VASRD: Infectious Diseases, Immune Disorders and Nutritional Deficiencies

The Veteran Affairs Schedule for Rating Disabilities (VASRD) includes a section defining procedures and ratings for infectious diseases, immune disorders and nutritional deficiencies.

Some medical issues may be service-connected, some were pre-existing conditions prior to military service and others may develop after starting military duty or retirement/separation.

What follows are descriptions of medical conditions reviewed by VA medical claims personnel, and the VA’s instructions on reviewing and assigning VA disability claim ratings for these issues.

Each claim is reviewed on a case-by-case basis, taking a variety of factors into account including severity, duration of the problem, and how it affects the ability to work and perform self-care. Please note this list is not an exhaustive collection of all possible maladies, but this is a good reference for most common issues reviewed at the VA level.

Chronic Fatigue Syndrome

The first part of this section of VASRD is devoted to chronic fatigue syndrome. In order to diagnose a veteran’s medical issue as chronic fatigue, both of the following must apply:

New onset of debilitating fatigue with severity reducing daily activity “to less than 50 percent of the usual level for at least six months.”

A review of medical history, physical examination, and laboratory tests that would exclude “all other clinical conditions that may produce similar symptoms.”

But that’s not all. Six or more of the following list must also apply:

• Acute onset of the condition
• Fever
• Nonexudative pharyngitis
• Palpable or tender cervical or axillary lymph nodes
• Generalized muscle aches or weakness
• Fatigue lasting 24 hours or longer after exercise
• Headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state)
• Migratory joint pains
• Neuropsychologic symptoms
• Sleep difficulties

Later in the VASRD documentation in this section, we find more instructions for VA raters. Chronic Fatigue Syndrome or CFS for short includes a VA rating potential at 100% for the following:

• Debilitating fatigue
• Cognitive impairments (forgetfulness, confusion, difficulty concentrating)
• A combination of “other signs and symptoms” described as “nearly constant,” bad enough to affect most daily activities “almost completely,” and which may affect the ability to perform self-care

Ratings under the 100% level may include a 60% VA disability rating when the impairments are “nearly constant and restrict routine daily activities to less than 50% of the pre-illness level,” among other criteria.

The lowest possible rating in this section is 10%, for symptoms which “wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or symptoms controlled by continuous medication.”

Infectious Diseases, Immune Disorders and Nutritional Deficiencies

VA rating criteria for its evaluators reviewing those with infectious diseases include observation of “any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria.”

VA evaluators are directed to include consideration of long-term health effects “potentially associated with infectious diseases as listed” which may include:

• Brucellosis
• Campylobacter jejuni
• Coxiella burnetii (Q fever)
• Malaria
• Mycobacterium Tuberculosis
• Nontyphoid Salmonella
• Shigella
• Visceral Leishmaniasis
• West Nile virus

There is a VA “general rating formula” for infections diseases. Any active disease that meets the criteria in this section is rated at 100% disability according to VA rating guidelines at the time of this writing.

In cases where an active disease “has resolved” according to VA documentation, the evaluator must rate at 0% for infection and is further directed to assign a VA disability rating to “any residual disability of infection within the appropriate body system.”

In addition to these instructions, VASRD also has some guidelines for a variety of specific conditions. They include (but are not limited to) the following. Remember, what follows in this section is a supplement to the previously mentioned criteria for 100% ratings in this section.

Vibriosis (Cholera, Non-cholera)

The rater is directed to consider residual effects of “cholera and non-cholera vibrio infections.” Those may include renal failure, skin and musculoskeletal conditions.

Visceral leishmaniasis

Raters are directed to assign a VA disability rating of 100% “beyond the cessation of treatment for active disease.” Six months after treatment ends, the rater must conduct an examination to determine the final amount of disability to award. Any system of the body damaged by a disease meeting the criteria of this portion may be rated including liver damage and bone marrow disease.

Leprosy (Hansen’s disease)

This is another VA condition where the evaluator is directed to keep the 100% disability rating for a period of time following the end of treatment of the active condition. A new examination may be required after the disease is no longer active, and the rater will evaluate “the appropriate body system” affected by any residual issue associated with the disease including:

• Skin lesions
• Peripheral neuropathy
• Amputations

Malaria

VA rating of malaria (the initial infection and/or any relapse) requires positive identification of malarial parasites in diagnostic lab tests. Samples from potential malaria patients may be subjected to testing such as:

• Antigen detection
• Immunologic / immunochromatographic tests
• Molecular testing

Malaria ratings may include factors such as the residual disability of infection which may cause liver or splenic damage, and central nervous system issues.

Lymphatic filariasis, to include elephantiasis

Like the other medical conditions listed above, the rating for this medical issue includes reviewing the patient’s body for residual disability caused by the infection. In this case may include:

• Epididymitis
• Lymphangitis
• Lymphatic obstruction
• Lymphedema affecting extremities, genitals, and/or breasts

Plague

VA claims evaluators are directed to rate this disease and assign a disability rating based on the appropriate body system suffering “any residual disability of infection.”

Syphilis, and other treponemal infections

The usual “any residual disability of infection” rules apply here; for this specific medical condition that may include a review of any associated diseases of the:

• Nervous system
• Vascular system
• Eyes
• Ears

Tuberculosis, Miliary

The VA examiner must determine if there is an active infection via diagnostic testing, and the usual residual disability issues apply. For this brand of tuberculosis this may include:

• Skin conditions
• Conditions of the respiratory tract
• Central nervous system
• Musculoskeletal, ocular, gastrointestinal and genitourinary systems

Nontuberculosis Mycobacterium infection

These instructions are similar to the military tuberculosis guidelines above, but also include a requirement to have a mandatory VA examination after the patient is no longer suffering from the active version of the disease.

If there is no relapse, the VA examiner is directed to move to review any residual issues which may include the same systems of the body mentioned in the above military tuberculosis guidelines.

VA instructions to evaluators for tuberculosis cases may also depend on whether the condition is inactive nonpulmonary tuberculosis that was “initially entitled” before or after Aug. 19, 1968. Ask your VA rater how current VA policy may affect a tuberculosis rating affected by such policy.

Avitaminosis

In cases where there are “marked mental changes,” moist dermatitis, or the “inability to retain adequate nourishment,” exhaustion, and cachexia, the rating is assigned at 100%. There are other levels of rating possible with this condition down to a 10% rating for “nonspecific symptoms such as: Decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate and irritability.”

Beriberi

Beriberi is rated differently depending on circumstances. Not all the conditions listed here have such variables, but this one does. As an active disease, Beriberi is rated by the VA as follows depending on the additional factors below:

• With congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome = 100%
• With cardiomegaly = 60%
• Peripheral neuropathy, footdrop, or atrophy of thigh or calf muscles = 60%
• Peripheral neuropathy, with absent knee or ankle jerks and loss of sensation = 30%
• Weakness, fatigue, anorexia, dizziness, heaviness and stiffness of legs, headache or sleep disturbance = 30%

Pellagra

This condition has VA ratings that vary depending on the severity of the symptoms. For pellagra that includes “mental changes” that are pronounced, plus the inability to “retain adequate nourishment” plus exhaustion and cachexia, the rating is 100%. From there, ratings between 60% and 10% are possible depending on the symptoms and related factors.

Rickettsial, Ehrlichia and Anaplasma infections

This group of conditions may affect a variety of body systems; the usual rating for residual impairment or disability related to infection applies. Body systems that may be evaluated or affected include bone marrow, the spleen, the central nervous system, and the skin. This section of the VA rating criteria covers a variety of conditions including:

• Scrub typhus
• Rickettsial pox
• African tick-borne fever
• Rocky Mountain spotted fever
• Ehrlichiosis
• Anaplasmosis

Lyme Disease

Evaluators will review potentially affected body systems for residual damage or disability from the infection. Such issues may include:

• Arthritis
• Bell’s palsy
• Radiculopathy
• Ocular issues
• Cognitive dysfunction

Hyperinfection syndrome or disseminated strongyloidiasis

No specific additional guidance for this condition is available at press time except for the following instructions for a mandatory re-exam once the condition is not an active infection.

In cases where no relapse occurs, the rater will move to the residual disability guidelines consistent in this section and any disability rating would be assigned based on residual disability where applicable.

Schistosomiasis

This particular condition gets a 0% VA disability rating as an “acute or asymptomatic chronic disease” and the residual disability instruction is in effect here for systems including but not limited to:

• Conditions of the liver
• Intestinal system
• Female genital tract
• Genitourinary tract
• Central nervous system

Coxiella burnetii infection (Q fever):

Q fever has the usual instructions to review residual damage from an infection of this type; affected body systems can include the liver, vascular system, etc. There are complications from Q fever that include:

• Chronic hepatitis
• Endocarditis, osteomyelitis
• Post Q-fever chronic fatigue syndrome
• Vascular infections

West Nile virus infection

The West Nile rating criteria is typical for this section; once there is no longer an active infection, the VA rater must review for infection-related disabilities or other issues including “variable physical, functional, or cognitive disabilities.”

Lupus erythematosus, systemic (disseminated)

This condition has unique instructions to the VA rate compared to others in this section. To start, the VA rater is directed not to combine VA ratings for this condition. It is rated alone, based on the instructions found in VA documents at press time.

A VA rating of 100% is possible in cases where the condition is acute and has a profound effect on the patient’s health. Other ratings include the lowest possible (10%) for “Exacerbations once or twice a year or symptomatic during the past 2 years.”

HIV-Related Illness

A 100% rating for HIV-related illness is possible in cases where the VA describes the patient as having AIDS with “recurrent opportunistic infections.”

A 100% VA disability rating is also possible in such cases where AIDS and secondary diseases affect multiple systems in the body. HIV-related illness “with debility” and progressive weight loss is also rated at 100% by the Department of Veterans Affairs.

A 60% VA disability rating for HIV-related illness is possible (depending on circumstances) in cases where one or more are present:

• Refractory constitutional symptoms
• Diarrhea
• Pathological weight loss
• Minimum rating following development of AIDS-related opportunistic infection or neoplasm

The VA rates conditions at 30% include recurrent constitutional symptoms, intermittent diarrhea, and “use of approved medication” or meet certain T4 cell count criteria. A ten percent rating is possible for those who develop symptoms of HIV-related problems, have qualifying T4 cell counts, and have evidence of depression or memory loss that can affect employment.

Those who are asymptomatic without decreased T4 cell counts or evidence of lymphadenopathy qualify for a zero percent VA disability rating.