Anorexia Nervosa — VA Disability Rating Criteria (DC 9520)
Diagnostic Code 9520 · 38 CFR §4.130
What Is It?
Anorexia nervosa is an eating disorder characterized by persistent restriction of food intake leading to significantly low body weight, along with intense concern about weight or body shape. The VA does not rate it on the General Rating Formula for Mental Disorders. 38 CFR 4.130 rates DC 9520 and DC 9521 on a separate Rating Formula for Eating Disorders, which looks at self-induced weight loss measured against expected minimum weight and at incapacitating episodes, at 0, 10, 30, 60 or 100 percent. An incapacitating episode is, in the schedule's words, "a period during which bed rest and treatment by a physician are required."
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Self-induced weight loss to less than 80 percent of expected minimum weight, with incapacitating episodes of at least six weeks total duration per year, and requiring hospitalization more than twice a year for parenteral nutrition or tube feeding. |
| 60% | Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of six or more weeks total duration per year. |
| 30% | Self-induced weight loss to less than 85 percent of expected minimum weight with incapacitating episodes of more than two but less than six weeks total duration per year. |
| 10% | Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder and incapacitating episodes of up to two weeks total duration per year. |
| 0% | Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight, with diagnosis of an eating disorder but without incapacitating episodes. |
Evidence Needed
A current diagnosis from a psychiatrist or psychologist is required. Treatment records documenting ongoing care — therapy, nutritional counseling, hospitalizations, or residential treatment — establish both the diagnosis and severity. Because the Rating Formula for Eating Disorders is written in terms of self-induced weight loss relative to expected minimum weight and of incapacitating episodes, records of your weight over time and of each period of physician-prescribed bed rest and treatment matter most. Records showing the condition began during or was aggravated by military service are needed for direct service connection. If claiming secondary to another condition (such as PTSD or MST), include the nexus opinion. Lay statements from family or friends describing the condition and its course can support the claim.
C&P Exam Tips
The examiner rates this condition on the Rating Formula for Eating Disorders, so the facts that matter are measurable: your weight against your expected minimum weight, how much weight you have lost, and how often and for how long you have needed bed rest and treatment by a physician. Bring records of your weights over time and of any hospitalizations, including any for tube feeding or parenteral (IV) nutrition. If they apply to you, describe binge eating, self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain. If you are in active treatment, describe what that involves.
How to File
File on VA Form 21-526EZ. Include mental health treatment records, therapy notes, and any hospitalization records. If the condition developed during service, include service treatment records showing onset. If filing secondary to PTSD or military sexual trauma, include the nexus opinion and primary condition documentation. Submit lay statements describing your weight loss relative to your expected minimum weight and any incapacitating episodes, the periods when bed rest and treatment by a physician were required. An Intent to File preserves your effective date while gathering evidence.
Common Mistakes
The most common mistake is preparing for the wrong formula. Eating disorders are not rated on the General Rating Formula for Mental Disorders; the Rating Formula for Eating Disorders is written in terms of self-induced weight loss relative to expected minimum weight and of incapacitating episodes, which require bed rest and treatment by a physician. Not having treatment and weight records makes it difficult to document either. Failing to connect the condition to a service-related cause or aggravation weakens service connection.
Frequently Asked Questions
How does the VA rate eating disorders?
Under 38 CFR 4.130, anorexia nervosa (DC 9520) is rated on the Rating Formula for Eating Disorders, not on the General Rating Formula for Mental Disorders used for PTSD, depression and anxiety. The levels are 0, 10, 30, 60 and 100 percent. The 30, 60 and 100 percent levels require self-induced weight loss to less than 85 percent of expected minimum weight (less than 80 percent at 100) together with incapacitating episodes of set total durations per year, and 100 percent also requires hospitalization more than twice a year for parenteral nutrition or tube feeding. The 0 and 10 percent levels cover binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain even when below expected minimum weight.
Can anorexia nervosa be secondary to PTSD or MST?
Yes. Eating disorders can develop secondary to PTSD, military sexual trauma, or other service-connected mental health conditions. A nexus opinion from a mental health professional explaining the causal relationship between your service-connected condition and the eating disorder is needed to establish secondary service connection.