9423 - Unspecified somatic symptom and related disorder

DBQ: Link to Index of DBQ/Exams by Disability for DC 9423 

Definition

Somatic symptom and related disorders are mental health disorders characterized by an intense focus on physical (somatic) symptoms that causes significant distress and/or interferes with daily functioning

Etiology

The etiology is unknown. However, according to current practicing physicians, the highest frequency of unexplained physical complaints occur in young women of low socioeconomic status. Such symptoms are not limited to any age, gender, or sociocultural group.

Signs & Symptoms

Most commonly, complaints are related to chronic fatigue, no appetite, and gastrointestinal (GI) or genitourinary (GU) problems.

Tests

Tests are performed to rule out any physical basis for the complaints. When negative, the diagnostic criteria, should be applied. Diagnostic criteria for undifferentiated somatoform disorder are as follows:

  • One or more physical complaints (e.g., fatigue, loss of appetite, and GI or urinary complaints).

  • The presence of either of the following:

    • Symptoms which cannot be attributed to a known medical condition or effects of a substance.

    • Complaints are in excess of what would be expected if a physical condition exists.

    • The symptoms are clinically distressful or impair functioning.

    • The duration of the disturbance is at least 6 months.

    • The disturbance is not accounted for by another mental disorder.

    • The symptom or symptoms are not intentionally produced.

Treatment

The chronic unexplained complaints generally lead to medical consultation usually with a primary care physician, not a psychiatrist.

Residuals

People sometimes express concerns about personal and social problems with medically unexplained symptoms of physical illness. Neurasthenia, a syndrome of fatigue and weakness for over six months, is classified as an undifferentiated somatoform disorder.

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.

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