38 CFR Part 4 — 38 CFR § 4.130
Bulimia Nervosa
dc-9521-bulimia-nervosa
Mental health
Diagnostic code
9521
Why your DC matters: DC 9521 is the exact code the VA uses to rate this condition. It determines which symptoms unlock which percentage, what evidence the rater looks for, and which secondaries are most likely to be approved.
Last verified against 38 CFR (eCFR Part 4):
Rating criteria (38 CFR Part 4)
Diagnostic code 9521 — Bulimia Nervosa — is listed under 38 CFR § 4.130 in 38 CFR Part 4. The paragraphs below summarize how this code is used; the official schedule text controls exact percentages, formulas, and notes.
Schedule summary (educational, not a substitute for the regulation): Educational index row from the rating schedule naming convention; confirm exact diagnostic code, effective date, and criteria in the current eCFR Part 4.
Exact rating criteria: Open Part 4 in the eCFR (link under “Official source” below). Locate your diagnostic code number (9521) in the correct body-system subpart, or use Find in Page (Ctrl+F / ⌘F) for “9521”. Copy the verbatim rating table, including any parenthetical notes, exceptions, and cross-references, for the version of Part 4 that applies to your effective date.
Effective dates & which schedule version applies
Which diagnostic code, percentage, and effective date apply depends on the facts of your claim and the version of the rating schedule in force for the period being decided. Generally, VA applies the schedule in effect at the specified time under 38 U.S.C. § 5110 and implementing rules, subject to exceptions (e.g., protected ratings, liberalizing law changes—see regulation and VA manual policy as applicable).
For older claims, the **current** eCFR may not match the text that applied years ago. If your decision references a prior percentage or code, compare against the Part 4 text **as of** your claim’s relevant dates; historical Federal Register / CFR snapshots may be needed for precise comparison.
The “Last verified” date on this page is when we last checked this educational summary against the electronic CFR—not the date of any VA policy or your personal claim decision.
Notes for your claim
Evidence: Show that your diagnosis and severity match the factors the schedule names for DC 9521 (e.g., measurements, frequency, treatment, functional loss), with medical and lay evidence as appropriate.
C&P exams: Results should reflect the schedule’s requirements (correct joints measured, correct formulas). If the exam omits required findings, consider submitting records or requesting clarification.
If you disagree with the DC, percentage, or effective date, review the Part 4 text for your period and consider a supplemental claim or appeal with a VA-accredited representative.
This site does not provide legal advice.
Official source
38 CFR Part 4 (eCFR) — locate diagnostic code 9521 in the subpart for your body system (use Find in Page if needed).
DC 9521 bulimia shares the same rating schedule as DC 9520 anorexia — weight loss + incapacitation + hospitalization tier the rating, NOT the General Rating Formula for Mental Disorders (§ 4.130). Veterans with deployment-stress-driven bulimia frequently get the diagnosis missed or absorbed into a PTSD or MDD rating. The play is the same as anorexia: explicit DSM-5 bulimia diagnosis on paper, then layer it onto any existing MH rating. Bulimia + PTSD don't pyramid — they rate independently under different formulas.
Rating Tiers — What Each Percentage Requires
| Rating | What It Takes | Evidence That Supports It |
|---|---|---|
| 100% | Self-induced weight loss to less than 80% of expected minimum weight, with incapacitating episodes of at least 6 weeks' total duration per year, and requiring hospitalization more than twice a year for parenteral nutrition or tube feeding. | Weight history < 80% expected + 6+ weeks/year incapacitation + 2+ hospitalizations/year with parenteral nutrition or tube feeding. |
| 60% | Self-induced weight loss to less than 85% of expected minimum weight with incapacitating episodes of 6 or more weeks' total duration per year. | Weight chart < 85% expected + 6+ weeks/year incapacitation. |
| 30% | Self-induced weight loss to less than 85% of expected minimum weight with incapacitating episodes of more than 2 but less than 6 weeks total duration per year. | Weight chart < 85% expected + 2-6 weeks/year incapacitation. |
| 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 2 weeks total duration per year. | DSM-5 bulimia diagnosis + binge/purge documentation + < 2 weeks/year incapacitation. |
| 0% | Binge eating followed by self-induced vomiting or other measures to prevent weight gain, or resistance to weight gain, with diagnosis but without incapacitating episodes. | DSM-5 diagnosis + behavioral documentation without incapacitation. |
What Qualifies Under DC 9521?
DSM-5 diagnosis of bulimia nervosa
Recurrent binge eating + compensatory behaviors (vomiting, laxatives, fasting, excessive exercise) + body image concern. Diagnosed by psychologist or psychiatrist.
Weight + incapacitation drive the tier
DC 9521 schedule (shared with DC 9520):
- • 0% — Binge/purge with diagnosis but no incapacitation
- • 10% — < 2 wks/yr incapacitation
- • 30% — < 85% expected weight + 2-6 wks/yr incapacitation
- • 60% — < 85% expected weight + 6+ wks/yr incapacitation
- • 100% — < 80% expected weight + 6+ wks/yr incapacitation + 2+ hospitalizations/yr for parenteral nutrition or tube feeding
Language Your Rater Needs to See
These are the exact (or near-exact) regulatory phrases that unlock specific tiers. If your DBQ or C&P report doesn't use this vocabulary, the rater may default to a lower percentage even when symptoms qualify.
“Hospitalization more than twice a year for parenteral nutrition or tube feeding”
100% gate. Requires both severe weight loss AND multiple hospitalizations specifically for nutritional rescue. Inpatient psychiatric admissions without nutritional rescue don't qualify for this specific 100% prong.
“Incapacitating episodes of 6 or more weeks' total duration per year”
Bridge to 60%. Includes inpatient stays, PHP, IOP, and bed rest. Total cumulative weeks per year is the gate.
“Binge eating followed by self-induced vomiting”
10% floor. Documented binge/purge behavior + DSM-5 diagnosis. Resistance to weight gain alone also qualifies — purging isn't strictly required.
Evidence Checklist — Specific to This Condition
Psychiatric DSM-5 diagnosis of bulimia nervosa
CRITICALFrom a psychologist or psychiatrist. DC 9521 specifically — distinct from DC 9520 anorexia (same schedule, different specific diagnosis).
Weight history with percent-of-expected calculation
CRITICALChart documenting weight over time + percentage below expected minimum. Drives 30/60/100% tiers.
Hospitalization records (especially for nutritional rescue)
CRITICAL100% requires 2+/year hospitalizations specifically for parenteral nutrition or tube feeding.
Treatment intensity log (PHP/IOP weeks)
IMPORTANTPartial hospitalization and intensive outpatient program weeks count toward incapacitation totals.
Medical complications workup
IMPORTANTDental erosion (chronic vomiting), esophageal injury, electrolyte derangements (hypokalemia), cardiac arrhythmia. Each rates separately.
C&P Exam Tips
Bring a chronological weight chart
Year-by-year with healthy baseline marked. Show percentage below expected minimum at worst point.
Bring hospitalization records with reason for admission
100% specifically requires admissions for parenteral nutrition or tube feeding. Document the indication clearly.
Don't minimize purging behaviors
Bulimia is shame-laden. Describe frequency, duration of episodes, and triggers honestly even if uncomfortable.
Document dental erosion and electrolyte issues
Each medical complication can be a separate rating.
Common Mistakes That Cost Veterans Points
Filing as 'PTSD with disordered eating' instead of bulimia
Bulimia is a separate diagnosis with its own DC and schedule. File DC 9521 separately on top of any existing MH rating.
Not documenting hospitalization indication for 100%
100% prong requires hospitalization for parenteral nutrition or tube feeding specifically. Generic psych admissions don't count for this gate (but may support incapacitation weeks).
Confusing DC 9521 with DC 9520
Same schedule, different specific diagnosis. File DC 9521 if your diagnosis is bulimia; DC 9520 if anorexia. Mixed-presentation cases may include both.
Missing medical complication secondaries
Dental erosion, esophageal injury, electrolyte issues — each can rate separately.
Tactical Plays
⚡ File bulimia ON TOP of PTSD — they don't pyramid
DC 9521 has its own schedule (weight loss + incapacitation + hospitalization), distinct from § 4.130 General Rating Formula. PTSD (DC 9411) and bulimia (DC 9521) rate independently.
⚡ Count every PHP / IOP week toward incapacitation
Outpatient treatment intensity adds up. Partial hospitalization, intensive outpatient programs, and bed-rest periods all count toward the weekly totals that drive the 30/60/100 tiers.
⚡ Stack medical complication secondaries
Dental erosion, esophageal injury, electrolyte issues, cardiac arrhythmia — each is potentially own rating. Run a full medical/dental workup before filing.
Secondary Conditions to File With This One
PTSD / MDD
STRONGDC 9411 / 9434
Eating disorders almost always coexist with PTSD or MDD. Different DCs, different formulas — they don't pyramid. File both.
Dental erosion from chronic vomiting
MODERATEChronic purging erodes tooth enamel and causes caries. Dental ratings under § 4.150 may apply.
Esophageal injury (esophagitis, stricture)
MODERATEChronic acid exposure from vomiting causes esophagitis. Rate under DC 7203/7204 if disabling.
Electrolyte derangements + cardiac arrhythmia
MODERATEDC 7011
Hypokalemia from purging can cause cardiac arrhythmia. Rate separately if documented.
Compensation Scenarios
2026 rates (effective Dec 1, 2025, per va.gov)
0% — single, no dependents
TOTAL
$0.00/mo
Bulimia diagnosis without incapacitation.
10% — single, no dependents
Base rating
$180.42
TOTAL
$180.42/mo
< 2 wks/yr incapacitation.
30% — single, no dependents
Base rating
$552.47
TOTAL
$552.47/mo
< 85% expected weight + 2-6 wks/yr incapacitation.
60% — single, no dependents
Base rating
$1,435.02
TOTAL
$1,435.02/mo
< 85% expected weight + 6+ wks/yr incapacitation.
100% — single, no dependents
Base rating
$3,938.58
TOTAL
$3,938.58/mo
< 80% expected weight + 6+ wks + 2+ nutrition hospitalizations/yr.
60% bulimia + 70% PTSD
Base rating
$2,362.30
TOTAL
$2,362.30/mo
Combined ~88% rounds to 90%. Eating disorder + PTSD stack — different DCs, different formulas.
Note: Amounts are approximations rounded to nearest dollar. Actual comp varies with effective date, dependents (spouse, children, parents — each adds), Aid & Attendance, and additional disabilities. Combined ratings use VA Math (§ 4.25), not simple addition.
Key Definitions
⚖️What's 'Expected Minimum Weight'?
Lower bound of healthy weight for height, age, frame size. Calculated from published reference tables — not just BMI. Provider should document the calculation.
📋Does bulimia rate under § 4.130 mental disorders formula?
No. DC 9521 has its own schedule based on weight loss, hospitalization, and incapacitating episodes. The General Rating Formula for Mental Disorders does NOT apply.
🏥What counts as 'incapacitating episode'?
Inpatient psychiatric admission, partial hospitalization (PHP), intensive outpatient (IOP), bed rest for medical complications. Outpatient treatment intensity counts toward weekly totals.
↔️Why isn't bulimia bundled with PTSD?
DC 9521 and DC 9411 are different codes with different rating formulas. They rate independently if both diagnoses are documented separately. Filing both is not pyramiding.
How to File Your Claim
Get DSM-5 bulimia nervosa diagnosis from psychologist/psychiatrist
Explicit 'bulimia nervosa' on paper — not 'eating disorder NOS' if a specific diagnosis fits.
Compile weight history with percent-of-expected calculation
Document lowest weight reached + percentage of expected minimum.
Pull all treatment records (inpatient, PHP, IOP)
Cumulative weeks/year drive the tier. For 100%, ensure 2+ hospitalizations include nutritional rescue documentation.
File 21-526EZ specifying 'bulimia nervosa (DC 9521)'
Separate line from any existing PTSD/MDD claim.
File medical complications as secondaries
Dental erosion, esophageal injury, electrolyte issues, cardiac arrhythmia.
Typical Claim Timeline
File initial claim
Day 0–7: Submit VA Form 21-526EZ with all medical evidence on file
VA acknowledges claim
Week 1–2: Receive confirmation letter and claim tracking number
C&P examination scheduled
Month 1–3: VA contracts an exam vendor and sends you appointment notice
Attend C&P exam
Bring your full evidence package; describe symptoms on your worst days, not your best
Decision & rating notice
Month 3–6: Decision letter with rating percentage and effective date
First payment & retro back pay
Within 15 days of decision; retroactive to claim date (or effective date if earlier)
Timeline varies by case complexity and VA regional office workload. Some claims resolve faster; others take longer.
Important Considerations
Does NOT pyramid with PTSD/MDD
Different DC, different formula. File DC 9521 separately on top of existing MH ratings.
100% requires hospitalization for nutritional rescue
Parenteral nutrition or tube feeding admissions specifically. Generic psych admissions don't qualify for this prong.
PHP/IOP weeks count toward incapacitation
Outpatient treatment intensity adds up. Track total weeks/year carefully.
Medical complications rate separately
Dental erosion, esophageal injury, electrolyte issues — pursue each as standalone rating.
Related Tools & Resources
Frequently Asked Questions
Is bulimia rated under the general mental health formula?
No — DC 9521 has its own schedule based on weight loss, hospitalization, and incapacitating episodes. It does NOT use the § 4.130 General Rating Formula for Mental Disorders.
Can I file bulimia AND PTSD?
Yes — different DCs, different formulas. They rate independently. Many veterans with deployment-stress eating disorders have both diagnoses.
What's the difference between DC 9520 and DC 9521?
Same rating schedule, different specific diagnoses. DC 9520 = anorexia nervosa. DC 9521 = bulimia nervosa. File under whichever specific diagnosis applies. Mixed-presentation cases may include both.
Do dental issues from chronic vomiting rate separately?
Yes — chronic purging erodes tooth enamel and causes caries. Dental ratings under § 4.150 may apply. File a dental secondary claim with documentation from a dentist.
Official Regulatory Source
Bulimia nervosa is rated under 38 CFR § 4.130, DC 9521 — shares the schedule with DC 9520 (anorexia).
38 CFR § 4.130 — Mental Disorders (eCFR) →Scroll to DC 9521. Note that 9520/9521 have their OWN schedule — NOT the General Rating Formula for Mental Disorders.
Next Steps
If your rating decision lists DC 9521, compare your current symptoms and documentation against the criteria above. Consider:
- Requesting a copy of your rating decision and C&P exam report from the VA
- Gathering all relevant medical records (VA and private providers)
- Documenting functional limitations and how they impact work and daily activities
- Obtaining a nexus letter if needed to establish or strengthen service connection
- Filing for secondary conditions that may be related to this primary condition
- Contacting a VA-accredited VSO, claims agent, or attorney to review your file
This is general educational information only — not legal or medical advice.
Also: DC code lookup (tools) lists the same index in a compact layout.
Source: 38 CFR Part 4, Diagnostic Code 9521 • va.gov
⚠️ Important Disclaimer
This page provides general educational information only based on public VA regulations (38 CFR) and va.gov resources. It is not legal, medical, or claims assistance. Ratings and service connections are decided case-by-case by the VA based on the individual veteran’s evidence. We do not prepare claims, generate documents, or provide personalized advice. Always consult a VA-accredited Veterans Service Organization (VSO), attorney, or your physician for help with your specific situation. Verify the latest rules on va.gov.