9425 - Illness anxiety disorder
DBQ: Link to Index of DBQ/Exams by Disability for DC 9425
Acronym: HYPO
Definition
Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill.
Etiology
Although the etiology is unknown, it does appear more commonly in depressed patients.
Signs & Symptoms
The symptoms presented do not follow the usual pattern of organic dysfunction and are not associated with abnormal physical or laboratory findings.
Tests
Physical findings and laboratory tests are used to rule out any serious medical condition. Diagnostic criteria for the condition are as follows:
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A thorough examination does not identify a medical condition that matches the patient's concerns.
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The patient's belief is not delusional.
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This preoccupation with bodily dysfunction causes significant distress or impairment of functioning.
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The condition lasts for at least six months.
Treatment
The treatment is difficult because the patient is convinced that something is wrong. Reassurance from regular office visits, and a caring physician are beneficial. In addition to the primary physician, a psychiatric referral is necessary if symptoms are not relieved.
Residuals
This is a chronic disorder, and less than 5% of patients recover permanently. Depression with hypochondriasis points to a poor prognosis for recovery.
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.