Mental Overview

The current First Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the sourcebook used for information related to the classes of mental disorders included in the diagnostic category for mental disorders. The definition of mental disorders, in accordance with DSM-5, involves consideration of behavioral or psychological patterns occurring in a person which are characterized by; present distress or incapacity; or with greater danger of suffering death, pain, and disability; or associated with a significant loss of independence. The group of symptoms, signs, or patterns of behavior is regarded as a behavioral, psychological, or biological abnormality. A total of 16 major diagnostic classes are included among the DSM-5 disorders. Eight of them are included in the diagnostic codes for Mental Disorders.

The eight major diagnostic classes comprising the diagnostic codes for Mental Disorders include the following:

  • Schizophrenia and Other Psychotic Disorders

  • Delirium, Dementia, and Amnestic Disorders and Other Cognitive Disorders

  • Anxiety Disorders

  • Dissociative Disorders

  • Somatoform Disorders

  • Mood Disorders

  • Chronic Adjustment Disorders

  • Eating Disorders

Criteria are established for each of the major diagnostic classes as means of setting up boundaries between disorders and to clarify differential diagnoses.

General Considerations for Rating

Diagnosis of mental disorders.

If the diagnosis of a mental disorder does not conform to DSM-5 or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. (38 CFR §4.125(a) [Diagnosis of mental disorders])

If the diagnosis of a mental disorder is changed, the rating agency shall determine whether the new diagnosis represents progression of the prior diagnosis, correction of an error in the prior diagnosis, or development of a new and separate condition. If it is not clear from the available records what the change of diagnosis represents, the rating agency shall return the report to the examiner for a determination. (Authority: 38 U.S.C. 1155) (38 CFR §4.125 (b) [Diagnosis of mental disorders])

Evaluation of disability from mental disorders.

When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. (38 CFR §4.126(a) [Diagnosis of mental disorders])

When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. (38 CFR §4.125(b) [Diagnosis of mental disorders]) Delirium, dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula for mental disorders; neurologic deficits or other impairments stemming from the same etiology (e.g., a head injury) shall be evaluated separately and combined with the evaluation for delirium, dementia, or amnestic or other cognitive disorder (see §4.25). (38 CFR §4.125(c) [Diagnosis of mental disorders])

When a single disability has been diagnosed both as a physical condition and as a mental disorder, the rating agency shall evaluate it using a diagnostic code which represents the dominant (more disabling) aspect of the condition (see §4.14). (Authority: 38 U.S.C. 1155) (38 CFR §4.126 (d) [Diagnosis of mental disorders])

Mental retardation and personality disorders.

Mental retardation and personality disorders are not diseases or injuries for compensation purposes, and, except as provided in §3.310(a) of this chapter, disability resulting from them may not be service-connected. However, disability resulting from a mental disorder that is superimposed upon mental retardation or a personality disorder may be service-connected. (Authority: 38 U.S.C. 1155) (38 CFR §4.127 [Diagnosis of mental disorders])

Convalescence ratings following extended hospitalization.

If a mental disorder has been assigned a total evaluation due to a continuous period of hospitalization lasting six months or more, the rating agency shall continue the total evaluation indefinitely and schedule a mandatory examination six months after the veteran is discharged or released to nonbed care. A change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. (Authority: 38 U.S.C. 1155) (38 CFR §4.128 [Diagnosis of mental disorders])

Mental disorders due to traumatic stress.

When a mental disorder that develops in service as a result of a highly stressful event is severe enough to bring about the veteran's release from active military service, the rating agency shall assign an evaluation of not less than 50 percent and schedule an examination within the six month period following the veteran's discharge to determine whether a change in evaluation is warranted. (Authority: 38 U.S.C. 1155) (38 CFR §4.129 [Diagnosis of mental disorders])

Schedule of ratings-mental disorders.

The nomenclature employed in this portion of the rating schedule is based upon the Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-5), of the American Psychiatric Association. Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130. (38 CFR §4.130 [Diagnosis of mental disorders])

Additional and visceral manifestations.

If, with a service-connected psychoneurotic disorder, or psychogenic disorder under other nomenclature (including psychological factor affecting physical condition), additional autonomic, visceral, or other psychophysiologic manifestations are added to the diagnosis, or appear in the findings, do not routinely consider them as part of the original service-connected entity. Their inclusion or noninclusion depends on their continuity and relationship with the original service-connected entity and severity of the latter over the period since discharge. Deny manifestations not considered service-connected under the appropriate denial code. (M21-1MR, Part III, Subpart iv, Chapter 4, Section H, Topic 27 [Psychiatric Conditions])

Reductions

Do not make drastic reductions in evaluations in ratings for psychiatric conditions if a reduction to an intermediate rate is more in agreement with the degree of disability. See also 38 CFR §3.344. The general policy to be observed is a gradual reduction in evaluation to afford the veteran all possible opportunities of adjustment. (M21-1MR, Part III, Subpart iv, Chapter 4, Section H, Topic 27 [Psychiatric Conditions])

Attempted Suicide.

A finding of "mental unsoundness" under the provisions of 38 CFR §3.302, in the absence of any underlying psychiatric disability subject to service connection, does not in itself constitute a service-connectable disability. See Elkins v. Derwinski, 8 Vet. App. 391 (1995). (M21-1MR, Part III, Subpart iv, Chapter 4, Section H, Topics 28, 30-32 [PTSD])

Psychosis--38 U.S.C. 1702.

Whenever a claim for service connection for a psychosis based on wartime service is denied, determine entitlement to service connection for treatment purposes under 38 U.S.C. 1702. Code the decision "48. Active Psychosis--SC. for treatment purposes only," or "49. Active Psychosis--Not SC.; 38 U.S.C. 1702." (M21-1MR, Part III, Subpart iv, Chapter 6, Section B, Topic 3 [Inferred Issues & Ancillary Benefits])

General.

Determination of service connection under 38 U.S.C. 1702 is solely for the purpose of providing eligibility for hospital and medical treatment (including outpatient treatment) for veterans of World War II, Korean Conflict, Vietnam era, or Persian Gulf War service who develop an active psychosis during or within two years from the date of separation (under other than dishonorable conditions) from such service or within two years of the end of the war period, whichever is earlier. It is not necessary for the veteran to have had 90 days service to qualify. (M21-1MR, Part IX, Subpart ii, Chapter 2, Topic 5 [Service Connection for Psychosis Under 38 U.S.C. 1702])

Presumption of Soundness.

The law provides a presumption of soundness which is not only applicable to the two-year period following discharge, but also qualifies veterans with a diagnosis of active psychosis during service despite a history of preservice existence. The presumption is equally applicable to psychosis of misconduct etiology. See chapter 1 regarding a request for physical examination. (M21-1MR, Part IX, Subpart ii, Chapter 2, Topic 5 [Service Connection for Psychosis Under 38 U.S.C. 1702])

Jurisdiction.

The issue of entitlement to medical treatment under 38 U.S.C. 1702 is routinely inferred whenever service connection for a psychosis based on World War II, Korean conflict, Vietnam era service, or Persian Gulf War service is denied. Requests for determination of service connection under 38 U.S.C. 1702 will also be received on VA Form 10-7131, "Exchange of Beneficiary Information and Request for Administrative and Adjudicative Action," accompanied by a copy of completed VA Form 10-10, "Application for Medical Benefits," or VA Form 10-10r, "Reapplication for Medical Benefits," and VA Form 10-10m, "Medical Certificate," and any other available professional report submitted with or developed in conjunction with the application for hospital or outpatient treatment. Authorization will furnish the requested information as provided in part IV, chapter 23 after a determination has been made. (M21-1MR, Part IX, Subpart ii, Chapter 2, Topic 5 [Service Connection for Psychosis Under 38 U.S.C. 1702])

Rating Conclusion.

Show either "48. Active Psychosis--SC for treatment purposes only" or "49. Active Psychosis--Not SC; 38 U.S.C. 1702." (M21-1MR, Part IX, Subpart ii, Chapter 2, Topic 5 [Service Connection for Psychosis Under 38 U.S.C. 1702])

Problematic Issues

  • Assessment Scales

  • Posttraumatic Stress Disorder

Schizophrenia

Diagnostic Code Name VA Exam Acronym
9201 Schizophrenia, disorganized type Mental Disorders (except PTSD & Eating Disorders) ---
9208 Delusional disorder Mental Disorders (except PTSD & Eating Disorders) DD
9210 Psychotic disorder, not otherwise specified (atypical psychosis) Mental Disorders (except PTSD & Eating Disorders) ---
9211 Schizoaffective disorder Mental Disorders (except PTSD & Eating Disorders) SAD

Delirium, Dementia, etc.

Diagnostic Code Name VA Exam Acronym
9300 Delirium Mental Disorders (except PTSD & Eating Disorders) DELIR
9301 Dementia due to infection (HIV, syphilis, and other systemic or intracranial infections) Mental Disorders (except PTSD & Eating Disorders) ARCD, HADC
9304 Dementia due to head trauma Mental Disorders (except PTSD & Eating Disorders) ---
9305 Vascular dementia Mental Disorders (except PTSD & Eating Disorders) VAD
9310 Dementia of unknown etiology Mental Disorders (except PTSD & Eating Disorders) ---
9312 Dementia of the Alzheimer's type Mental Disorders (except PTSD & Eating Disorders) AD
9326 Dementia due to neurologic or general medical conditions (endocrine disorders metabolic disorders, Pick's disease, brain tumors, etc.) or that are substance-induced (drugs, alcohol, poisons Mental Disorders (except PTSD & Eating Disorders) ---
9327 Organic mental disorder, other (including personality change due to a general medical condition) Mental Disorders (except PTSD & Eating Disorders) OMD

Anxiety Disorders

Diagnostic Code Name VA Exam Acronym
9400 Generalized anxiety disorder Mental Disorders (except PTSD & Eating Disorders) GAD
9403 Specific (simple) phobia; social phobia Mental Disorders (except PTSD & Eating Disorders) SP, SOP
9404 Obsessive compulsive disorder Mental Disorders (except PTSD & Eating Disorders) OCD
9410 Other and unspecified neurosis Mental Disorders (except PTSD & Eating Disorders) ---
9411 Post-traumatic stress disorder PTSD PTSD
9412 Panic disorder and/or agoraphobia Mental Disorders (except PTSD & Eating Disorders) AGOR
9413 Anxiety disorder, not otherwise specified Mental Disorders (except PTSD & Eating Disorders) ---

Dissociative Disorders

Diagnostic Code Name VA Exam
9416 Dissociative amnesia, dissociative fugue, dissociative identity disorder (multiple personality disorder) Mental Disorders (except PTSD & Eating Disorders)
9417 Depersonalization disorder Mental Disorders (except PTSD & Eating Disorders)

Somatoform Disorders

Diagnostic Code Name VA Exam Acronym
9421 Somatization disorder Mental Disorders (except PTSD & Eating Disorders) SD
9422 Pain disorder Mental Disorders (except PTSD & Eating Disorders) ---
9423 Undifferentiated somatoform disorder Mental Disorders (except PTSD & Eating Disorders) ---
9424 Conversion disorder Mental Disorders (except PTSD & Eating Disorders) ---
9425 Hypochondriasis Mental Disorders (except PTSD & Eating Disorders) HYPO

Mood Disorders

Diagnostic Code Name VA Exam Acronym
9431 Cyclothymic disorder Mental Disorders (except PTSD & Eating Disorders) CYCD
9432 Bipolar disorder Mental Disorders (except PTSD & Eating Disorders) ABD, BD, BPT
9433 Dysthymic disorder Mental Disorders (except PTSD & Eating Disorders) ---
9434 Major depressive disorder Mental Disorders (except PTSD & Eating Disorders) MDD, MDE
9435 Mood disorder, not otherwise specified Mental Disorders (except PTSD & Eating Disorders) ---

Chronic Adjustment Disorder

Diagnostic Code Name VA Exam
9440 Chronic adjustment disorder Mental Disorders (except PTSD & Eating Disorders)

Eating Disorders

Diagnostic Code Name VA Exam Acronym(s)
9520 Anorexia nervosa Eating Disorders AN, ANNER, ANR
9521 Bulimia nervosa Eating Disorders ABN