[Federal Register Volume 67, Number 198 (Friday, October 11, 2002)]
[Proposed Rules]
[Pages 63352-63353]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-25995]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 3

RIN 2900-AK21


Definition of Psychosis for Certain VA Purposes

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

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SUMMARY: This document proposes to amend the Department of Veterans 
Affairs (VA) adjudication regulations to define the term ``psychosis.'' 
The term is used but not defined in certain statutes that provide 
presumptive service connection for compensation or health care 
purposes. The intended effect of this proposed amendment is consistent 
application of these statutory provisions.

DATES: Comments must be received on or before December 10, 2002.

ADDRESSES: Mail or hand-deliver written comments to: Director, Office 
of Regulations Management (02D), Department of Veterans Affairs, 810 
Vermont Ave., NW, Room 1154, Washington, DC 20420; or fax comments to 
(202) 273-9289; or e-mail comments to [email protected]. 
Comments should indicate that they are submitted in response to ``RIN 
2900-AK21.'' All comments received will be available for public 
inspection in the Office of Regulations Management, Room 1158, between 
the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (except 
holidays).

FOR FURTHER INFORMATION CONTACT: Caroll McBrine, M.D., Consultant, 
Regulations Staff (211A), Compensation and Pension Service, Veterans 
Benefits Administration, 810 Vermont Avenue, NW, Washington, DC 20420, 
telephone (202) 273-7284.

SUPPLEMENTARY INFORMATION: 

Statutory and Regulatory Provisions

    There are three sections in title 38, United States Code, that 
refer to psychosis in veterans and are pertinent to this regulation.
    Section 1112(a)(1) of title 38, United States Code, presumes that 
certain chronic diseases that become manifest to a compensable degree 
within one year of a veteran's separation from active service were 
incurred or aggravated during that service. The term ``chronic 
disease,'' as defined at 38 U.S.C. 1101(3), includes ``psychoses.'' 
Section 3.309(a) of title 38, Code of Federal Regulations, implements 
38 U.S.C. 1112(a)(1) and 1101(3).
    Section 1112(b)(8) of title 38, United States Code, presumes that a 
``psychosis'' that becomes manifest to a compensable degree at any time 
after service in a former prisoner-of-war was incurred or aggravated 
during that service. Section 3.309(c) of title 38, Code of Federal 
Regulations, implements this statutory provision.
    Section 1702 of title 38, United States Code, presumes that 
``active psychosis'' that develops in certain wartime veterans within 
two years of separation from active service was incurred during active 
service. This presumption is only for purposes of hospital, nursing 
home, domiciliary, and medical care.
    None of these statutory or regulatory provisions defines the term 
``psychosis'' or specifies which mental disorders are included in that 
category. In addition, the legislative histories of the relevant 
statutory provisions provide no guidance with regard to interpreting 
these terms.

Medical Interpretation

    VA's Schedule for Rating Disabilities requires that mental 
disorders be diagnosed according to the diagnostic criteria of the 
American Psychiatric Association's Diagnostic and Statistical Manual of 
Mental Disorders (APA Manual), Fourth Edition (DSM-IV). Although the 
term ``psychosis'' continues to be widely used, it has not served as an 
organizing principle in the APA Manual since 1980 when DSM-III was 
published. DSM-IV does not have a ``psychosis'' category of mental 
disorders.
    Appendix C of DSM-IV, at page 770, states that the term 
``psychotic'' has historically had a number of definitions, ``none of 
which has achieved universal acceptance.'' It therefore appears that 
the term ``psychosis,'' and its plural form ``psychoses,'' have no 
commonly accepted meaning.

Proposed Definition

    DSM-IV, Appendix A, pages 689 and 694-695, in addressing 
differential diagnoses of psychotic disorders, generally includes 
mental disorders in which at least one of the following psychotic 
symptoms is a defining feature: delusions; hallucinations; disorganized 
speech; or grossly disorganized behavior. In our judgment, these 
defining features are reasonable and appropriate for VA purposes.
    According to DSM-IV, pages 19 and 694-695, the following mental 
disorders contain at least one of the above-mentioned DSM-IV, Appendix 
A, psychotic symptoms: psychotic disorder due to a general medical 
condition; substance-induced psychotic disorder; schizophrenia; 
schizophreniform disorder; schizoaffective disorder; mood disorder with 
psychotic features; delusional disorder; psychotic disorder not 
otherwise specified; brief psychotic disorder; and shared psychotic 
disorder. If one of these conditions is diagnosed in a veteran, all 
other regulations involved in determining entitlement to service 
connection must be considered.
    We propose to add new Sec.  3.384 to title 38, Code of Federal 
Regulations, to state that for purposes of 38 CFR part 3, those 
conditions are defined as psychoses.

Unfunded Mandates

    The Unfunded Mandates Reform Act requires, at 2 U.S.C. 1532, that 
agencies prepare an assessment of anticipated costs and benefits before 
developing any rule that may result in an expenditure by State, local, 
or tribal governments, in the aggregate, or by the private sector of 
$100 million or more in any given year. This rule would have no 
consequential effect on State, local, or tribal governments.

Paperwork Reduction Act

    This document contains no provisions constituting a collection of 
information under the Paperwork Reduction Act (44 U.S.C. 3501-3520).

Regulatory Flexibility Act

    The Secretary hereby certifies that this regulatory amendment will 
not have a significant economic impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act, 5 
U.S.C. 601-612. The reason for this certification is that this 
amendment would not directly affect any small entities. Only VA 
beneficiaries could be directly affected. Therefore, pursuant to 5 
U.S.C. 605(b), this amendment is exempt from the initial and final 
regulatory flexibility analysis requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance Program Numbers

    The Catalog of Federal Domestic Assistance program number is 
64.109.

List of Subjects in 38 CFR Part 3

    Administrative practice and procedure, Claims, Disability benefits,

[[Page 63353]]

Health care, Pensions, Veterans, Vietnam.

    Approved: October 4, 2002.
Anthony J. Principi,
Secretary of Veterans Affairs.

    For the reasons set forth in the preamble, 38 CFR part 3 is 
proposed to be amended as follows:

PART 3--ADJUDICATION

Subpart A--Pension, Compensation, and Dependency and Indemnity 
Compensation

    1. The authority citation for part 3, subpart A continues to read 
as follows:

    Authority: 38 U.S.C. 501(a), unless otherwise noted.

    2. Section 3.384 is added under the undesignated center heading 
``Rating Considerations Relative to Specific Diseases'' to read as 
follows:


Sec.  3.384  Psychosis.

    For purposes of this part, the following conditions are considered 
psychoses:
    (a) Psychotic disorder due to a general medical condition;
    (b) Substance-induced psychotic disorder;
    (c) Schizophrenia;
    (d) Schizophreniform disorder;
    (e) Schizoaffective disorder;
    (f) Mood disorder with psychotic features;
    (g) Delusional disorder;
    (h) Psychotic disorder not otherwise specified;
    (i) Brief psychotic disorder; and
    (j) Shared psychotic disorder.

(Authority: 38 U.S.C. 501(a))


[FR Doc. 02-25995 Filed 10-10-02; 8:45 am]
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