9433 - Persistent depressive disorder (dysthymia)

DBQ: Link to Index of DBQ/Exams by Disability for DC 9433 

Definition

This mood disorder is characterized by chronic depression that occurs more frequently than not, and has lasted for at least 2 years.

Etiology

The condition is found more often among first-degree relatives of people with a major depressive disorder.

Signs & Symptoms

During the depressive times, the patient usually demonstrates a poor appetite but may overeat, insomnia or hypersomnia, low energy, low self-esteem, inability to make decisions, and feelings of hopelessness.

Tests

Diagnostic criteria for dysthymic disorder include the following behaviors:

  • Depressed mood for most of the day, more often than not, for at least 2 years.

  • Presence of at least two or more of the following symptoms:

    • Poor appetite or overeating

    • Insomnia or hypersomnia

    • Low energy or fatigue

    • Low self-esteem

    • Poor concentration or difficult decision making

    • Feelings of hopelessness.

  • Prevalence of symptoms, which have not been absent for more than two months for 2 years or longer.

  • Absence of a major depressive episode.

  • No history of a manic episode.

  • The disturbance does not occur exclusively during the course of a psychotic disorder.

  • The symptoms are not due to the effects of a substance.

  • The symptoms cause significant distress in important areas of functioning.

Associated laboratory findings are that adults with dysthymic disorder have some of the same polysomnographic (measurement of physiologic activity during sleep) features as those found in persons with major depressive disorder. Some of these signs are reduced rapid eye movement (REM), reduced slow-wave sleep, and impaired sleep continuity.

Treatment

Antidepressants are effective, and the newer second-generation drugs do not have some of the drawbacks of weight gain and problems with cardiac conduction. Vocational counseling is important because the nature of these people tends to be pains-taking about detail.

Residuals

If the patient has a dysthymic disorder that precedes a major depressive disorder, it is less likely that there will be a spontaneous inter-episode recovery.

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 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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