§4.130 Schedule Of Ratings-mental Disorders.

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§4.130 Schedule of ratings-mental disorders.

The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. The schedule for rating for mental disorders is set forth as follows:

Rating

SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

9201 Schizophrenia, disorganized type

9202 Schizophrenia, catatonic type

9203 Schizophrenia, paranoid type

9204 Schizophrenia, undifferentiated type

9205 Schizophrenia, residual type; other and unspecified types

9208 Delusional disorder

9210 Psychotic disorder, not otherwise specified (atypical psychosis)

9211 Schizoaffective disorder

DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS

9300 Delirium

9301 Dementia due to infection (HIV infection, syphilis, or other systemic or

intracranial infections)

9304 Dementia due to head trauma

9305 Vascular dementia

9310 Dementia of unknown etiology

9312 Dementia of the Alzheimer’s type

9326 Dementia due to other neurologic or general medical conditions (endocrine

disorders, metabolic disorders, Pick’s disease, brain tumors, etc.) or that are

substance-induced (drugs, alcohol, poisons)

9327 Organic mental disorder, other (including personality change due to a general

medical condition)

ANXIETY DISORDERS

9400 Generalized anxiety disorder

9403 Specific (simple) phobia; social phobia

9404 Obsessive compulsive disorder

9410 Other and unspecified neurosis

9411 Post-traumatic stress disorder

9412 Panic disorder and/or agoraphobia

9413 Anxiety disorder, not otherwise specified

DISSOCIATIVE DISORDERS

9416 Dissociative amnesia; dissociative fugue; dissociative identity disorder (multiple

personality disorder)

9417 Depersonalization disorder

SOMATOFORM DISORDERS

9421 Somatization disorder

9422 Pain disorder

9423 Undifferentiated somatoform disorder

9424 Conversion disorder

9425 Hypochondriasis

MOOD DISORDERS

9431 Cyclothymic disorder

9432 Bipolar disorder

9433 Dysthymic disorder

9434 Major depressive disorder

9435 Mood disorder, not otherwise specified

CHRONIC ADJUSTMENT DISORDER

9440 Chronic adjustment disorder

General Rating Formula for Mental Disorders:

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 100

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 70

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 50

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) 30

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 10

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 0

EATING DISORDERS

9520 Anorexia nervosa

9521 Bulimia nervosa

Rating Formula for Eating Disorders:

Self-induced weight loss to less than 80 percent of expected minimum

weight, with incapacitating episodes of at least six weeks total duration

per year, and requiring hospitalization more than twice a year for

parenteral nutrition or tube feeding 100

Self-induced weight loss to less than 85 percent of expected minimum

weight with incapacitating episodes of six or more weeks total

duration per year 60

Self-induced weight loss to less than 85 percent of expected minimum

weight with incapacitating episodes of more than two but less than

six weeks total duration per year 30

Binge eating followed by self-induced vomiting or other measures to

prevent weight gain, or resistance to weight gain even when below

expected minimum weight, with diagnosis of an eating disorder and

incapacitating episodes of up to two weeks total duration per year 10

Binge eating followed by self-induced vomiting or other measures to

prevent weight gain, or resistance to weight gain even when below

expected minimum weight, with diagnosis of an eating disorder

but without incapacitating episodes 0

Note: An incapacitating episode is a period during which bed rest and treatment by a physician are required. (Authority: 38 U.S.C. 1155)

[53 FR 23, Jan. 4, 1988; 53 FR 1441, Jan. 19, 1988. Redesignated and amended at 61 FR 52700, Oct. 8, 1996]

Supplement Highlights reference: 19(1)

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http://www.warms.vba.va.gov/regs/38CFR/BOO...ART4/S4_130.DOC