Bulimia Nervosa
Bulimia nervosa involves cycles of binge eating followed by compensatory behaviors such as self-induced vomiting, laxative misuse, or excessive exercise. VA rates it under the eating disorders formula, based on weight loss and incapacitating episodes rather than occupational and social impairment.
How the VA rates it
Bulimia uses the eating disorders formula in 38 CFR 4.130 (0, 10, 30, 60, or 100 percent), driven by self-induced weight loss below expected minimum weight and the annual duration of incapacitating episodes - periods when bed rest and physician treatment are required. Because many people with bulimia maintain near-normal weight, ratings above 10 percent can be hard to reach without documented weight loss; the 10 percent level requires only binge-purge behavior with limited incapacitating episodes.
Rating criteria by percentage
Rated up to 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.
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.
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.
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 diagnosed eating disorder and incapacitating episodes of up to two weeks total duration per year.
A diagnosed eating disorder with binge eating followed by purging or other weight-gain prevention measures, or resistance to weight gain, but without incapacitating episodes.
What those terms mean
- incapacitating episode
- — A flare-up so bad that a doctor prescribed bed rest for it. The VA counts how many days of doctor-prescribed bed rest you had in the past year.
Secondary condition strategy
Commonly claimed secondary to this
Conditions veterans often develop from this one — each can be its own rating under 38 CFR 3.310.
- GERD — Recurrent self-induced vomiting damages the esophagus and lower esophageal sphincter; GERD and esophagitis are common medical complications claimable as secondary.
- Dental erosion — Stomach acid from repeated vomiting erodes tooth enamel - a well-recognized complication of bulimia.
- Anemia — Nutritional deficiency and electrolyte disturbance from purging can contribute to anemia.
This is often secondary to
If you already have one of these service-connected, it may support connecting this condition.
- PTSD — Bulimia frequently develops secondary to trauma, including military sexual trauma, and can be claimed secondary to service-connected PTSD.
- Major Depressive Disorder — Depression commonly precedes or aggravates binge-purge cycles.
Evidence that strengthens this claim
- Get a formal eating disorder diagnosis in your treatment records - the 10 percent level requires the diagnosis plus documented binge-purge behavior even without significant weight loss.
- Document incapacitating episodes with dates: the formula counts only periods where a physician required bed rest and treatment.
- Medical complications (esophagitis, dental erosion, electrolyte abnormalities in lab work) both corroborate the severity of the disorder and can support separate secondary claims.
- If the condition traces to military sexual trauma, marker evidence from service records (performance changes, transfer requests) supports service connection.
Rating rules to know
Eating disorders are rated under their own formula, separate from the single combined mental health rating under the general formula. A bulimia rating can coexist with a general-formula rating such as PTSD or depression, but overlapping symptoms cannot be double-counted (38 CFR 4.14). Anorexia and bulimia are not rated as two separate eating disorder ratings for the same disability picture.
Related diagnostic codes
More mental health conditions
Post-Traumatic Stress Disorder (PTSD)
PTSD is a trauma-related condition marked by re-experiencing, avoidance, negative mood changes, and hyperarousal after an in-service traumatic event. VA rates it on how much it impairs your ability to work and maintain relationships, not on the severity of the trauma itself.
Rated up to 100%
Major Depressive Disorder
Major depressive disorder involves persistent low mood, loss of interest, and changes in sleep, energy, and concentration. VA rates it on the degree of occupational and social impairment, and it is one of the most common conditions claimed secondary to chronic pain.
Rated up to 100%
Generalized Anxiety Disorder
Generalized anxiety disorder involves persistent, excessive worry that is hard to control, with physical symptoms like restlessness, muscle tension, and sleep problems. VA rates it on how much it impairs work and social functioning.
Rated up to 100%
Chronic Adjustment Disorder
Chronic adjustment disorder is an ongoing emotional or behavioral reaction to a stressor - often a service-connected disability, injury, or major life change - with symptoms of depression, anxiety, or both. VA rates it the same way as every other mental disorder: by occupational and social impairment.
Rated up to 100%
Panic Disorder and/or Agoraphobia
Panic disorder involves recurrent, unexpected panic attacks and persistent fear of future attacks; agoraphobia is avoidance of places where escape feels difficult. VA rates both under one diagnostic code based on occupational and social impairment.
Rated up to 100%
Bipolar Disorder
Bipolar disorder causes cycling episodes of mania or hypomania and depression. VA rates it under the general mental disorders formula based on occupational and social impairment across the full cycle of the illness, not just during episodes.
Rated up to 100%
Disclaimer: Valor Rating is not affiliated with the U.S. Department of Veterans Affairs. This content is for educational purposes only and does not constitute legal or medical advice. Always review your documents carefully before submitting to the VA. For official guidance, consult an accredited VSO, claims agent, or attorney.