9400 - Generalized anxiety disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9400

Acronym: GAD

Definition

One of a collection of mental conditions that manifests primarily by excessive anxiety and worry about a number of events or activities occurring for a period of at least six months.

Etiology

Anxiety as a trait has a familial association. However, inconsistent findings have been reported regarding familial patterns for generalized anxiety disorder with most reports failing to find specific clustering among closely-related families (familial aggregation).

Signs & Symptoms

Trembling, twitching, feeling shaky, and muscle aches or soreness may appear. In addition, the patient may complain of cold, clammy hands; dry mouth; nausea or diarrhea; urinary frequency; difficulty in swallowing or a lump in the throat; and an exaggerated startle response.

Tests

Diagnosis of generalized anxiety disorder is based largely on its signs and symptoms, and the ability to demonstrate that the condition is not due to the direct physiological effects of a substance or of a general medical condition. In addition, it would not occur exclusively during a mood disorder, a psychotic disorder, or a pervasive developmental disorder.

Treatment

Supportive psychotherapy is a vital part of the treatment of all anxiety disorders. Drugs, such as antidepressants and anxiety-reducing medications, can prevent or greatly reduce anxiety.

Residuals

The course is chronic, but fluctuating, and often worsens during times of stress.

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 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.