Huntington Disease (Chorea) — VA Disability Rating (DC 8106)

Diagnostic Code 8106 · 38 CFR §4.124a

What Is It?

Huntington disease is a progressive, fatal, autosomal dominant neurodegenerative disorder caused by expansion of a CAG trinucleotide repeat in the huntingtin gene. It typically begins between the ages of 30 and 50 with progressive choreiform movements, cognitive decline, and psychiatric symptoms — depression, anxiety, irritability, psychosis — with complete loss of function over 15 to 20 years from onset. Because the mutation is inherited, direct causation by service is not the usual pathway; aggravation is recognized where service clearly accelerated onset or progression, and some veterans first develop symptoms during active duty. 38 CFR §4.124a opens the neurological schedule with a bracketed instruction: disability from the diseases it lists "may be rated from 10 percent to 100 percent in proportion to the impairment of motor, sensory, or mental function," referring the rater to the appropriate body system of the schedule for each manifestation. Inside the 8000–8025 block the schedule prints either a single flat percentage, a single minimum rating, or no percentage at all — there is no severity ladder anywhere in it. A Note closing the block adds two conditions: the minimum ratings for residuals require ascertainable residuals, and when a rating above the minimum is assigned, the diagnostic codes used as the basis of that evaluation must be cited alongside the code identifying the diagnosis. DC 8106's own rating cell is empty and its entry reads: "Rate as Sydenham's chorea. This, though a familial disease, has its onset in late adult life, and is considered a ratable disability." So the table that governs is DC 8105's — five steps, 100 / 80 / 50 / 30 / 10 — and the second sentence of that entry is worth reading twice, because it is the schedule saying in its own words that a familial disease of adult onset is ratable.

Rating Criteria

Evidence Needed

Genetic testing confirming CAG repeat expansion in the huntingtin gene is the definitive diagnostic test. A neurology consult documenting the motor, cognitive, and psychiatric features supports the evaluation, MRI showing caudate atrophy supports the diagnosis, and neuropsychological testing characterizes the cognitive decline. Because the schedule rates this code on five undefined severity steps, the evidence that decides the percentage is descriptive rather than numeric: an examination that records the movements at rest and with purposeful movement, and an account of what they and the cognitive changes prevent. Records of psychiatric treatment, antichorea medication such as tetrabenazine or deutetrabenazine, and functional assessments establish the disease state. Service medical records documenting onset during active duty or in-service worsening support the nexus.

C&P Exam Tips

Bring genetic testing results, neurology and neuropsychology consults, brain imaging, and the medication history. Demonstrate the chorea both during quiet sitting and during purposeful movement. Because the rating turns on five severity words the schedule never defines, the specific description is what carries the claim — say what tasks you can no longer complete, what work or activities you have given up, and how memory and decision-making have changed, rather than letting the examination settle on an adjective. Address the psychiatric component directly; depression and irritability are characteristic features and warrant separate evaluation. If you need any assistance with activities of daily living, document the level required, because that drives the SMC evaluation.

How to File

File VA Form 21-526EZ listing Huntington disease under DC 8106 and reference 38 CFR §4.124a. Attach genetic testing, the neurology consult, neuropsychological testing, brain imaging, and the medication history. The service-connection theory is typically aggravation or in-service onset rather than direct causation, so document the in-service onset or worsening explicitly. As the disease progresses, file cognitive decline, depression, and dysphagia separately, and request SMC evaluation when functional losses justify it.

Common Mistakes

Expecting DC 8106 to carry a table of its own. Its rating cell in §4.124a is empty and the entry says to rate it as Sydenham's chorea, so the governing steps are DC 8105's 100 / 80 / 50 / 30 / 10. Filing without genetic testing, which is the standard for confirming the diagnosis. Missing the aggravation pathway where service accelerated onset. Letting an examination summarize the movements with a severity word and no description, when those words are the entire criteria.

Frequently Asked Questions

What table is Huntington disease rated on?

DC 8106's own rating cell in 38 CFR §4.124a is empty. The entry reads: "Rate as Sydenham's chorea. This, though a familial disease, has its onset in late adult life, and is considered a ratable disability." So the governing table is DC 8105's five steps — pronounced, progressive grave types at 100 percent; severe at 80; moderately severe at 50; moderate at 30; and mild at 10. DC 8107, acquired athetosis, is routed into the same table by its own one-line entry, "Rate as chorea."

Can a genetic disease be service-connected?

The mutation itself is not caused by service, so direct causation is not the usual pathway. Two others are recognized: aggravation, where service accelerated symptom onset or progression beyond its natural course, supported by a nexus opinion; and in-service onset, where symptoms first appeared during active duty. The schedule's own language helps here — the DC 8106 entry says in terms that a familial disease with onset in late adult life "is considered a ratable disability." Both pathways benefit from a representative experienced with genetic-disease claims.

What benefits flow to family members?

Huntington disease is autosomal dominant, so each child of an affected veteran has a 50 percent chance of inheriting the mutation. The disability rating itself does not extend benefits to family members beyond the standard dependency and survivor frameworks. Genetic counseling for children is appropriate but sits outside the VA disability system and is typically pursued through civilian healthcare.