9201 - Schizophrenia
DBQ: Link to Index of DBQ/Exams by Disability for DC 9201
Definition
Schizophrenia is a mental disorder that alters perception, inferential thinking, language and communication, affect, behavior, volition and drive, social functioning and attention. The disorder lasts for at least six months, and includes at least one month of active phase symptoms. Disorganized Schizophrenia is a type of schizophrenia characterized by thought disorder and bizarre behavior termed disorganized symptom cluster. The cluster includes disorganized speech, disorganized behavior, and flat or inappropriate affect.
Etiology
Generally, the specific cause is unknown; however, schizophrenia has a biologic base. The most widely accepted explanation is that schizophrenia is viewed as occurring in persons with (nervous system-based) vulnerabilities. This is referred to as a vulnerability-stress model. There may be a genetic predisposition. The onset, remission, and recurrence of symptoms are seen as products of interaction between identified vulnerabilities and environmental stressful events.
Signs & Symptoms
The essential features of the condition are speech that rambles and shifts from one topic to another, and speech that is non-goal-directed (disorganized speech). The behavior may include a lack of goal orientation, childlike silliness, agitation, and inappropriateness of appearance, hygiene or conduct (disorganized behavior). The patient's face may appear immobile and lack expressiveness. Symptoms of the condition typically impair the ability to function and, if severe, interfere with work, social relations, and self-care. Symptoms tend to develop an average of 12 to 24 months before the patient presents for medical care. No single symptom is indicative of schizophrenia; the diagnosis involves the recognition of a variety of signs and symptoms associated with impaired occupational or social functioning.
Tests
There are no definitive tests for schizophrenia. Diagnosis is based on an assessment of clinical history symptoms and signs. Laboratory tests may be performed to rule out medical, neurologic, and endocrine disorders appearing as psychosis, e.g., vitamin deficiencies, uremia, thyrotoxicosis, and electrolyte imbalance. All of the following are diagnostic criteria to be met for the condition:
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Disorganized speech
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Flat or inappropriate affect
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Disorganized behavior
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The criteria are not met for Catatonic type. (See Diagnostic Code: 9202 Schizophrenia, catatonic type)
Treatment
The major components of treatment include: continuous antipsychotic drug therapy; psychotherapy, including patient, family and physician collaborative relationships; and rehabilitation with community support.
Residuals
Continuous prescribed psychoactive drug therapy can reduce the relapse rate. Residual varies from significant improvement to intermittent relapses to severely and permanent incapacitation. Prognosis is poor, and is significantly poorer than for the paranoid type.
Special Considerations
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This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a).[chronic disease].
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If a Veteran is a former prisoner of war, this disease shall be service connected if manifest to a degree of disability of 10% or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 3.309(c) Disease subject to presumptive service connection].
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May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).
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Competency must be addressed in cases where a mental condition is initially evaluated as totally disabling or when the total evaluation is continued in a rating decision. This includes when individual unemployability is awarded or continued on the basis of a single mental health disability, and when assigning or continuing a temporary total evaluation for a mental disorder under 38 CFR 4.29 [38 CFR 3.353 [Determinations of incompetency and competency]].
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Reference 38 CFR 3.384 for the applicability of the term psychosis.
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Review 38 CFR 3.354 with regard to determinations of insanity
Notes
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An incapacitating episode is a period during which bed rest and treatment by a physician are required.
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Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.
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Review the special provision outlined in 38 CFR 4.125 through 38 CFR 4.129 for decisions related to mental disorders.
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The nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) (see 38 CFR 4.125 for availability information). Rating agencies must be thoroughly familiar with this manual to properly implement the directives in 38 CFR 4.125 through 38 CFR 4.129 and to apply the general rating formula for mental disorders in 38 CFR 4.130.