9413 - Unspecified anxiety disorder
DBQ: Link to Index of DBQ/Exams by Disability for DC 9413
Definition
This category includes those disorders that do not meet the criteria for any specific anxiety disorder, adjust disorder with anxiety, or adjustment disorder with mixed anxiety and depressed mood.
Etiology
In general, anxiety is considered an undesirable emotional state and its causes are not fully known. It is often accompanied by physical bodily changes and behaviors resembling those caused by fear.
Signs & Symptoms
Persons with anxiety disorder who cannot be diagnosed based on the criteria for the anxiety and phobias noted above are considered to have an anxiety disorder, not otherwise specified. Examples are listed below.
Tests
Examples of anxiety or phobic avoidance that do not meet the criteria for any specific anxiety disorder, adjust disorder with anxiety, or adjustment disorder with mixed anxiety and depressed mood include:
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Mixed anxiety-depressive disorder - the person displays considerable symptoms of anxiety and depression, but the criteria are not met for a definite mood disorder or a specific anxiety disorder.
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The person displays considerable social phobic symptoms that are related to the collective effect of having a medical or mental disorder, (e.g., skin disorders, stuttering or Parkinson's disease).
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It is apparent by a clinician that an anxiety disorder is present, but is unable to determine whether it is primary or secondary to a medical condition or substance abuse.
Treatment
Sympathetic psychotherapy is an essential part of treatment of all anxiety disorders. Therapy involving the individual, groups, and families may help resolve problems associated with a lasting disorder. Medications, such as antidepressants and anti-anxiety drugs, may be indicated in some cases.
Residuals
If the patient is taking anti-anxiety medication, they may experience adverse effects including drowsiness, ataxia, and memory problems. Long-term drug treatment may be necessary because panic attacks often recur when drugs are discontinued. Exposure therapy can also be helpful. This form of behavior therapy confronts the patient with what is feared and often helps diminish the fear.
Special Considerations
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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].
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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).
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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]].
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Reference 38 CFR 3.384 for the applicability of the term psychosis.
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Review 38 CFR 3.354 with regard to determinations of insanit
Notes
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An incapacitating episode is a period during which bed rest and treatment by a physician are required.
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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.
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Review the special provisions outlined in 38 CFR 4.125 through 38 CFR 4.129 for decisions related to mental disorders
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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.