Depersonalization/Derealization Disorder — VA Rating (DC 9417)
Diagnostic Code 9417 · 38 CFR §4.130
What Is It?
Depersonalization/derealization disorder involves persistent or recurrent experiences of feeling detached from your own mind, body, or actions (depersonalization), or feeling that your surroundings are unreal, dreamlike, or distorted (derealization). Unlike psychotic conditions, the person maintains awareness that these experiences are not actually reality — they know something feels wrong, which itself causes significant distress. Veterans may develop this condition after combat trauma, military sexual trauma, blast exposure, or prolonged extreme stress during service. The episodes can be profoundly disorienting and interfere with the ability to engage with daily life, work, and relationships. The VA rates it under the General Rating Formula for Mental Disorders.
Rating Criteria
| Rating | Criteria |
|---|---|
| 100% | Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. |
| 70% | Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. |
| 50% | Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. |
| 30% | Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). |
| 10% | Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. |
| 0% | A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. |
Evidence Needed
A diagnosis from a psychiatrist or psychologist documenting the depersonalization and/or derealization episodes is required. Treatment records showing ongoing therapy and any medication management are important. Because these symptoms can be difficult to describe and measure objectively, detailed clinical notes from providers who understand the condition are valuable. Buddy statements from family describing episodes where you appeared detached, confused, or unresponsive to surroundings help corroborate the condition. A nexus opinion linking the condition to service trauma or stress is needed.
C&P Exam Tips
Describe your episodes in concrete terms: what does it feel like when you are depersonalized — do you feel like you are watching yourself from outside, that your hands are not your own, that you are in a dream? For derealization, describe how surroundings feel unreal — objects look distorted, sounds seem muffled, environments feel like a movie set. Explain how often episodes occur, how long they last, and what triggers them. Describe the functional impact: difficulty driving because the road feels unreal, trouble at work because you feel disconnected, strained relationships because you cannot feel emotionally present.
How to File
File on VA Form 21-526EZ with DC 9417. Submit psychiatric treatment records, therapy notes, and medication records. If the condition developed after military trauma, describe the connection clearly. If filing as secondary to PTSD or TBI, include the primary claim number and a medical opinion linking the conditions. Buddy statements describing observed episodes of detachment are particularly helpful.
Common Mistakes
Many veterans struggle to describe depersonalization and derealization experiences and end up not reporting them at all, or describing them so vaguely that the examiner does not grasp the severity. Practice describing your experiences in specific, concrete language before the exam. Another mistake is not connecting the condition to a triggering trauma or service event. Veterans sometimes have this condition misdiagnosed as anxiety or depression without the dissociative component being recognized.
Frequently Asked Questions
Is depersonalization/derealization the same as psychosis?
No. In depersonalization/derealization, you maintain awareness that your experiences are distorted — you know something feels wrong. In psychosis, the person may believe the distorted perceptions are real. This distinction matters clinically but does not change the rating criteria, which focus on functional impairment.
Can this condition be secondary to PTSD?
Yes. Depersonalization and derealization commonly develop alongside PTSD as dissociative responses to trauma. If you are already service-connected for PTSD, you can file a secondary claim with a nexus opinion linking the conditions.