Bulimia Nervosa — VA Disability Rating Criteria (DC 9521)
Diagnostic Code 9521 · 38 CFR §4.130
What Is It?
Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors, along with excessive concern about body weight or 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. Its 0 and 10 percent levels describe binge eating followed by self-induced vomiting or other measures to prevent weight gain, and its 30, 60 and 100 percent levels require self-induced weight loss below 85 percent of expected minimum weight (80 percent at 100), each with incapacitating episodes. 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 mental health care, therapy, and any hospitalizations establish both 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 onset during service or aggravation by service are needed for direct connection. If claiming secondary to PTSD, depression, or MST, include a nexus opinion. Medical records documenting any secondary physical health effects (dental damage, gastrointestinal issues) can support a separate secondary claim for those conditions.
C&P Exam Tips
The examiner rates this condition on the Rating Formula for Eating Disorders. Describe binge eating and what follows it — self-induced vomiting or other measures to prevent weight gain — and say whether you have had periods when a physician prescribed bed rest and treatment, how often, and for how long. Bring records of your weight over time and of any hospitalizations, including any for tube feeding or parenteral (IV) nutrition. Be honest about your worst periods and typical patterns.
How to File
File on VA Form 21-526EZ. Include mental health treatment records, therapy documentation, and hospitalization records if applicable. If the condition began during service, include service treatment records. If claiming secondary to another service-connected condition, include the nexus opinion. Secondary physical effects (dental erosion, gastrointestinal damage) can be filed as separate secondary claims with appropriate medical documentation. Submit lay statements and file an Intent to File to preserve your effective date.
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 the behaviors it names, of self-induced weight loss relative to expected minimum weight, and of incapacitating episodes, which require bed rest and treatment by a physician. Not documenting those episodes and your weight makes the higher levels hard to show. Not filing secondary claims for physical health consequences (dental damage, GERD, electrolyte disorders) is another common gap. Failing to establish the service connection through either direct onset or secondary nexus weakens the claim.
Frequently Asked Questions
How does the VA rate bulimia nervosa?
Under 38 CFR 4.130, bulimia nervosa (DC 9521) 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 I get separate ratings for physical effects of bulimia?
Yes. Physical health consequences such as dental erosion, gastrointestinal conditions, or other medical problems caused by the eating disorder can be claimed as secondary conditions with their own diagnostic codes and ratings. You would need medical documentation linking the physical condition to the service-connected eating disorder.