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 rates this condition under the General Rating Formula for Mental Disorders, meaning the rating is determined by the degree of occupational and social impairment rather than specific physical symptoms alone.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Total occupational and social impairment with inability to perform activities of daily living, persistent danger to self, grossly impaired judgment, and complete inability to function in a work or social environment. |
| 70% | Deficiencies in most areas including work, family relations, judgment, thinking, or mood. May include near-continuous anxiety or depression affecting independent functioning, inability to maintain effective relationships, and neglect of physical health. |
| 50% | Reduced reliability and productivity due to symptoms such as disturbances of motivation and mood, difficulty maintaining effective work and social relationships, and impaired judgment. |
| 30% | Occasional decrease in work efficiency with intermittent inability to perform occupational tasks, though generally functioning satisfactorily. May include anxiety, depressed mood, and social withdrawal. |
| 10% | Mild or transient symptoms that reduce work efficiency only during periods of significant stress, or symptoms managed by continuous medication. |
| 0% | Condition is diagnosed but symptoms do not interfere with occupational or social functioning and continuous medication is not required. |
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. 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. Lay statements describing functional impact are valuable.
C&P Exam Tips
The C&P exam evaluates occupational and social impairment. Focus on how the condition affects your ability to work reliably, maintain relationships, and manage daily life. Describe missed work, social isolation, impact on family relationships, and any hospitalizations or intensive treatment. If the condition causes shame or secrecy that affects your relationships or work, describe that impact. The examiner needs to understand the functional limitations, not just the diagnosis. Be honest about your worst days and typical functioning.
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 the same as with other eating disorders — not focusing on occupational and social impairment during the C&P exam. The rating is based on how the condition affects your ability to function, not on frequency of specific behaviors. Not filing secondary claims for physical health consequences (dental damage, GERD, electrolyte disorders) means leaving compensation on the table. 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?
The VA rates bulimia nervosa under the General Rating Formula for Mental Disorders (DC 9521), the same framework used for PTSD and depression. Your rating is based on overall occupational and social impairment — how the condition affects your work, relationships, and daily functioning — not on the frequency of specific behaviors.
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.