Somatic Symptom Disorder (SSD), previously called Chronic Pain Syndrome, means a veteran is having a considerable focus on his/her physical symptoms, such as pain, weakness, limitations, and shortness of breath.
This is typically tied to the daily chronic pain and life/health limitations related to a disabled veteran’s current service-connected disabilities rated at 0 percent or higher.
Thus, it is sometimes referred to as a “Lifestyle Impact Claim” although no such claim exists in CFR 38, Part 4, Schedule for Rating Disabilities.
The disabled veteran normally has excessive thoughts, feelings, and behaviors relating to these physical symptoms, which causes significant occupational and social impairment in the veteran’s work, life, and/or social functioning.
These associated physical symptoms may then trigger a host of mental health related symptoms, such as depression, anxiety, panic attacks, anger issues, insomnia, obsessive rituals, memory loss, among many others.
Excessive thoughts, feelings, or behaviors related to Somatic Symptom Disorder include at least one of the following in disabled veterans:
- Disproportionate and persistent thoughts about the seriousness of one’s physical symptoms and impairment.
- Persistently high level of anxiety about health or symptoms, which may or may not trigger other mental health related symptoms.
- Excessive time and energy devoted to these symptoms or health concerns, which can be characterized as “unhealthy.”
How to Diagnose Somatic Symptom Disorder in Veterans
Primary Care Physicians and/or Psychologists and Psychiatrists should be clear when diagnosing and characterizing disabled veterans with Somatic Symptom Disorder and their corresponding severity of symptoms:
- With predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain.
- Persistent: A persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months).
Specify current severity:
- Mild: Only one of the symptoms specified in Criterion B is fulfilled.
- Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
- Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).
A diagnosis of Somatic Symptom Disorder, which is widely recognized as a disabling condition, is accepted by VA as a disability for compensation purposes.
Because Somatic Symptom Disorder may also stem from an underlying disease such as multiple sclerosis or arthritis, and variations of somatic symptom disorder may be found throughout all body systems, the condition should be evaluated under the most appropriate diagnostic code (DC) based on the clinical picture demonstrated.
- The VA already recognizes conditions such as fibromyalgia and low back pain syndrome, which are forms of somatic symptom disorder, as disabilities for compensation purposes.
- Originally diagnosed as Chronic Pain Syndrome, the terminology was revised to Somatic Symptom Disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5).
Important: Adequate medical evidence must be of record that identifies the specific manifestations of the disease present in order to accurately evaluate the condition.
- This means veterans need a medical diagnosis of Somatic Symptom Disorder.
- There must be a clear Nexus or logical link to a veteran’s current service-connected disabilities for secondary service connection.
- The veteran must have current symptoms of Somatic Symptom Disorder that are causing occupational and social impairment.
Somatic Symptom Disorder VA Ratings
Somatic Symptom Disorder VA ratings are based upon the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (see §4.125 for availability information).
Rating agencies must be thoroughly familiar with this manual to properly implement the directives in §4.125 through §4.129 and to apply the general rating formula for mental disorders in §4.130.
Code 9421 specifies Somatic Symptom Disorder for VA Rating purposes, meaning, it’s characterized as a mental health claim, in which a disabled veteran’s level of occupational and social impairment determines the final VA rating.
100 VA Rating for Somatic Symptom Disorder
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 VA Rating for Somatic Symptom Disorder
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 work like setting); inability to establish and maintain effective relationships.
50 VA Rating for Somatic Symptom Disorder
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 VA Rating for Somatic Symptom Disorder
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 VA Rating for Somatic Symptom Disorder
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 VA Rating for Somatic Symptom Disorder
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.
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