9422 - Other specified somatic symptom and related disorder
DBQ: Link to Index of DBQ/Exams by Disability for DC 9422
Definition
Somatic symptom disorder is characterized by an extreme focus on physical symptoms — such as pain or fatigue — that causes major emotional distress and problems functioning. You may or may not have another diagnosed medical condition associated with these symptoms, but your reaction to the symptoms is not normal.
Etiology
This is a psychogenic pain. First-degree biological relatives of patients with pain disorder commonly suffer from depressive disorders, dependence on alcohol, or chronic pain.
Signs & Symptoms
Pain is the major complaint. The most common areas affected are the back, head, chest, and abdomen. There may be an underlying disorder that could be related to the pain, but not to the severity of the pain, (e.g., osteoporosis, disc herniation, postherpetic neuralgia). In these cases, the diagnosis is pain disorder associated with a medical condition.
Tests
Diagnostic criteria for pain disorder include:
-
Pain in one or more areas that is the predominant focus of the clinical presentation, and is severe enough to receive clinical attention.
-
The pain causes significant distress or impairment in important areas of functioning.
-
The onset, severity, continuation, and outbreaks of pain are judged to be of a psychological nature.
-
These symptoms of the pain are not intentionally produced.
-
The pain is not attributed to a mood, or anxiety disorder, and does not meet the criteria for psychotic disorder.
If there is an associated medical condition, there may be some appropriate laboratory tests such as a magnetic resonance imaging (MRI) for a herniated lumbar disc.
Treatment
Building trust, establishing a good relationship and receiving positive reassurance from a physician may be sufficient treatment. However, most patients do not want to associate their problems with psychological causes, and want physical cure instead.
Residuals
The patient is at risk for potentially costly and unsafe procedures while seeking a cure.
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.