9440 - Chronic adjustment disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9440

Definition

The characteristic feature of chronic adjustment disorder is the development of significant emotional or behavioral symptoms in response to a stressor or stressors. The duration of the disturbance is longer than 6 months in the chronic form, as compared to less than 6 months in the acute.

Etiology

The condition represents a response to a psychosocial stressor. The stressor may be a single event (broken romance) or multiple in nature (business difficulties). Chronic stressors have enduring consequences (e.g., divorce).

Signs & Symptoms

Predominant symptoms characterizing the type:

Depression - manifest tears, hopelessness
Anxiety - manifest nervousness, worry
Disturbance of conduct - manifest recklessness, vandalism, truancy
Unspecified - manifest maladaptive behavior such as social withdrawal, physical complaints.

Tests

Diagnostic criteria for chronic adjustment disorder are as follows:

Emotional or behavioral symptoms lasting longer than 6 months
The symptoms are clinically significant as noticed by: marked distress in excess of what would be expected from exposure to a stress, and significant impairment in functioning
The stress-related disturbance does not meet any other criteria
The symptoms do not represent bereavement
Once the stressor has terminated, the symptoms do not persist for more than an additional six months.

Treatment

Anti-anxiety or antidepressant medication or both.

Residuals

Adjustment disorders are associated with an increased risk of suicide.

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.