VA appoint a fiduciary if I am rated for dementia?
- Sources
Dementia has no rating table of its own. Alzheimer's disease, vascular dementia, dementia after a brain injury and the other neurocognitive disorders all sit in the mental disorders schedule, and all of them are rated with the same formula VA uses for PTSD and depression. The percentage turns on how much the condition limits your work and daily life, not on which type of dementia you have.
This page covers that formula, how VA handles dementia that overlaps with a traumatic brain injury rating, the rule that ties three types of dementia to a moderate or severe TBI, competency and aid and attendance, and why these claims are denied. Parkinson's disease has its own page. The Board section further down shows how dementia and neurocognitive disorder appeals have ended.
Dementia VA rating criteria (38 CFR § 4.130)
38 CFR § 4.130 lists the neurocognitive disorders by diagnostic code, using the names from DSM-5:
| Code | Schedule name |
|---|---|
| DC 9301 | Major or mild neurocognitive disorder due to HIV or other infections |
| DC 9304 | Major or mild neurocognitive disorder due to traumatic brain injury |
| DC 9305 | Major or mild vascular neurocognitive disorder |
| DC 9310 | Unspecified neurocognitive disorder |
| DC 9312 | Major or mild neurocognitive disorder due to Alzheimer's disease |
| DC 9326 | Major or mild neurocognitive disorder due to another medical condition or substance/medication-induced major or mild neurocognitive disorder |
The code does not change the percentage. Note 2 to § 4.130 says "Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders," and 38 CFR § 4.126(c) says neurocognitive disorders "shall be evaluated under the general rating formula for mental disorders." Ask the examiner to identify the neurocognitive diagnosis and appropriate code; do not select a code solely from the type named in the TBI presumption.
Here is the formula in full (eCFR current through October 5, 2026):
| Rating | General Rating Formula for Mental Disorders |
|---|---|
| 100% | "Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name." |
| 70% | "Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships." |
| 50% | "Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships." |
| 30% | "Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events)." |
| 10% | "Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication." |
| 0% | "A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication." |
How the formula reads for memory loss and confusion
Memory appears at several levels of the formula. These are examples of symptoms, not automatic ratings or clinical stages. The overall occupational and social impairment controls:
- 30 percent lists "mild memory loss (such as forgetting names, directions, recent events)."
- 50 percent lists "impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks)."
- 100 percent lists "memory loss for names of close relatives, own occupation, or own name," along with "disorientation to time or place" and "intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene)."
The 70 percent level adds "spatial disorientation" and "neglect of personal appearance and hygiene."
Two rules decide how the evidence is weighed. 38 CFR § 4.126(a) tells VA to rate "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." That means statements from your spouse, children or caregiver about a normal week count, not just the exam hour. And 38 CFR § 4.7 says that when the picture falls between two levels, VA assigns the higher one if the disability "more nearly approximates the criteria required for that rating."
Dementia and a TBI rating: one rating or two
If you already have a rating for a traumatic brain injury under DC 8045, know how it interacts with dementia. The TBI code rates cognitive impairment on its own table of facets, where the highest facet sets the rating: "0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent," and 100 percent if any facet is "total." It also sends emotional and behavioral problems to the mental disorders schedule, § 4.130, "when there is a diagnosis of a mental disorder."
When a neurocognitive disorder and the TBI cognitive rating describe the same problems, Note (1) to DC 8045 controls:
Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.
Physical problems from the same injury are a different matter. 38 CFR § 4.126(c) says "neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for neurocognitive disorders." Distinct headaches, seizures, balance problems or vision loss attributable to the injury may be evaluated separately when the manifestations can be separated and the applicable criteria are met.
If your decision folded dementia into a TBI rating, check that it says which set of criteria it used and why that set better captures your overall functioning. The TBI table has a 40 percent level the mental formula lacks, and the mental formula has 30 and 50 percent levels the TBI table lacks, so the choice can change the number.
Competency, fiduciaries and aid and attendance
A dementia rating can raise two other questions: whether you can manage your VA money, and whether you need another person's help.
Competency. Under 38 CFR § 3.353(a), "A mentally incompetent person is one who because of injury or disease lacks the mental capacity to contract or to manage his or her own affairs, including disbursement of funds without limitation." If VA proposes that finding, it must notify you and offer a hearing first, unless a court has already found you incompetent (§ 3.353(e)), and "such doubt will be resolved in favor of competency" when reasonable doubt arises (§ 3.353(d)). If VA does rate a veteran incompetent, it appoints or recommends a fiduciary to receive the payments (§ 3.353(b)(2)).
Aid and attendance. For qualifying impairment due to service-connected disability, 38 CFR § 3.350(b) provides special monthly compensation to a veteran "so helpless as to be in need of regular aid and attendance." The criteria in § 3.352(a) include "incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment," and the evidence must show the veteran is so helpless as to need regular aid and attendance, "not that there be a constant need." DC 8045 also tells raters to consider aid and attendance "for protection from hazards or dangers incident to the daily environment due to cognitive impairment." Wandering, leaving the stove on and being unable to manage medicines are the kind of facts to put in writing.
How much VA pays for dementia
At VA's rates effective December 1, 2025, a veteran alone receives $180.42 a month at 10 percent, $552.47 at 30 percent, $1,132.90 at 50 percent, $1,808.45 at 70 percent and $3,938.58 at 100 percent. Special monthly compensation for aid and attendance is paid at its own rate under 38 U.S.C. 1114(l), listed in VA's special monthly compensation tables. When you have other ratings, VA combines them rather than adding them; the combined rating calculator shows the result. A veteran who cannot work because of dementia may also qualify for TDIU, which pays at the 100 percent rate.
How to prove dementia is service connected
Dementia after a moderate or severe TBI
38 CFR § 3.310(d)(1) says that "In a veteran who has a service-connected traumatic brain injury, the following shall be held to be the proximate result of the service-connected traumatic brain injury (TBI), in the absence of clear evidence to the contrary." The third item on that list reads:
(iii) Dementias of the following types: presenile dementia of the Alzheimer type, frontotemporal dementia, and dementia with Lewy bodies, if manifest within 15 years following moderate or severe TBI;
That gives four things to show: a service-connected TBI, a TBI that was moderate or severe, one of the three named types of dementia, and signs of it within 15 years of the injury. If all four are present, VA cannot deny the link without clear evidence against it. The same paragraph covers parkinsonism, including Parkinson's disease, following a moderate or severe TBI, with no time limit.
When VA wrote this rule in 2013, it dropped the phrase "post-traumatic dementia" from the list because it is not a recognized ICD-9 diagnosis, and it said in the Federal Register that the change "is not intended to suggest that dementia noted by a physician as being 'post-traumatic' or otherwise related to a TBI would be outside the scope of this rule."
Severity is judged at the time of injury, not now. 38 CFR § 3.310(d)(3) sets out the levels in a table, shown here in plain words:
| Factor | Mild | Moderate | Severe |
|---|---|---|---|
| Structural imaging of the brain | Normal | Normal or abnormal | Normal or abnormal |
| Loss of consciousness (LOC) | 0 to 30 minutes | More than 30 minutes and less than 24 hours | More than 24 hours |
| Alteration of consciousness (AOC) | A moment up to 24 hours | More than 24 hours, severity based on other criteria | More than 24 hours, severity based on other criteria |
| Post-traumatic amnesia (PTA) | 0 to 1 day | More than 1 and less than 7 days | More than 7 days |
| Glasgow Coma Scale (GCS) | 13 to 15 | 9 to 12 | 3 to 8 |
The rule adds that "VA will not require that the TBI meet all the criteria listed under a certain severity level in order to classify the TBI at that severity level," and that a TBI meeting criteria in more than one category is ranked "at the highest level in which a criterion is met, except where the qualifying criterion is the same at both levels." One finding, such as more than 30 minutes of unconsciousness or more than a day of amnesia, can make a TBI moderate. Medics' notes, aid station records, award citations and statements from people who were there are where those details live.
A mild TBI, or dementia after 15 years
Missing the severity level or the 15-year window does not end the claim. Under § 3.310(d)(2), "VA will develop and decide the claim under generally applicable principles of service connection without regard to paragraph (d)(1)." That means a medical opinion linking your dementia to the TBI.
When VA wrote the rule, it left mild TBI out of the dementia presumption because the Institute of Medicine review it relied on found only "limited/suggestive evidence" of a link between mild TBI and dementia of the Alzheimer type, and only for mild TBI with loss of consciousness. Later research has examined this association in veterans. A study of 178,779 veterans diagnosed with TBI in VA care from 2001 to 2014, compared with the same number of matched veterans without TBI, found dementia in 6.1 percent of those with TBI and 2.6 percent of those without. After adjusting for other conditions, even mild TBI without loss of consciousness was linked with more than twice the risk of dementia (hazard ratio 2.36), and moderate to severe TBI with 3.77 times the risk (Barnes and colleagues, 2018). In a study of post-9/11 veterans, a history of TBI was linked with about three times the odds of early-onset Alzheimer's disease or frontotemporal dementia (odds ratio 3.05), and the odds rose after more severe TBIs (Kennedy and colleagues, 2022). These are observational associations, not proof that a particular injury caused dementia. An opinion should explain how the evidence applies to your history.
If your TBI is not yet service connected, claim it at the same time. The TBI page covers how.
Secondary to PTSD or another service-connected condition
Under 38 CFR § 3.310(a) and (b), a condition caused or aggravated by a service-connected condition is service connected too. The medical opinion must explain how the claimed relationship applies to your history.
The research on PTSD discussed here is specific to veterans. Among 181,093 veterans aged 55 or older in VA care, those with PTSD developed dementia at a rate of 10.6 percent over seven years, against 6.6 percent without PTSD. After adjustment, PTSD was linked with 1.77 times the risk, and results were similar when veterans with head injury, substance abuse or depression were left out (Yaffe and colleagues, 2010). This association does not establish that PTSD caused dementia in an individual veteran.
The opinion should cover aggravation as well as cause: the dementia is aggravated by the veteran's service-connected PTSD, meaning it would be less severe but for the PTSD. When aggravation is at issue, an opinion addressing only cause can be inadequate under El-Amin v. Shinseki, 26 Vet. App. 136 (2013). For an aggravation claim, § 3.310(b) asks for medical evidence of how severe the dementia was before the aggravation began, or the earliest evidence after it began, so early memory testing and notes matter.
Dementia that began in or after service
Under 38 CFR § 3.303(d), "Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service." A direct claim needs a current diagnosis, an in-service event such as a head injury, an infection or a toxic exposure, and a medical opinion linking them.
When a veteran with dementia has died
Survivors can claim Dependency and Indemnity Compensation when a service-connected condition caused or contributed to the death. Under 38 CFR § 3.312(a), a service-connected disability counts when it "was either the principal or a contributory cause of death." If dementia was service connected, or should have been, the death certificate and final medical records are the starting point.
The C&P exam and the Mental Disorders DBQ
VA examines neurocognitive disorders with the Mental Disorders DBQ. The examiner records the diagnosis, symptoms and the level of occupational and social impairment. Before the exam:
- Get the type of dementia named. The § 3.310(d) presumption covers three specific types, so a diagnosis that says only "memory loss" or "cognitive decline" is not enough. Neuropsychological testing and brain imaging reports help.
- Bring statements from the people who see you every day. Under § 4.126(a), VA weighs all the evidence, not just the exam hour. Family can describe getting lost, missed medicines, unpaid bills and help with bathing. The buddy letter tool helps them write it.
- Bring the injury record. For a TBI claim, gather anything showing loss of consciousness, confusion, amnesia or a Glasgow Coma Scale score at the time of injury.
- Plan for a reliable history. Ask the exam provider about bringing a support person, and submit their written observations so the record includes details you may not remember.
Raven Scan can help you review your uploaded medical records as you prepare for the exam.
Why VA denies dementia claims
The Board section below shows what the Board found missing in denied dementia and neurocognitive disorder appeals and why it sent others back. These are the patterns behind those numbers.
No current diagnosis. The most common failure is the diagnosis. Memory complaints without a diagnosed neurocognitive disorder, or a diagnosis that does not follow DSM-5 (38 CFR § 4.125(a)), leave VA without a current disability. Under McClain v. Nicholson, 21 Vet. App. 319 (2007), a diagnosis made at any time while the claim was pending meets the requirement.
No link to service. An examiner may call dementia a disease of aging and stop there. A favorable opinion has to engage with your TBI, PTSD or other service-connected condition and the research above.
No in-service event. If your head injury in training or combat was never charted, statements from you and from people who served with you about the blast, fall or crash, and what you were like afterward, are evidence of what happened.
The wrong TBI severity. A decision that calls a TBI mild because you function well now applies the wrong test. Severity is judged at the time of injury, and one qualifying finding is enough.
No exam, or an inadequate one. An inadequate VA exam is the most common reason the Board sends these claims back, and a missing exam is another frequent one; the remand reasons below show how often.
Questions veterans ask about dementia
What is the VA rating for dementia?
Dementia is rated 0, 10, 30, 50, 70 or 100 percent under the General Rating Formula for Mental Disorders, based on how much it impairs work and social functioning. The 100 percent level includes disorientation to time or place, memory loss for close relatives' names, and intermittent inability to handle daily self-care.
Is dementia a presumptive condition for veterans with a TBI?
For three types, yes. Under 38 CFR § 3.310(d), presenile dementia of the Alzheimer type, frontotemporal dementia and dementia with Lewy bodies are held to be caused by a service-connected moderate or severe TBI if they appear within 15 years, unless there is clear evidence to the contrary. Dementia is not named on VA's other presumptive lists in § 3.309.
What if my TBI was mild or my dementia started more than 15 years later?
VA must still decide the claim under the general rules of service connection, under § 3.310(d)(2). You need a medical opinion linking the dementia to the TBI. Research in veterans has linked even mild TBI without loss of consciousness to more than twice the risk of dementia.
Can dementia be secondary to PTSD?
Yes, if a medical opinion shows the PTSD caused the dementia or made it worse. A large VA study found veterans with PTSD had 1.77 times the risk of dementia after adjustment. The opinion should address both cause and aggravation.
Can VA rate my TBI and my dementia separately?
Only for symptoms that can be clearly separated. If the cognitive problems overlap, Note (1) to DC 8045 calls for one rating under whichever criteria better assess your overall functioning. Distinct physical manifestations from the same injury may be separately evaluated when the applicable criteria are met.
Will VA appoint a fiduciary if I am rated for dementia?
Not automatically. A fiduciary follows a separate finding that you cannot manage your own affairs, VA generally must provide notice and a chance for a hearing, with the court-declaration exception in § 3.353(e), and reasonable doubt is resolved in favor of competency under 38 CFR § 3.353.
Sources
- 38 CFR § 4.130, mental disorders and the General Rating Formula (opens in a new tab), eCFR current through October 5, 2026
- 38 CFR § 4.125 and § 4.126, diagnosis and evaluation of mental disorders (opens in a new tab)
- 38 CFR § 4.124a, DC 8045, residuals of traumatic brain injury (opens in a new tab)
- 38 CFR § 4.7, higher of two evaluations (opens in a new tab)
- 38 CFR § 3.310, secondary service connection and the TBI rule (opens in a new tab)
- VA final rule, Secondary Service Connection for Diagnosable Illnesses Associated With Traumatic Brain Injury, 78 FR 76196 (opens in a new tab), December 17, 2013, effective January 16, 2014
- 38 CFR § 3.303, principles of service connection (opens in a new tab)
- 38 CFR § 3.309, presumptive diseases (opens in a new tab)
- 38 CFR § 3.312, cause of death (opens in a new tab)
- 38 CFR § 3.350 and § 3.352, special monthly compensation and aid and attendance (opens in a new tab)
- 38 CFR § 3.353, competency (opens in a new tab)
- McClain v. Nicholson, 21 Vet. App. 319 (2007); El-Amin v. Shinseki, 26 Vet. App. 136 (2013)
- Barnes DE, Byers AL, Gardner RC, Seal KH, Boscardin WJ, Yaffe K. Association of mild traumatic brain injury with and without loss of consciousness with dementia in US military veterans. JAMA Neurol. 2018;75(9):1055-1061. doi:10.1001/jamaneurol.2018.0815 (opens in a new tab)
- Kennedy E, Panahi S, Stewart IJ, and colleagues. Traumatic brain injury and early onset dementia in post 9-11 veterans. Brain Inj. 2022;36(5):620-627. doi:10.1080/02699052.2022.2033846 (opens in a new tab)
- Yaffe K, Vittinghoff E, Lindquist K, and colleagues. Posttraumatic stress disorder and risk of dementia among US veterans. Arch Gen Psychiatry. 2010;67(6):608-613. doi:10.1001/archgenpsychiatry.2010.61 (opens in a new tab)
- VA disability compensation rates (opens in a new tab), effective December 1, 2025
- Mental Disorders DBQ guide
- El-Amin, court opinion (opens in a new tab)
- McClain, court opinion (opens in a new tab)
- 38 CFR § 4.16, unemployability (opens in a new tab)