Infectious, Immune, and Nutritional Conditions Rating Guide

Infections, immune disorders, and nutritional conditions look like very different problems, but they share one rating framework under 38 CFR § 4.88. Many are rated 100 percent while the disease is active, then re-rated on what they leave behind once the active phase clears. This guide walks the whole path for this group of conditions: how service connection actually gets proven, the direct and secondary pathways (including the Gulf War presumption most of these claims rely on), what evidence wins, why these claims get denied, a filing checklist, what the claims process looks like step by step, how to read your decision letter, and what to do whether you win or you're denied. Learn the shared rules once and you understand how the VA scores this whole group, then use the directory below to open the detailed guide for your specific condition.

Last updated: July 2026 · Educational use only. Not legal advice. Verify current rules at VA.gov or eCFR.

The Rules That Decide These Claims

Infectious diseases, immune disorders, and nutritional deficiencies are rated under 38 CFR § 4.88b and 4.89. Instead of one fixed rating table, this group runs on a pattern: score the disease highly while it is doing active damage, then re-score it on the lasting harm once the active phase ends. A few rules shape how that plays out, and they decide far more of these claims than any single number does.

1. Active disease is often rated 100 percent

Many infectious diseases, for example active tuberculosis and certain other infections, are rated 100 percent while the disease is active. The rating then moves to the disease's residuals once the active phase resolves, usually after a mandatory review examination that confirms the disease is no longer active.

2. When the active phase clears, the rating shifts to residuals

Once the active disease is gone, the rating is based on the lasting damage it caused, for example lung, liver, or kidney residuals. Each residual is rated under the body system it affects, not under the infectious-disease code. A cleared infection that scarred the lungs, for instance, is then rated under the respiratory schedule.

3. Some conditions are rated on ongoing symptoms, not an active-versus-residual split

Not everything in this group follows the active-then-residual pattern. Some conditions are rated on ongoing symptoms and functional loss. Chronic fatigue syndrome (DC 6354), for example, is rated on how often and how severely the symptoms restrict your daily activity, not on whether a disease is "active." Fibromyalgia and irritable bowel syndrome, two other conditions frequently claimed alongside CFS, follow a similar symptom-based approach on their own diagnostic codes.

4. Nutritional deficiencies are rated on their effects

Nutritional deficiencies are rated on their measurable effects on the body. The rating follows the damage the deficiency causes, so the objective findings, not the deficiency label alone, drive the level.

5. Several conditions here are Gulf War and burn-pit presumptives

A number of conditions in this group are Gulf War and burn-pit presumptives. For covered veterans with qualifying service, the VA presumes the link to service, so you often do not have to prove the medical connection yourself. See the PACT Act guide and the Gulf War illness guide for who and what qualifies, and the service connection pathways section below for how the Gulf War presumption actually works as a filing strategy.

For how a condition in this group is actually rated over time, including the full chronic fatigue syndrome rating tiers, see Rating Criteria below.

Find the Guide for Your Condition

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific condition, open the dedicated guide:

Area	Guide	DC codes
Gulf War illness and chronic fatigue	Gulf War Illness Guide	6354
Infection-related cancers	Cancer Claims Guide	varies

For any code not listed here, including a specific infection, immune disorder, or nutritional deficiency, open its condition lookup page for the rating levels and Board data.

How Service Connection Works, At a High Level

Before getting into the specific pathways below, it helps to understand the three things every claim in this group ultimately has to show on the usual, direct path. This is the same basic test that applies to any VA disability claim, applied here to infectious, immune, and nutritional conditions.

A current diagnosis. A doctor must confirm you actually have the condition now, or had it while your claim was pending. Chronic fatigue syndrome carries an especially strict clinical definition: debilitating fatigue that cuts your daily activity by more than half for at least six months, with other causes ruled out, plus at least six of ten listed symptoms such as muscle aches, headaches, sore lymph nodes, and sleep problems (38 CFR § 4.88a). This is the single most common reason claims in this group fail, so make sure a diagnosis that actually meets the definition is in your file before you file.
An in-service event, or qualifying service. This can be an event, injury, illness, or toxic exposure documented during service, or, for Gulf War claims, verified service in the Southwest Asia theater (38 CFR § 3.303; 38 CFR § 3.317).
A medical nexus. A doctor's opinion connecting your current condition to service, explaining the reasoning rather than stating a bare conclusion.

You don't always have to prove all three. Under the Gulf War presumption you do not need a nexus opinion at all, VA presumes the connection once qualifying service and a matching diagnosis are established (38 CFR § 3.317). On a secondary claim, an already service-connected disability that caused or worsened your condition takes the place of the in-service event (38 CFR § 3.310). Knowing which of the three elements is actually contested in your case tells you where to focus your evidence. See the Service Connection Guide for how this test works generally.

What VA Looks For: Tests, Records, and Diagnostic Codes

Whether you are filing directly, under a presumption, or secondary to another condition, the record VA actually reviews centers on a small set of documents and data points.

Laboratory confirmation of the infection or immune disorder, the objective proof the diagnosis rests on.
Records dating the active phase and the residuals, so the file clearly shows when the disease was active and what damage remained afterward.
A symptom log for chronic fatigue syndrome, a dated record of how often and how severely symptoms restrict your daily activity, which is what sets the rating.
Proof of qualifying Gulf War or burn-pit service for the presumptive path, so VA can presume the link instead of asking you to prove it.
The diagnostic codes involved: DC 6354 for chronic fatigue syndrome, plus whatever code applies to a related condition claimed alongside it, for example fibromyalgia (DC 5025), irritable bowel syndrome (DC 7319), or a mental-health condition such as PTSD (DC 9411) or depression (DC 9434/9435) claimed as the cause of secondary CFS.
The matching DBQ for the condition, which structures the exam findings into the specific data points VA's rating schedule requires. For CFS, the examiner completes a rheumatology DBQ documenting symptom frequency and severity and how much your daily activity is restricted compared to before you were ill. See the DBQ guide.

Service Connection Pathways: Direct, Presumptive, and Secondary

Across published Board decisions for this group, claims succeed through a handful of well-documented pathways. Which one applies to you determines what evidence actually matters.

Direct Service Connection

A veteran demonstrates that the condition began during, or was caused by, active military service, supported by treatment records and a medical nexus opinion connecting the diagnosis to an in-service event or exposure. A memo conceding toxic exposure (see below) can supply that in-service event even when service records themselves are silent.

Direct connection through conceded toxic exposure

When VA formally concedes a toxic exposure, for example fuels, fumes, or solvents documented through a TERA (Toxic Exposure Risk Activity) memo, that concession can supply the in-service event on its own. Paired with a positive medical opinion tying your specific conditions to that exposure, this has supported direct service connection for chronic fatigue syndrome and related conditions filed together, such as sinusitis, rhinitis, fibromyalgia, and irritable bowel syndrome, in the same decision. See 38 CFR § 3.303 and the PACT Act guide.

Gulf War Presumption (medically unexplained chronic multi-symptom illness)

If you served in the Southwest Asia theater during the Persian Gulf War era, chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome are presumed related to service as a medically unexplained chronic multi-symptom illness, or MUCMI. You do not have to prove a nexus at all (38 USC § 1117; 38 CFR § 3.317). The PACT Act expanded the qualifying locations and removed the old filing deadline, so the illness can now appear at any time to any degree. This is the shortcut behind most CFS grants in the published record. See the Gulf War Illness Guide.

The presumption only covers unexplained illness. If your fatigue is already explained by a diagnosed condition, for example sleep apnea or a kidney transplant, CFS is not "medically unexplained" and the presumption does not apply. Rating both the known condition and a separate CFS claim for the same symptoms would also amount to pyramiding, rating the same disability twice (38 CFR § 3.317(a)(2)(ii); 38 CFR § 4.14).

Secondary Service Connection (38 CFR § 3.310)

A veteran demonstrates that the condition was caused or chronically aggravated by an already service-connected disability. You do not need an in-service event of your own, the connection runs through the condition VA has already service-connected. Across the published record, CFS has been granted as secondary to service-connected anxiety and PTSD, to an infectious disease such as malaria, and to fibromyalgia, and related whole-body conditions have been granted as secondary to a somatic symptom disorder. See our Secondary Service Connection Guide.

How the Board's Explore data breaks this down for CFS, by legal theory:

Service Connection by Aggravation

When a veteran had a documented pre-service condition in this group that was significantly worsened beyond its natural progression by military service, aggravation-based service connection under 38 CFR § 3.306 is available. This works alongside secondary aggravation under § 3.310(b): either a service event, or an already service-connected condition, can be the thing that made the pre-existing condition worse.

Rating Criteria: Chronic Fatigue Syndrome (DC 6354)

Chronic fatigue syndrome is the condition most often claimed in this group, and it illustrates rule 3 above: it is rated on ongoing symptoms and functional loss, not on an active-versus-residual split. It is rated under DC 6354, 38 CFR § 4.88b, on how much your symptoms restrict routine daily activity compared to your pre-illness level, or on how many weeks per year you're effectively incapacitated.

100%Nearly constant, near-total restriction

Symptoms are nearly constant and so severe that they restrict routine daily activities almost completely, and may occasionally prevent self-care.

60%Restricted to under half of pre-illness level

Symptoms are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level, or symptoms wax and wane, resulting in periods of incapacitation of at least six weeks total per year.

40%Restricted to 50-75% of pre-illness level

Symptoms are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or symptoms wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total per year.

20%Restricted by less than 25%

Symptoms are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or symptoms wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total per year.

10%Intermittent, or controlled by medication

Symptoms wax and wane, resulting in periods of incapacitation of at least one but less than two weeks total per year, or symptoms controlled by continuous medication.

Two ratings over time, one condition. For conditions that do follow the active-then-residual pattern (rule 1 and 2 above), one disease can carry a 100 percent rating during its active phase and a different rating on its residuals afterward. When the active phase ends and the 100 percent stops, filing for the residuals is a separate step, the residual damage does not rate itself automatically.

Evidence That Wins

Across the Board's published DC 6354 decisions, a private doctor's opinion in the file goes with a meaningfully higher grant rate than a VA-exam-only record, shown below.

A current diagnosis that actually meets the clinical definition. For CFS this means the six-month debilitating-fatigue threshold, other causes ruled out, and at least six of ten listed symptoms (38 CFR § 4.88a). A confirmed diagnosis from your own doctor, or a complete VA exam that actually addresses the criteria, is the single most important item in the file.

Proof of qualifying Gulf War service. Deployment records verifying Southwest Asia theater service let you claim the presumption and skip the nexus requirement entirely.

A private opinion that explains its reasoning and rules out other causes. A well-reasoned private opinion can outweigh a weaker VA opinion, particularly when the private examiner reviews the full record, rules out competing explanations for the fatigue, and cites supporting medical literature applied to your own facts. A bare conclusion with no explanation is given little weight, and an advocate's brief citing general literature is not a substitute for a doctor applying that literature to your specific facts (Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008)).

Claiming it as secondary to a condition you already have. If a disability you are already service-connected for caused or worsened your condition, you can win without an in-service event of your own. See the pathway cards above.

A dated symptom log. For CFS specifically, a record kept over time of how often and how severely symptoms restrict your daily activity is the evidence that most directly supports the rating level, because the rating itself is built around that frequency and severity.

Lay statements. First-person descriptions of your symptoms and functional limits, along with statements from people who observed your activity level change, contribute to the record and help establish onset and severity. See our Buddy & Lay Statements Guide.

Why These Claims Get Denied

Among the Board's classified service-connection denials for DC 6354, here is what claims most often fell short on. The gap is large: missing diagnosis is by far the leading reason, well ahead of missing nexus or missing in-service event.

No current diagnosis in the record. This is the single biggest reason claims in this group fail. Having symptoms, even severe ones, is not enough without a diagnosis that meets the clinical definition. Claims have been denied for exactly this reason even when a VA exam otherwise confirmed the veteran's Gulf War service and the exam simply marked "no" on the current-diagnosis question.
The veteran's own belief about the cause, without a doctor's opinion behind it. VA treats the medical cause of a condition like CFS as a question a non-doctor cannot answer alone. A personal belief that service caused the condition, without a supporting medical opinion, does not carry a direct claim.
Fatigue already explained by another diagnosed condition. The Gulf War presumption only covers illness that is medically unexplained. When fatigue is attributed to a known condition, the presumptive CFS claim is denied because the symptom is already accounted for elsewhere, and rating it again separately would double-count the same impairment.
A bare diagnosis, with nothing else. A diagnosis is only the first of the three elements. Even with a confirmed diagnosis, a claim still needs an in-service cause (or qualifying service) and a nexus connecting them, missing any one element results in denial (Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004)).
Missing a scheduled VA examination without good cause. VA then decides the service-connection claim on the existing record, and an increased-rating claim is denied outright as a matter of law (38 CFR § 3.655).

Common Mistakes

The section above covers what the evidence record is missing. These are procedural and presentation mistakes, separate from the missing-element problem, that show up often enough in the published decisions to call out on their own.

Not filing for the residuals. When the active disease resolves and the 100 percent ends, the lasting organ damage does not rate itself. Filing for the residuals is a separate step that is easy to miss.
Missing the Gulf War presumptive. An undiagnosed illness or chronic fatigue can qualify under the Gulf War presumptive, so covered veterans should not try to prove a medical link the law already presumes.
No symptom log. Without a dated record of how often symptoms flare and how bad they get, the frequency that sets a chronic-fatigue rating is left unproven.
Rating organ damage under the wrong schedule. Lung, liver, or kidney residuals belong under the system they actually affect, not under the infectious-disease code.
Relying on a note that just repeats what you told the provider. An opinion from a provider who did not independently examine you or review your records, and simply restates your own report, is given little to no weight.
Assuming subjective fatigue by itself is a disability. Pain or fatigue counts as a disability only if it causes functional impairment, for example to your earning capacity, reporting symptoms alone is not enough (Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018)).
Giving different accounts to different examiners. Reporting symptoms one way to a private examiner and a different way at the VA exam undermines the reliability of the whole record. Report your history the same way to everyone.
Waiting decades with nothing connecting the condition to service. A long gap with silent service records and no theory linking the condition to service weakens a direct claim considerably, especially when a later condition is instead traceable to a non-service-connected cause.

Do's and Don'ts

A condensed version of everything above, in the order it actually matters when you sit down to build your file.

Get a current diagnosis in writing from a qualified provider before you file, and confirm it actually meets the clinical definition for the condition you're claiming.
If you served in Southwest Asia, gather your deployment records and claim the Gulf War presumption for CFS, fibromyalgia, or IBS.
List every service-connected disability that could plausibly have caused or worsened your condition, and claim it as secondary.
Ask any private provider to review your records, examine you, explain their reasoning, and rule out other causes.
If VA has conceded a toxic exposure, point to it directly and ask the examiner for a full opinion tying your specific conditions to it.
Report for every scheduled VA examination and keep your mailing address and phone number current.
Tell every examiner the same consistent history of your symptoms and when they started.
Keep a dated symptom log if you're claiming chronic fatigue syndrome; the frequency and severity in that log is what sets the rating.
If you were denied before, file a Supplemental Claim with new and relevant evidence rather than starting over.

Don't

Don't assume symptoms alone prove a diagnosis, VA needs the clinical criteria actually documented.
Don't rely only on your own opinion about what caused it, causation for these conditions is treated as a medical question.
Don't claim CFS separately when your fatigue is already explained by another diagnosed condition, that path is closed and can amount to double-counting the same symptom.
Don't rely on a provider's note that just repeats what you told them, without an independent exam or record review it carries little weight.
Don't let your account of symptoms shift between examiners.
Don't skip a scheduled VA exam, VA can decide against you on the existing record alone.
Don't forget to file for the residuals once an active-phase 100 percent rating ends.
Don't wait decades to connect a condition to service with nothing in the file supporting the link.

Common Secondary Conditions

Infections and immune disorders rarely stay contained to one system. Because they can damage organs and wear a person down over time, one service-connected condition often opens the door to several secondary claims:

Organ residuals. After an infection resolves, the lung, liver, or kidney damage it left behind is rated under its own body system as a separate condition.
Chronic fatigue and pain. Lasting fatigue and pain can overlap with a mental-health condition, and each can be claimed in its own right.
Conditions from long-term immunosuppression. Treatments that suppress the immune system can lead to further conditions that may be claimed as secondary.
Depression secondary to a chronic condition. Living with a chronic infectious or immune condition can drive depression and anxiety, which can be claimed as secondary to the physical condition. See secondary conditions.

Each dedicated guide above shows the live Board grant rates for that condition's most common secondary pairings. For chronic fatigue syndrome specifically, here is what the current published record shows for DC 6354:

Conditions that can cause chronic fatigue syndrome (CFS as the secondary)

Claims where chronic fatigue syndrome was argued as secondary to an already service-connected condition. This is the "ways to connect via another condition" list, and PTSD and depression are by far the most common:

Conditions chronic fatigue syndrome can cause (CFS as the primary)

Conditions veterans have claimed as caused or aggravated by a service-connected chronic fatigue syndrome, in other words, conditions secondary to CFS once CFS itself is already service-connected:

Quick Checklist Before You File

Bring these together before you submit anything.

A current diagnosis in writing from a qualified provider that actually meets the clinical definition for the condition you're claiming.
If you served in Southwest Asia, your deployment records, so you can claim the Gulf War presumption for CFS, fibromyalgia, or IBS.
A list of every service-connected disability that could plausibly have caused or worsened your condition, to claim it as secondary.
A private opinion from a provider who reviewed your records, examined you, explained the reasoning, and ruled out other causes.
Documentation of any conceded toxic exposure (a TERA memo or similar), if it applies to your case.
A dated symptom log if you're claiming chronic fatigue syndrome, showing frequency and severity of flare-ups.
A personal statement describing your symptoms and their onset, consistent with everything else in your file.
If your fatigue is already explained by another rated condition, focus your claim there rather than filing CFS separately.
If you were denied before: new and relevant evidence for a Supplemental Claim, not just a repeat of what was already considered.

For the mechanics of actually submitting the claim, see the Standard Claim Guide and the Fully Developed Claim Guide (filing with all your evidence up front can speed up the decision).

The Claims Process, Step by Step

Once you file, your claim moves through a series of hand-offs. Understanding who does what helps you know who to contact, and what to expect, at each stage.

You file the claim. Directly with VA, through VA.gov, or with the help of an accredited representative.
VA acknowledges the claim and assigns it for development. A Veteran Service Representative (VSR) is assigned to gather your service treatment records, VA and private medical records, and any other evidence needed.
The VSR orders a Compensation & Pension (C&P) exam if one is needed. Most claims in this group require one, especially where the current diagnosis or its severity is in question.
The C&P exam is conducted. By a VA clinician or a contracted examiner, who completes a Disability Benefits Questionnaire (DBQ) documenting the diagnosis, severity, and, where relevant, a nexus opinion.
The file goes to a Rating Veteran Service Representative (RVSR), the "rater." The rater reviews the complete file, including the exam results, and decides whether service connection is warranted and at what percentage.
A senior reviewer may review the decision before it's finalized, depending on the complexity of the claim.
VA issues the decision letter. This states whether the claim is granted or denied, the rating percentage if granted, and the reasons behind the decision.
If you disagree, you choose an appeal lane. Higher-Level Review, Supplemental Claim, or a Board appeal, covered later in this guide.

Who's who: VSO vs. VSR vs. Rater vs. C&P Examiner

Your VSO

An accredited representative from a veterans service organization, or an accredited attorney or claims agent. Not a VA employee. Helps you prepare, gather evidence, and file, and can represent you through an appeal. Has no authority to decide your claim.

VSR (Veteran Service Representative)

VA staff who "develops" your claim: requests records, schedules the C&P exam, and assembles the file. Does not decide the rating.

Rater (RVSR)

VA staff who reviews the completed file and makes the actual decision, service connection or denial, and the percentage. This is the person whose judgment the decision letter reflects.

C&P Examiner

A VA clinician or a contracted medical examiner who conducts the exam and completes the DBQ. Documents findings and, where asked, a nexus opinion. Does not decide the claim.

For the full walkthrough of every stage with more detail, see Inside Your Claim and Claim Stages.

DBQs and Your C&P Exam

A Disability Benefits Questionnaire (DBQ) is the standardized form an examiner completes for your condition, it structures the exam findings into the specific data points VA's rating schedule requires. For chronic fatigue syndrome, the examiner uses a rheumatology DBQ and documents your reported energy levels, how much your daily activity is restricted compared to before you were ill, and how often you have "crash" periods where you're effectively bedridden. See the DBQ Guide for how these forms work, including whether a private DBQ completed by your own doctor can be submitted instead of relying solely on a VA exam.

Before your C&P exam, bring specific examples of activities you've had to give up or reduce, describe both your worst days and your best days rather than an averaged impression, and be consistent with what's already in your medical records and prior statements. For a full walkthrough of what to expect and how to prepare, see the C&P Exam Prep Guide.

Reading Your Decision Letter, and What to Do If Denied

Your decision letter has two parts: a narrative section explaining the reasoning (often called "reasons and bases"), and a codesheet showing the actual rating percentage, the effective date, and the diagnostic code used. See the Reading Your Decision Letter Guide for how to find and interpret each part, or use the Letter Interpreter tool to upload your own letter and get a plain-English breakdown.

If your claim is denied, or the rating is lower than you expected, you have three main lanes:

Supplemental Claim: refile with new and relevant evidence, such as a new diagnosis, nexus opinion, or symptom log. See Supplemental Claim Guide.
Higher-Level Review (HLR): a senior reviewer looks at the same evidence again for a difference of opinion, no new evidence is added. See HLR Guide.
Board Appeal: your case goes to a Veterans Law Judge at the Board of Veterans' Appeals, with options for a direct review, an evidence docket, or a hearing. See Board Appeal Guide.

Not sure which lane fits your situation? See the Appeals decision guide for a side-by-side comparison of all three.

After You Win: Ratings, Effective Dates, and Maintaining Your Rating

A grant is not always the end of the story. Keep your treatment consistent, continued follow-up and, for CFS, an ongoing symptom log, protects you if VA schedules a future reexamination. Not every rating gets reexamined; understand when a rating becomes protected from future review (including Permanent and Total status) and what to do if VA proposes to reduce it. See Protect Your Rating and Future Reexaminations for the specifics.

A few rating and effective-date rules come up often once service connection for a condition in this group is already granted:

Some related codes have a rating cap. Irritable bowel syndrome maxes out at a 30 percent rating under Diagnostic Code 7319, so an appeal for more than 30 percent will not succeed on that code alone. Tinnitus is capped at 10 percent regardless of how it's claimed.
Fatigue can sometimes be rated by analogy to a closely matching diagnostic code when no code exactly fits the condition causing it, for example using the sleep-apnea criteria for persistent daytime sleepiness when chronic fatigue stems from an already service-connected sleep-disordered-breathing condition.
A liberalizing law sets a floor on the effective date. When your grant comes from a liberalizing law like the PACT Act, the effective date cannot be earlier than the date that law took effect, August 10, 2022 (38 CFR § 3.114).
Your effective date is usually the claim date, not the symptom-onset date. It is typically the date VA received your claim or intent to file, not the date your symptoms or diagnosis actually began, so file as early as you reasonably can (38 CFR § 3.400).

If your condition worsens after the initial grant, you can file for an increased rating. See the Rating Increase Guide.

Quick Reference Tables

Service Connection Pathways at a Glance

Pathway	What it requires	Skips
Direct	Diagnosis, in-service event, medical nexus	Nothing, all three elements needed
Gulf War presumption	Qualifying Southwest Asia service, a matching diagnosis (CFS, fibromyalgia, IBS)	Nexus opinion
Conceded toxic exposure	A TERA memo or similar concession, a positive medical opinion	Proving the in-service event yourself
Secondary	An already service-connected disability that caused or worsened your condition, a nexus opinion	An in-service event of your own
Aggravation	A documented pre-service condition, evidence it worsened beyond natural progression	Proving the condition began in service

Rating Caps and Special Rules for Related Codes

Condition	Code	Note
Chronic fatigue syndrome	6354	Rated 10% to 100% on symptom frequency and how much routine activity is restricted; see full tiers above
Irritable bowel syndrome	7319	Maxes out at 30%
Tinnitus	6260	Capped at 10%, regardless of how it's claimed
Fibromyalgia	5025	Also a Gulf War MUCMI presumptive; symptom-based rating, not active-versus-residual

From Filing to Decision: Who Does What

Role	Does	Decides your rating?
VSO / accredited representative	Helps prepare, gather evidence, and file; represents you on appeal	No
VSR	Develops the claim: orders records and the C&P exam	No
C&P Examiner	Conducts the exam, completes the DBQ, may give a nexus opinion	No / but has a strong impact
Rater (RVSR)	Reviews the full file and decides service connection and percentage	Yes

Frequently Asked Questions

How does the VA rate infectious diseases?

Many are rated in two phases under 38 CFR 4.88. While the disease is active, it is often rated 100 percent. Once the active phase resolves, usually confirmed by a mandatory review examination, the rating moves to the residuals, the lasting lung, liver, kidney, or other damage the disease left behind, each rated under the body system it affects.

What is the Gulf War presumption?

For veterans with qualifying Gulf War service, the VA presumes that certain conditions, including undiagnosed illnesses and chronic fatigue syndrome, are connected to service. That means you often do not have to prove the medical link yourself, and no medical nexus opinion is required. The PACT Act and Gulf War illness guides explain who and what qualifies.

How is chronic fatigue syndrome rated?

Chronic fatigue syndrome (DC 6354) is rated on how often and how severely the symptoms restrict your daily activity, rather than on an active-versus-residual split. Ratings run from 10% to 100% depending on how much routine activity is restricted compared to your pre-illness level, or how many weeks per year you're effectively incapacitated. A dated symptom log showing the frequency and severity of your flare-ups is the evidence that most directly supports the rating.

Do I get 100 percent while an infection is active?

For many infectious diseases, yes, the condition is rated 100 percent while it is active. That 100 percent is tied to the active phase. When the active disease clears, the rating shifts to the residuals, which are rated on the lasting damage under the body system involved. Exact levels are on each condition lookup page.

What happens at the mandatory review exam?

After a period at 100 percent for an active infectious disease, the VA schedules a mandatory review examination to check whether the disease is still active. If it has resolved, the rating is re-evaluated on the residuals, the lasting damage that remains, rather than staying at the active-disease rate.

Can chronic fatigue syndrome be service connected as secondary to another condition?

Yes. If a disability you are already service-connected for caused or worsened your CFS, you can win secondary service connection without any in-service event of your own. In the published Board record, PTSD and other mental-health conditions are the most common conditions CFS has been connected to this way, along with fibromyalgia and certain infectious diseases. See the Secondary Service Connection Guide.

Why was my chronic fatigue syndrome claim denied?

The leading reason in the published record is a missing current diagnosis, VA requires the specific clinical criteria for CFS to actually be documented, not just reported fatigue. Other common reasons include the fatigue already being explained by another diagnosed condition (which closes off the Gulf War presumption), and a missing medical nexus on a direct claim. See Why These Claims Get Denied above.

Disclaimer. This guide is educational information, not legal advice, and it does not create any attorney relationship or constitute representation. It is based on general VA rules and patterns in published Board decisions that are not binding on other cases, so it shows patterns, not promises. Individual claims have unique facts, and outcomes depend on the specific evidence presented. Veterans seeking help with their claims should work with a VA-accredited VSO representative, claims agent, or attorney, and should not pay for basic help. The laws, regulations, and benefit rates referenced in this guide are current as of July 2026. Verify current rules at VA.gov or eCFR or through your VSO. Find an accredited representative →

Sources

38 CFR § 4.88b, infectious diseases, immune disorders, and nutritional deficiencies
38 CFR § 4.88a, VA diagnostic criteria for chronic fatigue syndrome
38 CFR § 3.303, basic rules for direct service connection
38 CFR § 3.310, secondary service connection
38 CFR § 3.306, aggravation of a pre-service disability
38 CFR § 3.317, Gulf War presumption for undiagnosed illness and MUCMI (CFS, fibromyalgia, IBS)
38 USC § 1117, compensation for Persian Gulf veterans with a qualifying chronic disability
38 CFR § 3.102 and 38 USC § 5107(b), benefit of the doubt
38 CFR § 4.114, Diagnostic Code 7319, rating irritable bowel syndrome
38 CFR § 3.655, effect of failing to report for a VA examination
38 CFR § 3.400 and 38 CFR § 3.114, effective dates, including the liberalizing-law rule
38 CFR § 4.14, pyramiding, no double rating for the same symptoms
38 CFR § 3.2501, new and relevant evidence to reopen a claim
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004), the three elements of service connection
Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), pain or symptoms causing functional impairment can be a disability
Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), a medical opinion is persuasive only if it explains its reasoning

Related Tools and Guides

Gulf War Illness Guide

Undiagnosed illness, chronic fatigue, and the presumptive path.

PACT Act Guide

Burn-pit and toxic-exposure presumptive conditions.

Cancer Claims Guide

Active-then-residual rating for cancers, including infection-related ones.

Hepatitis C Guide

A chronic infection rated on its liver and systemic effects.

Secondary Conditions

Organ residuals and depression from a chronic condition.

DBQ Guide

The exam forms that capture the findings your rating needs.

Service Connection Guide

The three-element test that underlies every VA disability claim.

Secondary Service Connection

How to claim a condition as caused or worsened by one you already have.

Nexus Letters

The medical link a direct or secondary claim usually needs to be granted.

Buddy & Lay Statements

How to document how your symptoms and activity level have changed.

C&P Exam Prep

What to expect at the exam and how to describe your worst and best days.

Inside Your Claim

Who handles your claim at each stage, from VSR to rater.

Reading Your Decision Letter

How to find the rating, the effective date, and the reasoning in your letter.

Letter Interpreter Tool

Upload your decision letter for a plain-English breakdown.

Appeals Guide

Supplemental Claim vs Higher-Level Review vs Board appeal, side by side.

Protect Your Rating

Permanent and Total status, reexaminations, and reduction defense.