VA Disability Ratings for Eating Disorders
*Note: This blog contains content that may be distressing or triggering for some readers.
What Are Eating Disorders?
Eating disorders are conditions related to persistent eating behaviors that negatively impact your health, your emotions, and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa, and more recently, binge-eating disorder. Most eating disorders involve obsessive and/or constant focus on weight, body shape, and food, thereby leading to dangerous eating behaviors. These behaviors can significantly impact your body’s ability to get appropriate nutrition and can harm vital organs. Symptoms tend to vary depending on the type of eating disorder.
Anorexia is a potentially life-threatening eating disorder characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight or shape. Individuals suffering from anorexia often use extreme efforts to control their weight and limit calories. Such efforts can include excessive exercise, using laxatives or diet aids, or vomiting after eating.
Bulimia is another serious, potentially life-threatening eating disorder that involves binging and purging. During these episodes, people typically eat a large amount of food in a short period of time, and then try to rid themselves of the extra calories in an unhealthy way. For example, people may force vomiting or use laxatives to get rid of the calories. Individuals with bulimia may be at a normal weight, but can still experience serious health complications.
Binge Eating Disorder
Individuals with binge eating disorder regularly eat too much food (i.e., binge) and experience a lack of control over their eating. Binging may occur even when the person is not hungry, and may continue even long after they are uncomfortably full. After a binge, people may feel guilty, disgusted, or ashamed by their behavior and the amount of food eaten. However, unlike bulimia, people with binge eating disorder do not try to compensate for their behavior with purging. Binging typically occurs at least once a week. Similar to anorexia and bulimia, people with binge eating disorder may experience adverse health outcomes.
Prevalence of Eating Disorders in Veterans
According to a June 2018 study published in the Defense Health Agency’s Medical Surveillance Monthly Report, eating disorder diagnoses among military personnel are up 26 percent over a five-year period. However, research suggests that the actual incidence of such disorders is even higher considering the fact that people with eating disorders do not usually seek medical care, and are sometimes able to conceal their illness. Diagnoses rose from 2.3 per 10,000 to 3 per 10,000 in 2016, before dropping to 2.9 per 10,000 in 2017. Results of the study suggest that service members likely experience eating disorders at rates that are comparable to rates in the general population, and that rates of these disorders are potentially rising among service members.
Far more women than men were diagnosed with an eating disorder in all branches of the military. Specifically, more than two-thirds of cases involved female troops and the overall incidence rate among women, at 11.9 cases per 10,000, was more than 11 times that of men. Of those cases, bulimia accounted for nearly 42 percent of diagnoses while anorexia only accounted for less than one-eighth. More than 46 percent were classified as other or unidentified eating disorders (e.g., binge eating).
Overall, military service could increase the risk of developing an eating disorder, due to potential exposure to trauma and the need to meet physical fitness and weight requirements.
Service Connection for Eating Disorders
To establish direct service connection for an eating disorder, veterans must demonstrate the following three elements: (1) a current diagnosis of an eating disorder; (2) an in-service event, injury, or illness; and (3) a medical nexus linking the current, diagnosed eating disorder to the in-service event. Veterans are able to submit service medical records, service personnel records, lay statements, and other forms of evidence to support their claims.
Eating Disorders and PTSD: Secondary Service Connection
A VA-funded study (2017) that looked at female veterans of war trauma stated that depression and post-traumatic stress disorder (PTSD) can trigger disordered eating. The onset of PTSD symptoms can induce negative thinking and cause individuals to engage in disordered eating in an effort to manage the PTSD symptoms. Purging can be seen as a way to get rid of unwanted feelings and thoughts while binging can be used as a way to fill a void within oneself. While veterans may experience both PTSD and an eating disorder, they are not always at the same level of severity at the same time. Instead, veterans may experience ebbs and flows in relation to symptomology and severity.
Importantly, if veterans are service-connected for PTSD and are later diagnosed with an eating disorder, they may qualify for secondary service connection. A secondary service-connected condition is one that is caused or aggravated by a primary service-connected condition. Veterans must demonstrate that their secondary condition is related to their already service-connected condition in order to receive VA disability benefits.
How VA Rates Eating Disorders
VA rates eating disorders under 38 CFR § 4.130, Schedule of Ratings – Mental Disorders, Rating Formula for Eating Disorders. Importantly, VA only includes anorexia (diagnostic code 9520) and bulimia (diagnostic code 9521) within this section, but the rating criteria is the same for both:
- 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
Here, an incapacitating episode is a period during which bed rest and treatment by a physician are required.
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