VA Diagnostic Code 9421Somatic symptom disorder

Somatic Symptom Disorder (VA Diagnostic Code 9421)

Mental Disorders • 38 CFR § 4.130

Understanding Somatic Symptom Disorder and How the VA Rates It

Somatic symptom disorder is a mental health condition listed under the VA's schedule for Mental Disorders. Like other conditions in this category, it is evaluated using the General Rating Formula for Mental Disorders, which assigns a disability percentage based on how much the condition affects your ability to work and function socially.

Because Somatic symptom disorder is rated under the General Rating Formula, the VA does not focus on the specific diagnosis alone. Instead, it looks at the overall level of occupational and social impairment your symptoms cause. The symptoms listed at each level are examples — they illustrate the kind and severity of impairment associated with each rating.

Available Rating Levels

The General Rating Formula for Mental Disorders provides the following levels:

100% — Total Impairment

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% — Deficiencies in Most Areas

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% — Reduced Reliability and Productivity

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% — Occasional Decrease in Work Efficiency

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% — Mild or Transient Symptoms

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% — Formally Diagnosed, No Significant Impairment

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.

What the VA Looks For

When rating Somatic symptom disorder, the VA evaluates:

• The degree of occupational and social impairment — how your symptoms affect your ability to work, maintain relationships, and function in daily life.
• The type and severity of symptoms — using the examples at each rating level as a guide for matching your condition to the appropriate percentage.
• Whether symptoms require continuous medication or appear primarily during periods of significant stress.

The examples listed at each level are illustrative. The rating reflects the overall picture of how the condition impairs functioning, evaluated under the General Rating Formula for Mental Disorders (§ 4.130).