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2026 Title 38 Pay Scale

What the Title 38 schedules actually contain, and why a single national VA nurse table does not exist.

Title 38 is not one pay scale. It is a hiring authority covering several different pay systems, and for the largest group of employees under it — nurses — there is deliberately no national table at all. Rates are set facility by facility against the local labour market, which is why the same registered nurse position pays $54,453 at one VA medical centre and $153,887 at another.

Three systems, not one scale

Most confusion about “the Title 38 pay scale” comes from treating three different things as one.

Comparison of pure Title 38, hybrid Title 38 and Title 5 employment at the Department of Veterans Affairs
 Pure Title 38Hybrid Title 38Title 5
Authority38 U.S.C. 7401(1)38 U.S.C. 7401(3)Title 5
Paid onTitle 38 schedulesGeneral Schedule, with GS locality payGeneral Schedule
Example occupationsPhysicians, dentists, nurses, physician assistants, chiropractorsPharmacists, psychologists, social workers, medical technologistsAdministrative, clerical, IT, logistics
Adverse actions and grievancesVA Disciplinary Appeals BoardTitle 5 procedures (38 U.S.C. 7403(f)(3))Title 5 procedures

The row worth reading twice is the last one. Hybrid Title 38 employees are hired under Title 38 authority but their adverse actions, reductions in force, veterans preference, part-time rights, discipline and grievances all run under Title 5. The Disciplinary Appeals Board bypass belongs to pure Title 38 only. Published guidance frequently states this backwards.

Why there is no national nurse pay table

Under 38 U.S.C. 7451(d)(2), the director of each VA medical centre sets the minimum rate of each nurse grade so that it is consistent with the starting pay of comparable health-care professionals in that facility’s local labour market. Where Bureau of Labor Statistics industry wage data exists, the director must use it; where it does not, the director runs a survey.

The result is 151 stations publishing 2,325 distinct salary plans. Holding the position completely constant — Registered Nurse-0610, Grade 1, Nurse Level 2, Step 1 — 2026 rates across 420 facilities in the 50 states and D.C. look like this:

Range of 2026 VA registered nurse pay for an identical position across facilities
MeasureAnnual rateFacility
Lowest$54,453stn 589COLMO, Marshfield MO
Median$75,766—
Highest$153,887stn 662, Alameda CA

That is a 183 percent spread for the same job title, grade, level and step. Any page quoting one number as “VA nurse pay” is quoting a facility, not a system.

Two further details matter if you are comparing offers. 7,962 schedules use 12 steps, but 557 use more — up to 26 — because 7451(c)(1) lets a grade’s range run to 133 percent of its minimum, or 175 percent with written justification to Congress. And roughly one in five nurse schedules was adjusted after January in 2026, because a director must act within 30 days of a new BLS survey landing.

The national Title 38 schedules that do exist

Executive Order 14368 of 18 December 2025 sets these ranges, effective January 11, 2026, incorporating a 1 percent increase.

Office of the Under Secretary for Health (38 U.S.C. 7306) and Directors of Medical Centers and Directors of Veterans Integrated Service Networks (38 U.S.C. 7401(4))
Office of the Under Secretary for Health (38 U.S.C. 7306) and Directors of Medical Centers and Directors of Veterans Integrated Service Networks (38 U.S.C. 7401(4))MinimumMaximum
Range$151,661$228,000
Physician, Podiatrist, Optometrist, and Dentist Base and Longevity Pay Schedule
Physician, Podiatrist, Optometrist, and Dentist Base and Longevity Pay ScheduleMinimumMaximum
Physician Grade$124,308$182,324
Podiatrist Grade$124,308$182,324
Optometrist Grade$124,308$182,324
Dentist Grade$124,308$182,324
Clinical Chiropractor Schedule
Clinical Chiropractor ScheduleMinimumMaximum
Chief Grade$126,384$164,301
Senior Grade$107,446$139,684
Intermediate Grade$90,925$118,204
Full Grade$76,463$99,404
Associate Grade$63,795$82,938
Expanded-Function Dental Auxiliary Schedule
Expanded-Function Dental Auxiliary ScheduleMinimumMaximum
Director Grade$126,384$164,301
Assistant Director Grade$107,446$139,684
Chief Grade$90,925$118,204
Senior Grade$76,463$99,404
Intermediate Grade$63,795$82,938
Full Grade$52,727$68,549
Associate Grade$45,373$58,981
Junior Grade$38,791$50,428

Note what is absent: nurses. The nurse schedule in 38 U.S.C. 7404(b) defines five grades, Nurse I through Nurse V, but the dollar amounts attached to them are set locally rather than by executive order. The Nurse I levels 1, 2 and 3 that appear on facility schedules come from VA’s qualification standard and Handbook 5007, not from statute.

Physician and dentist pay

Physicians, podiatrists and dentists are paid under 38 U.S.C. 7431 in three components. Base pay is the longevity ladder above, driven purely by total VHA service in two-year bands. Market pay is set individually by a compensation panel for speciality and local market. Performance pay is capped at the lower of $15,000 or 7.5 percent of base plus market pay — a two-part test where most published summaries mention only the dollar figure. Total compensation under the section is capped at $400,000.

One 2026 change to watch: optometrists moved off the chiropractor schedule onto physician-and-dentist market pay in 2025, so guidance describing the old arrangement is now wrong.

Sources

6 of 6 references are official U.S. government publications. Pay tables and hiring rules change — each link shows when we last verified it.

  1. [1]Executive Order 14368 of December 18, 2025, 90 FR 60521 — Schedule 3, Title 38 pay schedules — U.S. Government Publishing Office. Verified .
  2. [2]38 U.S.C. § 7451 — Nurses and other health-care personnel: competitive pay — United States Code, U.S. Government Publishing Office. Verified .
  3. [3]38 U.S.C. § 7431 — Pay for physicians, podiatrists, and dentists — United States Code, U.S. Government Publishing Office. Verified .
  4. [4]Title 38 and Hybrid Title 38 Occupations — U.S. Department of Veterans Affairs. Verified .
  5. [5]VA Handbook 5007, Pay Administration — U.S. Department of Veterans Affairs. Verified .
  6. [6]January 2026 pay adjustments memorandum — U.S. Office of Personnel Management. Verified .

Common questions

Is there a national Title 38 pay scale?
Partly. Executive Order 14368 sets national schedules for a handful of Title 38 groups: the Under Secretary for Health and medical centre directors, physicians and dentists on base and longevity pay, clinical chiropractors, and expanded-function dental auxiliaries. There is no national pay table for nurses. Under 38 U.S.C. 7451 the director of each VA medical centre sets nurse rates locally, so the answer for a nurse depends entirely on which facility employs them. Pages presenting a single "Title 38 nurse pay scale" are presenting something that does not exist.
Why does VA nurse pay vary so much between facilities?
Because the statute requires it to. 38 U.S.C. 7451(d)(2) directs each medical centre director to set the minimum rate of each nurse grade for consistency with what comparable health-care employers pay in that facility's local labour market, using Bureau of Labor Statistics survey data where it exists. The measured effect is large: holding schedule title, grade, level and step identical across 420 facilities in the 50 states and D.C., 2026 rates run from $54,453 to $153,887 — a 183 percent spread, with a median of $75,766.
What is the difference between Title 38, hybrid Title 38, and Title 5?
Pure Title 38 occupations, listed in 38 U.S.C. 7401(1), include physicians, dentists, podiatrists, optometrists, chiropractors, nurses, physician assistants and expanded-function dental auxiliaries. They are paid on Title 38 schedules and their discipline and appeals run through VA's own Disciplinary Appeals Board. Hybrid Title 38 occupations, under 7401(3), are appointed using Title 38 authority but paid on the General Schedule with normal GS locality pay. Crucially, 38 U.S.C. 7403(f)(3) sends adverse actions, reductions in force, veterans preference, part-time rights, disciplinary actions and grievances for hybrid staff to Title 5 procedures. The Disciplinary Appeals Board route belongs to pure Title 38 only, which is a distinction a lot of published guidance gets backwards.
How is VA physician pay calculated?
Three components under 38 U.S.C. 7431: base pay, market pay and performance pay. Base pay is a longevity ladder of 15 steps driven purely by total VHA service in two-year bands, running from $124,308 at step 1 to $182,324 at step 15 in 2026. Market pay is set for the individual by a compensation panel based on speciality and local market. Performance pay is capped at the lower of $15,000 or 7.5 percent of base plus market pay for that fiscal year — most sources quote only the $15,000 figure and omit the percentage test. Total compensation under the section is capped at $400,000, though the Secretary gained authority in 2025 to grant up to 300 waivers.
Are there caps on Title 38 nurse pay?
Yes, set by 38 U.S.C. 7451(c)(2)(A) against the Executive Schedule. In 2026 the ceiling is $253,100 for advanced practice nurses and physician assistants, $228,000 for registered nurses, and $197,200 for other covered positions. Separately, the maximum rate of any grade is 133 percent of that grade's minimum, which the Secretary may raise to at most 175 percent with written justification to the House and Senate Veterans' Affairs Committees.
Where can I find the 2026 Title 38 pay tables as a PDF?
The national Title 38 schedules are published in Schedule 3 of Executive Order 14368, printed in the Federal Register at 90 FR 60521 and available as a PDF from GovInfo. Facility-level nurse schedules are published separately by VA as Local Pay System files per medical centre, not as one national PDF. Note that survey data underlying local nurse rates is exempt from Freedom of Information Act disclosure under 38 U.S.C. 7451(d)(5), so the inputs to a facility's decision are not publicly retrievable even though the resulting rates are.
When do the 2026 Title 38 rates take effect?
On the first day of the first applicable pay period beginning on or after 1 January 2026, which is January 11, 2026. The increase is 1 percent. Facility nurse schedules are a separate matter: a director may adjust rates whenever a new BLS survey lands, and roughly one in five nurse schedules moved after January in 2026, with effective dates running into August. A static annual table goes stale within months.