9410 - Other and unspecified neurosis

9410 - Other specified anxiety disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9410

Definition

The definition of this term is controversial. Some feel its use should be limited to describing an unpleasant mental symptom in an individual with intact reality testing; others would have it apply to the etiological process, (i.e., unconscious conflict that arouses anxiety and leads to maladaptive use of defensive mechanisms that result in symptom formation). Alternatively, some consider the neuroses to have a physical basis. To further confuse the picture, some would entirely abandon the terms neurosis and psychoneurosis and replace them with anxiety disorders.

Etiology

Psychoneurosis is a general category in mental illness and is categorized by the consistent symptoms that dominate. Expressive maladjustments are secondary to unresolved unconscious conflicts. These lead to disorders in thought, feelings, attitudes, and behavior.

Signs & Symptoms

The patient is usually able to distinguish that the distorted thoughts and feelings are not normal. This differentiates this disorder from psychosis or character disorder. The disorder leads to irregular use of defensive mechanisms that result in symptom formation, e.g., excessive fear or anxiety.

Tests

Diagnosis is based on specified criteria. (See Diagnostic Code: 9400 Generalized anxiety disorder, Diagnostic Code: 9403 Specific (simple) phobia; social phobia, Diagnostic Code: 9404 Obsessive compulsive disorder, Diagnostic Code: 9411 Post-traumatic stress disorder, Diagnostic Code: 9412 Panic disorder and/or agoraphobia, or Diagnostic Code: 9413 Anxiety disorder, not otherwise specified)

Treatment

Psychotherapy, tranquilizers, and sedatives are the treatments most often used. In addition, according to the literature, disorders resulting from a neurotic symptom may be much more difficult to treat than those stemming from organic disease.

Residuals

Because patients who have mastered the self-help approach continue to use it as a way of life after formal treatment has ended, improvement usually continues for years. Return of symptoms is usually brought on by stress. Approximately 15% of patients realize a continuous decline in job-related and social functioning. Five percent of patients may experience symptoms in episodes with nominal or no symptoms in between.

Special Considerations

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].
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].
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).
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]].
Review 38 CFR 3.354 with regard to determinations of insanity.
Reference 38 CFR 3.384 for the applicability of the term psychosis

Note

Consider competency as an issue whenever a mental disorder is evaluated as 100% disabling, or if other evidence raises a question as to the beneficiary's mental capacity to contract or to manage his or her own affairs, including disbursements of funds, without limitation.
An incapacitating episode is a period during which bed rest and treatment by a physician are required.
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.
Review the special provisions outlined in 38 CFR 4.125 through 38 CFR 4.129 for decisions related to mental disorders
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.