9431 - Cyclothymic disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9431

Acronym: CYCD

Definition

Essentially this disorder is a chronic, intermittent disturbance in mood. The mood variation is from numerous mild periods of depressive symptoms to hypomanic ones. Neither episode is able to meet the criteria for a major depression or a manic disorder.

Etiology

There is a familial pattern to Bipolar I and II disorders (see Diagnostic Code: 9432 Bipolar disorder), appearing more commonly among relatives of persons with cyclothymic disorders.

Signs & Symptoms

Brief cycles of mild depression with features of low self-confidence and increased sleep alternating with increased elation, enthusiasm, and shortened sleep.

Tests

Diagnostic criteria for the disorder are as follows:

For at least two years, periods of hypomania alternating with numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode.
Over a two-year period, the person has not been free of symptoms for two months at a time.
During the first two years of the disturbance, there has been no major depressive episode, manic episode, or mixed episode.

Treatment

Living with persons with cyclothymic disorders is difficult due to volatile interpersonal relationships. Patients need to be taught how to live with their temperamental extremes. The decision to give medication to stabilize the mood depends on the benefits and limitations it would bring in regard to productivity.

Residuals

Persons with this condition contribute in leadership, artistic creativity, and in other achievements; however, the interpersonal effects of their behavior are detrimental and constitute a social problem. Their instability leads to impulsiveness, marital breakups, uneven work patterns, and episodic abuse of alcohol and drugs.

Special Considerations

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

Notes

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.