Sydenham Chorea — VA Disability Rating (DC 8105)

Diagnostic Code 8105 · 38 CFR §4.124a

What Is It?

Sydenham chorea is an autoimmune movement disorder that follows infection with group A streptococcus, the same bacterium behind strep throat and rheumatic fever. It is part of the rheumatic fever spectrum and usually presents in children and adolescents weeks to months after the initial infection, with rapid involuntary movements of the face, hands, and feet, plus emotional lability, hypotonia, and dysarthria. Most cases resolve within several months, but a subset persists or recurs in adulthood. For veterans the relevant cases are a childhood diagnosis that recurred or worsened during service, or an adult-onset case following a documented in-service strep infection. 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 8105 is one of the few codes in §4.124a with a real table of its own: five steps, 100 / 80 / 50 / 30 / 10, keyed to severity and nothing else. It matters well beyond this page, because DC 8106 (Huntington's chorea) and DC 8107 (acquired athetosis) are both routed into it.

Rating Criteria

Evidence Needed

A neurology diagnosis distinguishing Sydenham chorea from other movement disorders is the anchor. Documentation of antecedent streptococcal infection — throat culture, anti-streptolysin O titer, anti-DNase B titer — supports the diagnosis when contemporaneous. Cardiac evaluation rules out rheumatic carditis, which can coexist and is evaluated separately. Because the five steps are set out by severity alone with no defining criteria, the evidence that decides the percentage is descriptive: video documentation of the movements, an examination that records their distribution, amplitude, and frequency at rest and with purposeful movement, and a clear account of what they prevent. Treatment records covering antibiotic prophylaxis, corticosteroids or IVIG, and movement-suppressing medication demonstrate the management burden. Service medical records establish the in-service infection or the in-service worsening.

C&P Exam Tips

Bring the neurology diagnosis, antibody titers, cardiac evaluation, video documentation, and the medication history. The schedule gives the examiner five severity words and no definitions, so the written description is the rating — ask that the examination record the movements specifically rather than summarizing them, and describe the functional consequences in concrete terms: what you cannot hold, write, or do without help, and what the movements do to speech and swallowing. Sydenham chorea is uncommon in adults, so a clear diagnosis matters; the examiner should distinguish it from Huntington's chorea at DC 8106, drug-induced chorea, and post-stroke chorea. If rheumatic fever cardiac involvement is present, request separate evaluation under the cardiac codes.

How to File

File VA Form 21-526EZ listing Sydenham chorea under DC 8105 and reference 38 CFR §4.124a. Attach the neurology diagnosis, antibody titers, cardiac evaluation, treatment history, and any video documentation. If rheumatic fever cardiac or joint involvement is present, file those separately under their own codes. If service connection runs through aggravation of a pre-service case, frame the claim that way and document the in-service worsening explicitly.

Common Mistakes

Filing without documentation of the antecedent streptococcal infection, leaving the diagnosis open to challenge. Letting an examination summarize the movements as "mild" or "moderate" without describing them, when those words are the entire rating criteria and an undescribed presentation defaults downward. Missing the rheumatic heart disease claim when an echocardiogram has documented valvular involvement. Treating the behavioral and emotional residuals as part of the chorea rating instead of claiming them separately.

Frequently Asked Questions

What are the rating levels for Sydenham chorea?

38 CFR §4.124a sets out five: pronounced, progressive grave types at 100 percent; severe at 80; moderately severe at 50; moderate at 30; and mild at 10. A Note directs the rater to consider rheumatic etiology and complications. The schedule defines none of the five words further, which is why the descriptive detail in the examination decides the outcome.

Is Sydenham chorea really a veteran-relevant condition?

It is uncommon in adult veterans, because it typically presents in children and adolescents and resolves within months. The relevant cases are a childhood history whose chorea recurred during active duty, supporting an aggravation theory; an adult-onset case following a documented in-service strep infection, supporting direct service connection; and persistent residuals from an episode that occurred during service. The code remains in the schedule for these situations — and because two other codes are rated on its table.

How is Sydenham chorea different from Huntington chorea?

Sydenham chorea is post-infectious, autoimmune, usually reversible, and most often pediatric. Huntington's chorea at DC 8106 is a progressive, autosomal dominant genetic disorder of adult onset with chorea, cognitive decline, and psychiatric symptoms, and it is ultimately fatal. They share the choreiform movement and almost nothing else — but the schedule rates them on the same table, because DC 8106 reads "Rate as Sydenham's chorea."