9211 - Schizoaffective disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9211

Acronym: SAD

Definition

A psychotic disorder characterized by significant mood symptoms such as mania or depression, and symptoms of schizophrenia. The two subtypes of the disorder are based on the mood component, bipolar type or depressive type. (See Diagnostic Code: 9432 Bipolar disorder and Diagnostic Code: 9434 Major depressive disorder)

Etiology

Generally, the causes of the disorder are unknown. There may be a familial linkage.

Signs & Symptoms

The symptoms of the disorder occur in several patterns, which may include pronounced auditory hallucinations and persecutory delusions. The symptoms during the depressive mode may include: loss of interest or pleasure in nearly all activities (depression, sadness); changes in appetite or weight or sleep; decreased energy; feelings of worthlessness or guilt; difficulty sleeping; difficulty in making decisions; and recurrent thoughts of death or suicidal ideation, with plans or attempts. The person may alternate between dejection and elation in the bipolar mode.

Tests

A comprehensive history of symptoms and the progress of the symptoms are used to determine the presence of the condition. Diagnostic criteria for the condition include:

An uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode. These episodes occur concurrently with symptoms that include delusions, hallucinations, and speech that rambles, shifts from one topic to another, and is non-goal directed.
Delusions or hallucinations lasting for at least 2 weeks in the absence of prominent mood symptoms.
Symptoms that meet the criteria for mood episode that occur during a substantial duration of active and residual period of the illness.
The illness is not due to physiological effects of drug or medications, or medical condition.

Treatment

Drug therapy, psychotherapy, and community support are parts of the treatment program.

Residuals

Disability may last for years or decades. There may be poor work functioning, limited social contact, difficulties with self-care, and increased risk of suicide.

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

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 provision 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.