Infections & Immune — VA Disability Ratings

How Infections & Immune conditions are rated

Infectious diseases, immune disorders and nutritional deficiencies are rated under 38 CFR §4.88b, diagnostic codes 6300 through 6354. The schedule covers infections such as malaria, brucellosis, Lyme disease, Q fever and miliary tuberculosis, nutritional deficiencies such as beriberi and pellagra, systemic lupus, HIV-related illness, and chronic fatigue syndrome, whose diagnostic requirements are set out in §4.88a.

Most infections here use the General Rating Formula for Infectious Diseases: 100% "for active disease," and then, "after active disease has resolved, rate at 0 percent for infection" and rate any residual disability "within the appropriate body system." Many codes' notes give examples of residuals. Lyme disease lists arthritis, Bell's palsy, radiculopathy, and ocular or cognitive dysfunction, and Campylobacter lists Guillain-Barre syndrome, reactive arthritis and uveitis. The note at the top of §4.88b also points the rater to the long-term health effects potentially associated with nine named infections, as listed in §3.317(d). After the active phase, the rating can come down to whether each residual has been identified and rated under its own code.

A few codes set how long 100% lasts and require a VA examination before it changes. For visceral leishmaniasis (DC 6301) and leprosy (DC 6302), the 100% rating continues after treatment ends, with a mandatory VA examination six months later. Nontuberculosis mycobacterium infection (DC 6312) stays at 100% "for the duration of treatment," and hyperinfection syndrome (DC 6325) "through active disease," each followed by a mandatory VA exam. Any change based on these examinations is subject to §3.105(e). Schistosomiasis (DC 6326) runs the other way, at 0% for acute or asymptomatic chronic disease.

Some codes have criteria of their own. Avitaminosis and pellagra run from 10% to 100% on listed symptoms, and beriberi is rated 30, 60 or 100 percent while active. Systemic lupus (DC 6350) is rated 10, 60 or 100 percent mainly on exacerbations, or on combined residuals, "whichever method results in a higher evaluation." HIV-related illness (DC 6351) runs from 0% for asymptomatic infection to 100%, with levels tied to symptoms, T4 cell counts, "approved medication(s)," and AIDS-defining infections. Diagnosed psychiatric illness, central nervous system manifestations, opportunistic infections and neoplasms may be rated separately "if a higher overall evaluation results," provided the symptoms do not overlap.

Chronic fatigue syndrome (DC 6354) is rated on "debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms." Most levels offer two routes: how far nearly constant symptoms restrict routine daily activities compared with the pre-illness level, or how many weeks of incapacitation a year symptoms that "wax and wane" cause. 10% is at least one but less than two weeks, or "symptoms controlled by continuous medication," and 60% is at least six weeks. At 100%, symptoms "restrict routine daily activities almost completely." Under the note, "incapacitation exists only when a licensed physician prescribes bed rest and treatment," so dated records of those prescriptions can matter.

One page on this hub is rated under another section. Hepatitis C is DC 7354 in the digestive schedule, §4.114, which reads "Rate under DC 7345 (Chronic liver disease without cirrhosis)." The Gulf War illness page uses the DC 6354 criteria above.