Essential Tremor VA Rating

Essential tremor is one of the conditions VA's rating schedule never names. The neurological schedule lists convulsive tics, myoclonus, two kinds of chorea and athetosis, but not essential tremor. VA therefore uses the analogous-rating rule. The selected code and its severity criteria must fit the disability shown by your records; the highest percentage available under another movement disorder code is not automatically available for essential tremor.

This page covers the movement disorder codes word for word (DCs 8103 to 8107), how an analogous rating for essential tremor works, the presumptive and secondary routes to service connection, the exam, and why VA denies these claims. Parkinson's disease and restless legs syndrome have their own pages, Parkinson's disease and restless legs syndrome. The Board section further down shows how movement disorder appeals have ended.

Essential tremor VA rating criteria

Several movement disorder codes sit in the "Miscellaneous Diseases" part of 38 CFR § 4.124a, the neurological schedule. Here they are word for word:

The note to DC 8103 says the level depends "upon frequency, severity, muscle groups involved." The note to DC 8105 says "Consider rheumatic etiology and complications."

The neurological schedule also opens with a general rule (the bracketed note at the top of § 4.124a) that applies to tremors by name:

With the exceptions noted, disability from the following diseases and their residuals may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function. Consider especially psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, etc., referring to the appropriate bodily system of the schedule. With partial loss of use of one or more extremities from neurological lesions, rate by comparison with the mild, moderate, severe, or complete paralysis of peripheral nerves.

38 CFR § 4.120 repeats the point: disability in this field "is ordinarily to be rated in proportion to the impairment of motor, sensory or mental function," and it lists tremors again. For a tremor that takes away part of the use of an arm or hand, the last sentence of the general rule points the rater to the peripheral nerve codes, which grade each limb as mild, moderate, severe or complete paralysis.

How VA rates essential tremor by analogy

38 CFR § 4.20 is the rule for any condition the schedule does not list:

When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings.

The schedule does not say which code fits essential tremor best. These examples illustrate different ways the schedule describes neurological impairment; they do not establish which analogy fits your case:

Your rating decision tells you which one VA used. Under 38 CFR § 4.27, an unlisted condition gets a built-up code whose last two digits are "99." Where the decision uses a hyphenated code, read both the unlisted-condition identifier and the listed code used to evaluate it. Ask VA to explain the comparison.

If the borrowed code does not capture what the tremor does to you, that is the argument to make. Describe each affected function and ask whether the decision accounts for it. Section 4.20 requires similarity in function, location and symptoms, not selection of a code because it has a higher ceiling. Within whichever code VA uses, 38 CFR § 4.7 says the higher of two levels applies when your disability "more nearly approximates the criteria required for that rating."

One limit runs the other way. In Copeland v. McDonald, 27 Vet. App. 333 (2015), the Court of Appeals for Veterans Claims held that a condition listed in the schedule may not be rated by analogy. If a neurologist later diagnoses Parkinson's disease (paralysis agitans, DC 8004, minimum rating 30 percent) or Huntington's chorea, VA has to use that listed code.

Can essential tremor be rated 100 percent?

There is no dedicated essential tremor code with an automatic 100 percent level. DC 8103 ends at 30 percent, while the chorea scale includes 100 percent. That does not establish that the chorea scale is an appropriate analogy for a particular tremor. VA must explain the code selection under § 4.20 and the severity under the selected criteria.

If service-connected conditions prevent substantially gainful employment, you may qualify for TDIU, which pays at the 100 percent rate. Separate manifestations may support separate evaluations only when the governing criteria permit it and the same manifestation is not counted twice under § 4.14.

How much VA pays for essential tremor

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, $1,435.02 at 60 percent, $2,102.15 at 80 percent and $3,938.58 at 100 percent. Which of those levels is available depends on the code VA borrows. When you have other ratings, VA combines them rather than adding them; the combined rating calculator shows the result.

How to prove essential tremor is service connected

A tremor that began in service

A neurology review describes essential tremor as "a chronic, progressive syndrome that primarily presents with an action tremor involving the arms and hands," with symptoms that can extend to gait, speech, cognition and mood (Wagle Shukla, 2022). The same review says diagnosis requires a bilateral action tremor for three years, and that dystonic tremor, Parkinson's tremor, physiologic tremor and drug-induced tremor are the common look-alikes.

That three-year requirement matters for veterans. Shaking hands noted at sick call, or a profile for a tremor in service, may never have been called essential tremor at the time. Those records are still evidence of when the condition started, and statements from people who saw the tremor in service help fill the gaps. The buddy letter tool walks you through one.

When a chronic-disease presumption may apply

Section 3.309(a) lists organic diseases of the nervous system among chronic diseases. Section 3.307 generally requires qualifying service of at least 90 days during a war period or after December 31, 1946, and manifestation to a compensable degree within one year for this route. Ask whether the diagnosed neurological disease qualifies; shaking alone does not establish a listed chronic disease.

Section 3.307(c) does not require a diagnosis during the presumptive period, but it does require characteristic manifestations to the required degree, followed without unreasonable delay by a definite diagnosis. Preserve early medical records and observations. If no diagnosis explains neurological symptoms, the separate Gulf War illness rules may also need review under § 3.317.

Secondary to PTSD, medication or a head injury

Under 38 CFR § 3.310, a tremor caused or aggravated by a service-connected condition is service connected too.

Medication. A 2022 review lists the drugs most often tied to tremor: amiodarone, SSRI and SNRI antidepressants, amitriptyline, lithium, valproate, beta-agonists and dopamine-blocking drugs, among others. Drug-induced tremor usually looks like essential or parkinsonian tremor and usually resolves when the drug is stopped, though it can persist in some cases (Baizabal-Carvallo and Morgan, 2022). If you take one of these drugs for a service-connected condition, the tremor can be claimed as secondary to that condition.

PTSD and stress. VA researchers searched the records of 5,854,223 veterans and found that PTSD, anxiety and depression were the most common psychiatric diagnoses among patients with essential tremor, with the odds more than doubled in every 15-year age group (Handforth and Parker, 2018). The authors proposed that chronic stress may in some cases bring on essential tremor. That is a hypothesis rather than proof that PTSD caused a particular tremor. A medical opinion must address your own history and other possible explanations. See PTSD.

Head injury. VA rates the physical effects of a traumatic brain injury under the TBI code (DC 8045), which lists "Motor and sensory dysfunction, including pain, of the extremities and face" and "gait, coordination, and balance problems" among the physical effects to rate under an appropriate diagnostic code. A tremor that follows a TBI belongs in that claim; see TBI. Parkinsonism after a moderate or severe TBI is presumed secondary under 38 CFR § 3.310(d), which the Parkinson's page covers.

A secondary opinion should address aggravation as well as cause: the tremor 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).

The C&P exam and the Central Nervous System DBQ

VA examines essential tremor with the Central Nervous System DBQ, formally the Central Nervous System and Neuromuscular Diseases questionnaire. It has a diagnosis line for movement disorders and sections for the neurologic exam, assistive devices, the remaining function of each arm and leg, and how the condition affects work. Before the exam:

• Bring the neurologist's diagnosis. Ask for a note that names essential tremor and says why Parkinson's, dystonic and drug-induced tremor were ruled out. § 4.20 does not allow analogous ratings "for conditions of doubtful diagnosis."
• Describe what the tremor stops you doing. Writing, eating, drinking from a cup, buttoning, using tools, typing. Include typical days and worse periods so the record describes the course of the condition.
• Mention every part of the body involved. Hands, head, voice, legs, balance. Each one matters to the analogy and to separate ratings.
• List your medications with start dates. If the tremor started or got worse after a drug for a service-connected condition, say so.
• Show a bad day. A short phone video of the tremor at its worst shows what the exam room may not.

Raven Scan can help you review your uploaded medical records as you prepare for the exam.

Why VA denies essential tremor claims

The Board section below shows what the Board found missing in denied movement disorder appeals and why it sent others back. These are the patterns behind those numbers.

No link to service. The most common gap in denied movement disorder appeals is the medical link. Doctors ask about family history when they diagnose essential tremor (Wagle Shukla, 2022), so an examiner may point to a parent's tremor and stop there. A favorable opinion has to deal with when your tremor started, what you were treated with in service, and any applicable chronic-disease presumption.

No current diagnosis. "Tremor" alone is a symptom. The diagnosis and supporting clinical findings help VA distinguish the possible causes and select a supported rating analogy.

No in-service or first-year evidence. Under 38 CFR § 3.307(b), lay evidence counts if it describes "the material and relevant facts as to the veteran's disability observed within such period, not merely conclusions based upon opinion." Write down when you first noticed the shaking and who else saw it.

The wrong code. If the decision does not explain how the selected code accounts for your documented impairment, ask for that reasoning and identify the relevant clinical findings.

An inadequate exam. An inadequate VA exam is the most common reason the Board sends movement disorder claims back; the remand reasons below show how often.

Questions veterans ask about essential tremor

What is the VA rating for essential tremor?

Essential tremor has no code of its own, so VA rates it by analogy under 38 CFR § 4.20. The convulsive tic code (DC 8103) gives 0, 10 or 30 percent, the chorea scale gives 10 to 100 percent, and partial loss of use of a limb can be rated by comparison with nerve paralysis. Your decision shows a code ending in 99 with the borrowed code after a hyphen.

Can essential tremor be rated 100 percent?

There is no automatic 100 percent level for essential tremor. Any analogous evaluation requires a supported code choice and severity findings. TDIU may pay at the 100 percent rate when its requirements are met.

Is essential tremor a presumptive condition?

Essential tremor is not named in § 3.309. A chronic-disease theory requires a qualifying diagnosis and all applicable service, timing and severity requirements of §§ 3.307 and 3.309. A symptom of tremor alone does not establish those requirements.

Can a tremor be secondary to PTSD?

Yes, with a medical opinion. A tremor caused by a medicine for service-connected PTSD can support a secondary claim. Research has also found an association between PTSD and essential tremor, but that does not establish causation in an individual case. The opinion should address both causation and aggravation.

Is essential tremor rated the same as Parkinson's disease?

No. Parkinson's disease has its own code, DC 8004, with a minimum rating of 30 percent, and its own page. Because it is listed, VA cannot rate Parkinson's by analogy to another code.

Can a tremor after a head injury be rated?

Yes. The TBI code tells VA to rate motor problems of the arms and legs and coordination and balance problems from a TBI under an appropriate code, separately from the TBI's thinking and memory effects, as long as the same symptom is not counted twice.

Sources

• 38 CFR § 4.124a, neurological conditions, DCs 8103 to 8107 and DC 8045 (opens in a new tab), eCFR current through October 5, 2026
• 38 CFR § 4.120, evaluations by comparison (opens in a new tab)
• 38 CFR § 4.20, analogous ratings (opens in a new tab)
• 38 CFR § 4.27, use of diagnostic code numbers (opens in a new tab)
• 38 CFR § 4.7, higher of two evaluations (opens in a new tab)
• 38 CFR § 4.14, avoiding pyramiding (opens in a new tab)
• 38 CFR § 3.307 and § 3.309(a), chronic disease presumption (opens in a new tab)
• 38 CFR § 3.310, secondary service connection (opens in a new tab)
• 38 CFR § 3.317, Persian Gulf veterans (opens in a new tab)
• Copeland v. McDonald, 27 Vet. App. 333 (2015); El-Amin v. Shinseki, 26 Vet. App. 136 (2013)
• Wagle Shukla A. Diagnosis and treatment of essential tremor. Continuum (Minneap Minn). 2022;28(5):1333-1349. doi:10.1212/CON.0000000000001181 (opens in a new tab)
• Baizabal-Carvallo JF, Morgan JC. Drug-induced tremor, clinical features, diagnostic approach and management. J Neurol Sci. 2022;435:120192. doi:10.1016/j.jns.2022.120192 (opens in a new tab)
• Handforth A, Parker GA. Conditions associated with essential tremor in veterans: a potential role for chronic stress. Tremor Other Hyperkinet Mov (N Y). 2018;8:517. doi:10.7916/D8VD8FF5 (opens in a new tab)
• VA disability compensation rates (opens in a new tab), effective December 1, 2025
• Central Nervous System DBQ guide
• El-Amin, court opinion (opens in a new tab)
• Copeland, court opinion (opens in a new tab)
• 38 CFR § 3.303, service connection (opens in a new tab)
• 38 CFR § 4.16, unemployability (opens in a new tab)