38 CFR Part 4 — 38 CFR § 4.130

Bulimia nervosa — VA Diagnostic Code 9521

Mental health

Diagnostic code

9521

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38 CFR § 4.130 lists Diagnostic Code 9521 as “Bulimia nervosa”. The schedule line does not end with a period, and the rating cell is empty. Diagnostic Code 9520, on the line above it, is “Anorexia nervosa”, also with no period and an empty rating cell. The table caption under those names is “Rating Formula for Eating Disorders.” Note 2 says ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders. Appendix B to Part 4 indexes “Bulimia nervosa.” The index adds the period. The catalog slug is dc-9521-bulimia-nervosa.

Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was last amended on 2026-08-27. On 2026-10-05 the titles list reports up to date as of 2026-10-02. The § 4.130 source note prints 79 FR 45100, Aug. 4, 2014.

The rating criteria at each level

Rating Formula for Eating Disorders — diagnostic codes 9520 and 9521

Rating %: 100

Criteria (verbatim). 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.

Rating %: 60

Criteria (verbatim). 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.

Rating %: 30

Criteria (verbatim). 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.

Rating %: 10

Criteria (verbatim). 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.

Rating %: 0

Rating %	Criteria (verbatim)
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.

Each formula line ends with a period. The 100 line is the only line that says “less than 80 percent” and the only line that says “parenteral nutrition or tube feeding.”

Note 1: An incapacitating episode is a period during which bed rest and treatment by a physician are required.

Note 2: Ratings under diagnostic codes 9201 to 9440 will be evaluated using the General Rating Formula for Mental Disorders. Ratings under diagnostic codes 9520 and 9521 will be evaluated using the General Rating Formula for Eating Disorders.

The table caption says “Rating Formula for Eating Disorders.” Note 2 calls the same formula the “General Rating Formula for Eating Disorders.”

The opening of § 4.130 says the nomenclature employed in this portion of the rating schedule is based upon the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and it points to § 4.125 for availability information. 38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just. 38 CFR § 4.14 says the evaluation of the same disability under various diagnoses is to be avoided, and that the evaluation of the same manifestation under different diagnoses is to be avoided. DC 9521 does print a 0 percent line.

Note 2 puts diagnostic codes 9201 to 9440 on the General Rating Formula for Mental Disorders. DC 9521 is not inside that span. The eating-disorder sentence is the sentence that names 9521.

The 2026-10-01 text of 38 CFR § 3.309 does not contain “bulimia” and does not assign DC 9521. This page does not add DC 9521 to a presumptive row. A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Source: 38 CFR § 4.130, Diagnostic Code 9521 and the Rating Formula for Eating Disorders, eCFR full-text XML for 2026-10-01.

What the words mean in your records

Two names, one formula

DC 9520 is “Anorexia nervosa”. DC 9521 is “Bulimia nervosa”. Note 2 sends both numbers to the eating-disorder formula. The formula lines are not divided into an anorexia column and a bulimia column.

Incapacitating episode

Note 1 says an incapacitating episode is a period during which bed rest and treatment by a physician are required. The 100, 60, 30, and 10 lines name a duration. The 0 line says “without incapacitating episodes.”

Caption and Note 2

The printed caption is “Rating Formula for Eating Disorders.” Note 2 says “General Rating Formula for Eating Disorders.” Both refer to the same five lines.

Evidence that speaks to each level

100

What the rater needs to see. Self-induced weight loss to less than 80 percent of expected minimum weight, incapacitating episodes of at least six weeks total duration per year, and hospitalization more than twice a year for parenteral nutrition or tube feeding.

Where that usually lives. The weight record, the physician’s bed-rest and treatment notes, and the hospital record.

60 or 30

What the rater needs to see. Self-induced weight loss to less than 85 percent of expected minimum weight, and the incapacitating-episode duration the line names: six or more weeks, or more than two but less than six weeks, total per year.

Where that usually lives. The same weight record and treatment notes.

10 or 0

What the rater needs to see. 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 a diagnosis of an eating disorder. The 10 line adds incapacitating episodes of up to two weeks total duration per year. The 0 line says without incapacitating episodes.

Where that usually lives. The examination and the treatment record.

Level	What the rater needs to see	Where that usually lives
100	Self-induced weight loss to less than 80 percent of expected minimum weight, incapacitating episodes of at least six weeks total duration per year, and hospitalization more than twice a year for parenteral nutrition or tube feeding.	The weight record, the physician’s bed-rest and treatment notes, and the hospital record.
60 or 30	Self-induced weight loss to less than 85 percent of expected minimum weight, and the incapacitating-episode duration the line names: six or more weeks, or more than two but less than six weeks, total per year.	The same weight record and treatment notes.
10 or 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 a diagnosis of an eating disorder. The 10 line adds incapacitating episodes of up to two weeks total duration per year. The 0 line says without incapacitating episodes.	The examination and the treatment record.

VA’s public DBQ list, checked October 5, 2026, names “Eating Disorders” under Psychological. It also names “Mental Disorders” as a separate form. The eating-disorders file is Eating Disorders.

The exam form

DC 9521 uses the eating-disorder formula. This page does not say the form replaces that formula. The mental-disorders form is the separate list entry Note 2 uses for codes 9201 to 9440.

Related codes and how they interact

Anorexia nervosa is the other eating-disorder number.

DC 9520 is “Anorexia nervosa”. DC 9521 is “Bulimia nervosa”. Note 2 names both codes and does not give them different percentages.

Secondary conditions and presumptions

The 2026-10-01 text of 38 CFR § 3.309 does not contain “bulimia” and does not assign DC 9521. This page does not add DC 9521 to a presumptive row.

A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Short answers

What is the VA rating for bulimia nervosa?

Under 38 CFR § 4.130, Diagnostic Code 9521 uses the Rating Formula for Eating Disorders. The formula prints 100, 60, 30, 10, and 0. Education only. VA decides on the evidence.

Does § 3.309 assign DC 9521?

No. The 2026-10-01 text of § 3.309 does not contain “bulimia” and does not assign diagnostic code 9521.

FAQ

How does VA rate bulimia nervosa under DC 9521?

Note 2 says ratings under diagnostic codes 9520 and 9521 use the eating-disorder formula. The formula prints 100, 60, 30, 10, and 0. DC 9521 does not print a percentage on its own name. Education only.

Does the mental-disorder formula apply to DC 9521?

No. Note 2 assigns the General Rating Formula for Mental Disorders to diagnostic codes 9201 to 9440. It assigns the eating-disorder formula to 9520 and 9521.

What is an incapacitating episode?

Note 1 says an incapacitating episode is a period during which bed rest and treatment by a physician are required.

Next steps

Read the decision for DC 9521 and which eating-disorder formula line it used.
The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. An accredited representative is at find a VSO.
Other mental-disorder codes are on the mental-health diagnostic-code index. The category page is mental health conditions.

Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.

Other codes in this body system

Nearby catalog entries in Mental health, ordered by diagnostic code number. All Mental health codes

Also: DC code lookup (tools) lists the same index in a compact layout.

Source: 38 CFR Part 4, Diagnostic Code 9521 • va.gov

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