Persistent Postural-Perceptual Dizziness (PPPD)

DC 6204Organs of Sense38 CFR 4.87, DC 6204

A chronic functional dizziness disorder that usually develops after a vestibular event such as an inner ear infection, concussion, or vestibular migraine. You feel unsteady, dizzy, or like the world is swaying, especially when standing, walking, or in visually busy environments. The VA rates PPPD under vestibular disorder criteria based on how often dizziness occurs and how much it affects your balance and daily life.

How the VA rates this condition

The VA rates this condition based on how often symptoms occur and how severe each episode is. The examiner will ask about the frequency, duration, and intensity of your episodes, as well as how they affect your ability to work.

Diagnostic code

DC 6204

Rating range

0% – 100%

Rating levels

Rating criteria are defined in 38 CFR 4.87, DC 6204. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

Your PPPD causes such severe chronic dizziness and balance impairment that you cannot care for yourself or maintain employment. You are at constant risk of falling and need assistance with daily activities.

What the VA looks for

Continuous severe dizziness and imbalance
Multiple documented falls
Inability to stand or walk safely without assistance
Complete occupational disability from vestibular symptoms
Home safety modifications required

Common Pitfalls

⚠Not getting a formal PPPD diagnosis from a neurologist or neuro-otologist — many providers are unfamiliar with this relatively new diagnosis (adopted by WHO in 2017), and it may be mischaracterized as anxiety or malingering.
⚠Not documenting the triggering vestibular event that started the PPPD — most cases begin after a specific event like a concussion, vestibular neuritis, or BPPV episode during service, and this establishes the service connection.
⚠Not keeping a dizziness diary with dates, duration, triggers, and functional impact — the rating depends on frequency and severity, and contemporaneous records are more persuasive than recollection at a C&P exam.
⚠Failing to claim PPPD as secondary to a service-connected TBI, tinnitus, or inner ear condition — PPPD commonly develops as a secondary condition and this connection should be clearly documented.
⚠Not requesting vestibular function testing (VNG/ENG, posturography) — objective test results strengthen the claim even though PPPD can exist with normal vestibular testing.

Related DBQ Forms

DBQ Ear Conditions

View evidence checklist →See secondary conditions →

Condition Rating Guides

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Persistent Postural-Perceptual Dizziness (PPPD)

How the VA rates this condition

Diagnostic code

DC 6204

Rating range

0% – 100%

Rating levels

Rating Levels

What the VA looks for

Continuous severe dizziness and imbalance
Multiple documented falls
Inability to stand or walk safely without assistance
Complete occupational disability from vestibular symptoms
Home safety modifications required

Common Pitfalls

⚠Not getting a formal PPPD diagnosis from a neurologist or neuro-otologist — many providers are unfamiliar with this relatively new diagnosis (adopted by WHO in 2017), and it may be mischaracterized as anxiety or malingering.

⚠Not documenting the triggering vestibular event that started the PPPD — most cases begin after a specific event like a concussion, vestibular neuritis, or BPPV episode during service, and this establishes the service connection.

⚠Not keeping a dizziness diary with dates, duration, triggers, and functional impact — the rating depends on frequency and severity, and contemporaneous records are more persuasive than recollection at a C&P exam.

⚠Failing to claim PPPD as secondary to a service-connected TBI, tinnitus, or inner ear condition — PPPD commonly develops as a secondary condition and this connection should be clearly documented.

⚠Not requesting vestibular function testing (VNG/ENG, posturography) — objective test results strengthen the claim even though PPPD can exist with normal vestibular testing.