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C&P Exam Prep: Bulimia Nervosa
DBQ Overview
Interview- Form Name
- Eating_Disorders
- Form Code
- Eating_Disorders
- Page Count
- 3
- Examiner Type
- Psychiatrist or Psychologist
- Estimated Duration
- 60-90 minutes
- Exam Format
- Interview
What to Expect During Your Exam
Exam Overview
To document the current severity of your Bulimia Nervosa, establish or confirm its diagnosis, assess its functional impact on occupational and social functioning, and determine an appropriate disability rating under the General Rating Formula for Eating Disorders (38 CFR - 4.130, DC 9521).
What the examiner evaluates:
- Confirmation of Bulimia Nervosa diagnosis (ICD-10: F50.2) and history of onset
- Frequency and severity of binge-eating episodes
- Compensatory behaviors including self-induced vomiting, laxative misuse, diuretics, fasting, or excessive exercise
- Incapacitating episodes and their total duration per year
- Need for hospitalizations including for tube feeding or parenteral nutrition
- Body image disturbance and weight preoccupation
- Physical sequelae such as electrolyte imbalances, dental erosion, esophageal damage, or cardiac complications
- Impact on occupational and social functioning
- Current and past treatment history including medications and therapy
- Co-occurring psychiatric conditions (depression, anxiety, PTSD, substance use)
Examination is typically conducted in person at a VA medical center or contracted facility. Telehealth examinations are increasingly common. In either format, the examiner will conduct a structured clinical interview. You have the right to request that the exam be recorded in most states - confirm state law and VA policy before your appointment. A same-sex examiner may be requested in advance if needed for comfort. Bring a trusted support person if permitted, though they may be asked to wait outside during portions of the interview.
Typical duration: 60-90 minutes
Frequency of Binge-Eating Episodes
How often discrete episodes of consuming abnormally large amounts of food, accompanied by a sense of loss of control, occur per week or month.
What to expect:
The examiner will ask you to describe a typical binge episode - its triggers, what you eat, how long it lasts, and how you feel during and after. They will ask how frequently this occurs and whether frequency has changed over time.
Key thresholds:
- Frequent episodes with compensatory behaviors — Supports higher rating levels under the General Rating Formula for Eating Disorders; influences whether incapacitating episode criteria are met
- Infrequent or well-controlled episodes — May support a lower rating; however, severity of functional impairment is the primary driver
Tips:
- Report your typical frequency honestly - do not minimize. If it varies week to week, describe the range including your worst periods.
- Describe emotional and physical state during and after binge episodes, including shame, disgust, anxiety, or physical pain.
- If frequency has increased during high-stress periods (work, family conflict, anniversaries), note those patterns.
- Document the time lost from normal activities during and after binge-purge cycles.
Pain considerations: Note any physical pain associated with bingeing or purging, including abdominal cramping, throat pain, chest pain, or esophageal discomfort, as these contribute to the functional impact picture.
Compensatory Behavior Assessment
Type, frequency, and severity of behaviors used to prevent weight gain following binge episodes, including purging (self-induced vomiting, laxatives, diuretics, enemas) and non-purging methods (fasting, excessive exercise).
What to expect:
The examiner will ask directly about each type of compensatory behavior. They may ask how long after eating you purge, how many times per day or week, and any physical consequences you have experienced.
Key thresholds:
- Self-induced vomiting as primary compensatory behavior — Directly maps to DBQ checkbox for binge eating followed by self-induced vomiting; documents severity
- Multiple compensatory methods used concurrently — Indicates more severe disorder and greater functional impairment
Tips:
- Be honest and specific - this is a medical examination, not a moral judgment. Accurate reporting is essential for a fair rating.
- Describe physical complications from purging: dental erosion, swollen salivary glands, calluses on knuckles, acid reflux, irregular heartbeat, muscle weakness from electrolyte loss.
- If you have ever been hospitalized or had emergency care due to complications from compensatory behaviors, report dates and facilities.
- Describe how much time per day compensatory behaviors occupy and how they disrupt your routine.
Pain considerations: Report any physical discomfort or pain associated with compensatory behaviors, including throat or esophageal pain after vomiting, abdominal cramping from laxative use, or musculoskeletal pain from excessive exercise.
Incapacitating Episodes Assessment
Periods during which symptoms are so severe that the veteran is unable to function, requiring bed rest or cessation of normal activities. Total duration per year is the key metric under the General Rating Formula for Eating Disorders.
What to expect:
The examiner will ask about periods when your symptoms prevented you from working, caring for yourself, or maintaining normal activities. They will estimate total days or weeks of incapacitation over the past 12 months.
Key thresholds:
- Up to 2 weeks total incapacitation per year — Supports 10% rating level under General Rating Formula
- More than 2 weeks but less than 6 weeks total per year — Supports 30% rating level
- 6 or more weeks total per year — Supports 50% rating level
- Hospitalization more than twice per year for tube feeding or parenteral nutrition — Supports 100% rating level
Tips:
- Keep a log of days you were unable to work or function normally due to your eating disorder before the exam if possible.
- Describe what 'incapacitation' looks like for you - unable to leave bed, unable to go to work, unable to care for children, hospitalized.
- Include partial incapacitation - days you went to work but could not perform duties or had to leave early due to symptoms.
- Flare-ups triggered by stress, anniversaries, or life events count - describe these in detail.
- If you called out sick from work, took FMLA, or had documented absences, gather those records.
Pain considerations: If physical symptoms during incapacitating episodes (electrolyte disturbances causing heart palpitations, muscle weakness, fainting, severe abdominal pain) contributed to your inability to function, describe these explicitly.
Occupational and Social Functional Impact Assessment
The degree to which Bulimia Nervosa impairs your ability to maintain employment, relationships, self-care, and participation in daily activities.
What to expect:
The examiner will ask about your work history, ability to maintain employment, interpersonal relationships, social isolation, and daily functioning. They may use structured clinical tools or ask open-ended questions about how your condition affects your life.
Key thresholds:
- Occupational and social impairment with reduced reliability and productivity — Supports moderate rating range under General Rating Formula
- Deficiencies in most areas: work, school, family relations, judgment, thinking, or mood — Supports higher rating range
- Total occupational and social impairment — Supports 100% rating
Tips:
- Give specific examples: 'I was fired from two jobs because I was spending up to 3 hours in the bathroom after lunch.' Or: 'I avoid all social eating situations, which has cost me promotions and friendships.'
- Describe impact on relationships - romantic partners, family members, friends - who have been affected by your eating disorder.
- Describe avoidance behaviors: restaurants, workplace cafeterias, family meals, social events involving food.
- Note impact on concentration, decision-making, energy, and mood that affect work performance.
Pain considerations: Physical fatigue, brain fog from electrolyte imbalances, and chronic physical pain from purging behaviors directly affect your ability to work and should be articulated as functional limitations.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 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. For eating disorders: requiring hospitalization more than twice per year for tube feeding or parenteral nutrition. |
CFR: Under the General Rating Formula for Eating Disorders: requiring hospitalization more than twice a year for tube feeding or parenteral nutrition. |
| 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; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. |
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of six or more weeks total duration in the past 12 months. |
| 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 normal routine behavior, self-care, and conversation. |
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of more than two weeks but less than six weeks total duration in the past 12 months. |
| 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. |
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of up to two weeks total duration in the past 12 months. |
| 0% | A mental condition has been formally diagnosed but symptoms are not severe enough to interfere with occupational and social functioning, or symptoms are controlled by continuous medication. |
CFR: Condition diagnosed but not currently causing functional impairment. A 0% rating is still a service-connected rating and can be increased if symptoms worsen. |
100% Total occupational and social impairment, due to such sympto ...
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. For eating disorders: requiring hospitalization more than twice per year for tube feeding or parenteral nutrition.
Key Symptoms
- Hospitalization more than twice per year for tube feeding
- Hospitalization more than twice per year for parenteral nutrition
- Total inability to maintain employment or social relationships
- Severe physical medical complications requiring ongoing intensive medical management
- Inability to maintain minimal self-care
- Persistent danger to self
CFR: Under the General Rating Formula for Eating Disorders: requiring hospitalization more than twice a year for tube feeding or parenteral nutrition.
50% Occupational and social impairment with reduced reliability ...
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; impaired judgment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.
Key Symptoms
- Incapacitating episodes of 6 or more weeks total duration per year
- Frequent binge-purge cycles significantly disrupting daily functioning
- Significant occupational impairment - job loss, frequent absences, inability to maintain employment
- Severe social withdrawal and avoidance of social situations involving food
- Significant physical complications requiring medical attention
- Co-occurring depressive or anxiety symptoms impairing functioning
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of six or more weeks total duration in the past 12 months.
30% Occupational and social impairment with occasional decrease ...
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care, and conversation.
Key Symptoms
- Incapacitating episodes of more than 2 weeks but less than 6 weeks total duration per year
- Moderate frequency of binge-purge cycles interfering with work and social life
- Intermittent inability to complete work tasks
- Increased social isolation related to eating behaviors
- Periodic physical complications from purging (e.g., electrolyte issues, dental damage)
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of more than two weeks but less than six weeks total duration in the past 12 months.
10% Occupational and social impairment due to mild or transient ...
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.
Key Symptoms
- Incapacitating episodes lasting up to 2 weeks total duration per year
- Binge-purge cycles are infrequent or well-controlled between episodes
- Mild impact on social or occupational functioning
- Symptoms worsen primarily under stress
CFR: Under the General Rating Formula for Eating Disorders: incapacitating episodes of up to two weeks total duration in the past 12 months.
0% A mental condition has been formally diagnosed but symptoms ...
A mental condition has been formally diagnosed but symptoms are not severe enough to interfere with occupational and social functioning, or symptoms are controlled by continuous medication.
Key Symptoms
- Diagnosis of Bulimia Nervosa exists but symptoms are minimal or in sustained full remission
- No significant occupational or social impairment
- Condition well-managed with treatment
CFR: Condition diagnosed but not currently causing functional impairment. A 0% rating is still a service-connected rating and can be increased if symptoms worsen.
How to Describe Your Symptoms
Binge Eating Episodes
How to describe:
Describe in concrete terms: 'I eat very large quantities of food - often thousands of calories - in a short period of time, usually under an hour. During the episode I feel completely out of control, like I cannot stop even when I want to. Afterward I feel intense shame, guilt, and physical discomfort.'
Worst-day example:
“On my worst days, I have multiple binge episodes in a single day. I have eaten until I was in physical pain, missed work because I spent hours in a binge-purge cycle, and then felt so ashamed and exhausted that I could not leave my home for the rest of the day.”
What the examiner listens for:
Loss of control during eating, large quantity of food consumed, distress associated with episodes, frequency and predictability of triggers, duration of episodes, and impact on daily functioning.
Understatements to avoid:
Do not minimize by saying 'I just overeat sometimes.' Binge eating disorder involves a genuine loss of control that is clinically distinct from overeating. Accurately describe the compulsive, distressing nature of the episodes.
Compensatory Behaviors (Purging and Non-Purging)
How to describe:
Be direct and clinical: 'After bingeing, I make myself vomit - usually within 30 minutes. I do this [X] times per week. I have also used laxatives [frequency]. I sometimes fast for 24-48 hours after a binge or exercise for 3-4 hours to compensate.' Describe each method you use.
Worst-day example:
“On my worst days, I may purge four or five times. I have passed out from dehydration, had heart palpitations from electrolyte imbalances, and had to call in sick to work because I was too weak from purging to function.”
What the examiner listens for:
Specific types of compensatory behaviors, frequency, duration of the behavior pattern, physical consequences experienced, and degree to which the behaviors consume time and mental energy.
Understatements to avoid:
Do not omit non-purging compensatory behaviors like excessive exercise or fasting - these are clinically significant and directly relevant to your diagnosis and rating.
Incapacitating Episodes
How to describe:
Define what incapacitation means for you: 'There are days - and sometimes stretches of multiple days in a row - when my eating disorder completely prevents me from functioning. I cannot go to work, cannot care for my family, and sometimes cannot get out of bed due to physical weakness, exhaustion, and emotional distress from my symptoms.'
Worst-day example:
“Last year I had approximately [X] weeks where I was completely unable to work or function normally. One stretch lasted 10 days - I called out of work every day, barely left my bedroom, and was not eating anything of nutritional value because the binge-purge cycle had completely taken over.”
What the examiner listens for:
Total number of days or weeks of functional incapacitation per year, whether incapacitation was due primarily to eating disorder symptoms, and whether medical care was required during these periods.
Understatements to avoid:
Do not only count days you were hospitalized. Incapacitating episodes include days when symptoms prevented you from working or maintaining normal activities even if you were not hospitalized.
Occupational Impact
How to describe:
Use concrete examples: 'I have been fired from two jobs in the last five years. I miss work an average of [X] days per month due to my eating disorder. I cannot focus on tasks at work because I am preoccupied with food, my body, and planning around eating. I avoid work events involving meals.'
Worst-day example:
“On bad weeks, I spend 4-6 hours per day engaged in eating disorder behaviors - planning binges, bingeing, purging, recovering physically, and dealing with the emotional aftermath. This leaves almost no functional capacity for work responsibilities.”
What the examiner listens for:
Job losses, demotions, or disciplinary actions related to attendance or performance; inability to maintain competitive employment; avoidance of work situations involving food or social eating; cognitive impairment affecting productivity.
Understatements to avoid:
Do not say 'I manage okay at work' if you have had significant difficulties. Accurately report attendance problems, performance issues, interpersonal conflicts, or accommodations you have required.
Social and Interpersonal Impact
How to describe:
Describe specific impacts: 'I avoid all social situations involving food - restaurants, family dinners, workplace lunches, parties. This has severely damaged my relationships. My family does not understand the disorder and there is significant conflict. I am isolated. I have lost friendships because I constantly cancel plans.'
Worst-day example:
“I have not attended a family holiday dinner in three years because the stress of eating in front of others triggers a binge-purge cycle. I have pushed away my closest friends because I cannot explain why I always cancel plans around meal times. I feel completely alone with this condition.”
What the examiner listens for:
Social isolation, relationship disruption, avoidance of social eating, shame and secrecy around the disorder, impact on intimate relationships, and participation in community activities.
Understatements to avoid:
Do not present an overly functional social picture if the reality is isolation and avoidance. Accurately describe how the disorder's secrecy and shame have affected your ability to maintain relationships.
Physical Complications and Medical Sequelae
How to describe:
List all physical consequences you have experienced: 'I have dental erosion from repeated exposure to stomach acid - my dentist has documented this. I have had cardiac arrhythmias from electrolyte imbalances. I have chronic acid reflux. I have muscle weakness and fatigue. I have had kidney problems from laxative abuse.'
Worst-day example:
“I have been to the emergency room twice for heart palpitations caused by low potassium from purging. I was told I had a dangerously low potassium level and required IV treatment. My throat bleeds occasionally from purging and I have been unable to speak normally for days afterward.”
What the examiner listens for:
Medical complications documented in records, emergency care or hospitalizations for physical sequelae, dental damage, metabolic or electrolyte disorders, and impact of physical symptoms on functioning.
Understatements to avoid:
Do not omit physical complications - they directly support your claim and may also form the basis for secondary service-connected conditions (dental, cardiac, renal, gastrointestinal).
Body Image Disturbance and Psychological Symptoms
How to describe:
Accurately describe: 'My self-worth is almost entirely dependent on my weight and body shape. Even when I am at a medically normal weight I believe I am overweight. I spend hours each day thinking about food, my body, and compensatory behaviors. This preoccupation is constant and distressing.'
Worst-day example:
“On my worst days I cannot look in mirrors, I have called in sick because I felt too ashamed of my body to be seen by coworkers, and I have been so preoccupied with food that I cannot concentrate on anything else. The psychological torture of this disorder is constant.”
What the examiner listens for:
Distorted body image, overvaluation of shape and weight, cognitive preoccupation with food and body, associated depressive and anxiety symptoms, and emotional dysregulation.
Understatements to avoid:
Do not present as 'recovered' if you are still experiencing significant body image disturbance or cognitive preoccupation. These are active symptoms that affect functioning even when visible behaviors are less frequent.
Common Mistakes to Avoid
Minimizing symptom frequency to avoid embarrassment or shame
Bulimia Nervosa carries significant shame and stigma. Veterans often underreport binge-purge frequency, compensatory behavior types, and functional impairment during the exam.
Instead: Prepare specific numbers and examples before the exam. Know your average weekly binge-purge frequency, how many days last year you were unable to function, and specific examples of occupational and social impairment. Report your actual experience, not your best behavior.
Impact: All rating levels - minimization is the single greatest risk factor for an inaccurately low rating.
Failing to track and report incapacitating episode duration
The General Rating Formula for Eating Disorders is heavily dependent on total weeks of incapacitation per year. Veterans often cannot recall or have not tracked this information, resulting in the examiner underestimating severity.
Instead: Before the exam, review your calendar, medical records, work absence records, and mental health treatment notes to reconstruct how many total days or weeks you were incapacitated by your eating disorder in the past 12 months. Present this as a specific estimate.
Impact: 10%, 30%, and 50% thresholds - incapacitation duration is the primary differentiator at these levels.
Not documenting hospitalizations for physical complications
Hospitalizations for tube feeding or parenteral nutrition directly support a 100% rating. Veterans may not connect emergency or inpatient care for electrolyte imbalances, cardiac events, or malnutrition to their eating disorder claim.
Instead: Gather all records of hospitalizations, emergency room visits, or intensive outpatient treatment related to your eating disorder or its physical complications. Bring copies to the exam or ensure VA has requested them.
Impact: 100% - hospitalization criteria are the primary pathway to the highest rating level.
Presenting only physical symptoms and omitting psychiatric and functional impact
Veterans sometimes focus on the physical aspects of Bulimia (weight, dental damage, GI issues) while underreporting the psychiatric, cognitive, and social impairment, which drives the rating under 38 CFR - 4.130.
Instead: Prepare specific examples of how Bulimia Nervosa has impaired your occupational functioning, social relationships, daily activities, and mental health. The examiner needs to assess functional impairment, not just physical symptoms.
Impact: 30%, 50%, and 100% - functional impairment criteria determine these levels.
Appearing overly composed or high-functioning during the exam
Many individuals with Bulimia Nervosa are practiced at appearing functional - they have hidden the disorder for years. Presenting as well-composed during the exam may lead the examiner to underestimate severity.
Instead: Be honest about how you feel, including anxiety, shame, or distress during the exam. Communicate that the ability to appear composed during a clinical interview does not reflect your functioning during a typical week.
Impact: All levels - examiner's clinical impression significantly influences the final assessment.
Failing to describe the full range of compensatory behaviors
Veterans may disclose vomiting but omit laxative abuse, diuretic misuse, fasting, or compulsive exercise, each of which contributes to the severity picture and may produce additional ratable secondary conditions.
Instead: Prepare to disclose all compensatory behaviors you have used, including those you may currently be using less frequently. Report the range and peak frequency of each behavior.
Impact: All rating levels - completeness of behavioral history affects both the diagnosis confirmation and severity assessment.
Not connecting service to the onset or exacerbation of the eating disorder
The nexus between military service and Bulimia Nervosa must be established. Veterans may not articulate how military culture, trauma, stress, food control in the military environment, or service-connected PTSD contributed to the eating disorder.
Instead: Clearly articulate when symptoms began relative to your military service. Describe any in-service stressors, traumas, military culture pressures (weight standards, physical appearance requirements, hypervigilance around food), or service-connected conditions that contributed to or worsened the disorder.
Impact: Service connection itself - this affects whether a rating is granted at all.
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to a thorough C&P examination that accurately reflects your current symptoms and functional impairment. An examination that fails to address the relevant rating criteria can be challenged as inadequate.
- You have the right to request a same-sex examiner in advance of your appointment. Contact VA scheduling to make this request.
- In most states, you have the right to record your C&P examination. Check your state's recording consent laws and inform the examiner at the start of the appointment if you intend to record.
- You have the right to submit a written statement to VA prior to your exam documenting your symptoms, functional impairment, and relevant history (VA Form 21-4138 - Statement in Support of Claim).
- You have the right to have a VSO representative or accredited claims agent assist you in preparing for and following up on your examination.
- You have the right to request a copy of the completed DBQ through your VA eFolder once it has been filed. Review it carefully for accuracy.
- If the examiner's opinion is inadequate, unsupported, or clearly contrary to your reported symptoms and medical evidence, you have the right to challenge it through a Notice of Disagreement, Higher-Level Review, or by requesting a new examination.
- You have the right to submit independent medical opinions (IMOs) from private clinicians to rebut or supplement the C&P examiner's findings.
- You have the right to have buddy statements (lay evidence) from family members, friends, or coworkers who have observed your symptoms considered as part of your claim.
- You have the right to claim secondary service-connected conditions that result from your Bulimia Nervosa, including dental conditions, cardiac arrhythmias, esophageal disorders, kidney disease, and gastrointestinal complications.
- Under the PACT Act and general VA regulations, VA has a duty to assist you in developing your claim, including obtaining relevant medical records and scheduling adequate examinations.
- You are not required to disclose your Social Security Number to the examiner beyond what is already in your VA file, and you have privacy rights regarding sensitive health information under HIPAA.
Related Conditions
- Major Depressive Disorder Highly comorbid with Bulimia Nervosa. Depression frequently co occurs and may be secondary to the eating disorder. If depression developed or worsened as a result of service connected Bulimia Nervosa, it may be ratable as a secondary service connected condition.
- Post-Traumatic Stress Disorder (PTSD) PTSD and Bulimia Nervosa frequently co occur, particularly among veterans with histories of military sexual trauma (MST). PTSD may have contributed to the development of the eating disorder, or both may have a common traumatic etiology. Each condition is separately ratable under 38 CFR 4.130.
- Generalized Anxiety Disorder Anxiety disorders commonly co occur with Bulimia Nervosa. Anxiety may drive binge purge cycles and may be separately ratable if it is a distinct condition or secondary to the service connected eating disorder.
- Dental and Oral Conditions Chronic exposure of tooth enamel to stomach acid from purging causes significant dental erosion and decay. These dental conditions may be ratable as secondary service connected conditions to service connected Bulimia Nervosa under DC 9999 9XXX by analogy.
- Gastroesophageal Reflux Disease (GERD) / Esophageal Conditions Repeated vomiting associated with Bulimia Nervosa causes esophageal damage, GERD, and in severe cases, Mallory Weiss tears or Barrett's esophagus. These gastrointestinal conditions may be ratable as secondary to service connected Bulimia Nervosa.
- Cardiac Arrhythmias Electrolyte imbalances (particularly hypokalemia) from purging behaviors can cause cardiac arrhythmias. If cardiac conditions developed as a result of service connected Bulimia Nervosa, they may be ratable as secondary service connected conditions.
- Substance Use Disorder Substance use disorders co occur with Bulimia Nervosa at elevated rates, particularly alcohol use disorder. If substance use disorder developed as a result of or is etiologically linked to service connected Bulimia Nervosa, secondary service connection may be pursued.
- Anorexia Nervosa Anorexia and Bulimia Nervosa may occur in the same individual across different time periods (diagnostic crossover) or concurrently. Both are evaluated using the General Rating Formula for Eating Disorders under 38 CFR 4.130 but are assigned separate diagnostic codes (9520 and 9521).
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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.