9521 - Bulimia nervosa | Medical EPSS

9521 - Bulimia nervosa

DBQ: Link to Index of DBQ/Exams by Disability for DC 9521

Acronym: ABN

Definition

An eating disorder characterized by repeated episodes of binge-eating, followed by an effort not to gain weight through self-induced vomiting. Laxatives and diuretics are abused excessive dieting; fasting and exercising are used. Body shape and weight are a consuming concern for patients with bulimia nervosa.

Etiology

Some studies suggest an increased frequency of bulimia, mood disorder, substance abuse, and dependence in the first-degree biological relatives of individuals with Bulimia.

Signs & Symptoms

Recurrent vomiting results in significant loss of tooth enamel, salivary and parotid gland enlargement that is painless, and fluid and electrolyte imbalances, especially low potassium. Cardiac problems occur with long-term use of ipecac syrup that induces vomiting. Amenorrhea occurs often in females. Long-term laxative abuse may lead to dependency. The stomach or esophagus may rupture from forced vomiting.

Tests

Diagnostic criteria for bulimia nervosa are as follows:

Recurrent episodes of binge-eating which is characterized as:
- Eating in a set period of time, (2 hours), an amount of food much larger than most people would eat during that period.
- A feeling or sense of loss of control over the eating (one cannot stop or control how much is eaten).
Frequent inappropriate behaviors to prevent weight gain, such as self-induced vomiting, abuse of laxatives, use of diuretics, administration of enemas, excessive exercising, and fasting.
The binge-eating and inappropriate behaviors both occur, on an average of at least twice a week for 3 months.
Body shape and weight unduly influence the evaluation of self.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Types of bulimia:
- Purging: performs self-induced vomiting, or misuse of laxatives, diuretics, or enemas.
- Non-purging type: inappropriate behaviors such as excessive exercise, and fasting, but does not engage in purging activities.

Treatment

Antidepressants and weekly psychotherapy sessions for at least 6 months seem to be effective.

Residuals

The aftermath of long-term vomiting results in tooth decay and enamel erosion. Laxatives will be needed to stimulate bowel movements due to abuse. These residuals are mostly associated with the purging type.

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.