In This Chapter

Introduction

Change Date

V.iii.3.1.a.  Definition:  Infectious Diseases

• 38 CFR 3.309(b) based on tropical service
• 38 CFR 3.309(c) based on confirmed former prisoner of war (FPOW) status, and
• 38 CFR 3.317(c) based on service in the Southwest Asia theater of operations during the Gulf War or on or after September 19, 2001, in Afghanistan.

• tropical diseases, see M21-1, Part VIII, Subpart iii, 1
• FPOW disabilities, see M21-1, Part VIII, Subpart iv, 2.D, and
• infectious diseases under 38 CFR 3.317, see M21-1, Part VIII, Subpart ii, 1.A.1.p.

V.iii.3.1.b.  Definition:  Immune Disorders

V.iii.3.1.c.  Definition:  Nutritional Deficiencies

V.iii.3.1.d.  Revisions of the Infectious Diseases, Immune Disorders, and Nutritional Deficiencies Rating Schedule

• August 11, 2019, and
• August 30, 1996.

• incorporate medical advances
• update medical terminology
• add disabilities not previously included, and
• refine rating criteria.

• these and other historical changes to 38 CFR 4.88b, see
  • 38 CFR 4, Appendix A
  • 38 CFR 4.88b (Historical), and
  • the Board of Veterans Appeal Research Tools website for historical 38 CFR 4.88b, and
• effect of rating schedule readjustment, see M21-1, Part V, Subpart ii, 3.D.2.i.

V.iii.3.1.e.  Evaluations Under the Infectious Diseases General Rating Formula

• assign the prescribed evaluation during the active disease phase, and thereafter,
• assign
  • a 0-percent evaluation for the infectious disease under the relevant 38 CFR 4.88b DC, and
  • evaluations for any residual disability of the infection within the appropriate body system as indicated by the notes in the evaluation criteria.

• Regardless of whether resolution occurs spontaneously or because of treatment, long-term disability in such situations results from residual functional impairment of the body systems affected by the infectious disease, rather than the infection itself.
• Infectious diseases for both the initial diagnosis and any relapse of active infection must be confirmed by diagnostic testing specific to the disease.

V.iii.3.1.f.  Evaluating Long-Term Health Effects of 38 CFR 3.317 Infectious Diseases

Introduction

• specific tropical diseases
• obtaining information about tropical diseases
• incubation periods of tropical diseases, and
• considering SC for tropical diseases not of record.

Change Date

V.iii.3.2.a. Specific Tropical Diseases

• bacterial infections, including
  • bacillary dysentery
  • cholera
  • Hansen’s disease (leprosy)
  • Oroya fever
  • pinta
  • plague
  • relapsing fever, and
  • yaws
• viral infections, including yellow fever
• roundworm parasitic infections, including
  • dracontiasis
  • filariasis (Bancroft’s type)
  • hookworm infection
  • loiasis, and
  • onchocerciasis
• other parasitic infections, including
  • amebiasis
  • blackwater fever
  • leishmaniasis
  • malaria, and
  • schistosomiasis.

• Rate amebiasis and schistosomiasis under the digestive system.
• Rate pinta, verruga peruana (a late residual of Oroya fever), onchoceriasis, oriental sore, and espundia (Old World cutaneous and American (New World) mucocutaneous leishmaniasis) under diseases of the skin.

• 38 CFR 3.307(a)(4)
• 38 CFR 3.309(b), and
• M21-1, Part VIII, Subpart iii, 1.

V.iii.3.2.b. Obtaining Information about Tropical Diseases

V.iii.3.2.c. Incubation Periods of Tropical Diseases

V.iii.3.2.d. Considering SC for Tropical Diseases Not of Record

• consider tropical residence other than that during military service, and
• consult standard texts for disease factors, such as
  • locality of confinement
  • early symptoms
  • course of the disease, and
  • periods of incubation.

Introduction

• definition of rheumatic fever
• complications of rheumatic fever
• the prognosis of rheumatic fever, and
• considering the effects of rheumatic heart disease.

Change Date

V.iii.3.3.a. Definition: Rheumatic Fever

V.iii.3.3.b. Complications of Rheumatic Fever

• cardiac arrhythmias
• pericarditis
• rheumatic pneumonitis
• pulmonary embolism
• pulmonary infarction
• valve deformity, and
• in extreme cases, congestive heart failure.

V.iii.3.3.c. Prognosis of Rheumatic Fever

• occurs in less than 20 percent of the cases, and
• is generally less severe than if the onset is during childhood.

V.iii.3.3.d. Considering the Effects of Rheumatic Heart Disease

• 38 CFR 4.104, DC 7000, and
• M21-1, Part V, Subpart iii, 5.1.g.

Introduction

• definition of
  • HIV, and
  • acquired immunodeficiency syndrome (AIDS)
• how HIV infection is diagnosed
• definition of CD4 T cells
• HIV transmission
• definition of approved medication(s)
• rating considerations for HIV-related illness, and
• rating AIDS.

Change Date

V.iii.3.4.a. Definition: HIV

• 38 CFR 4.88b, and
• M21-1, Part V, Subpart iii, 3.4.g.

V.iii.3.4.b.  Definition:  AIDS

V.iii.3.4.c.  How HIV Is Diagnosed

V.iii.3.4.d.  Definition: CD4 T Cells

• A healthy, uninfected person has 800-1200 (or 500 to 1500 by some references) CD4 T cells per cubic millimeter of blood.
• During HIV, the number of these cells in the blood progressively declines.
• When the count falls below 200, the person is vulnerable to the opportunistic infections and cancers that typify AIDS.

V.iii.3.4.e.  HIV Transmission

• sexual contact
• infected blood, and
• needle stick accidents.

• No evidence exists that HIV is transmitted through
  • saliva, sweat, tears, urine, or feces
  • casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats, or
  • biting insects such as mosquitoes, flies, ticks, fleas, bees, wasps, or bedbugs.
• If there is evidence indicating that the HIV-related illness was the result of intravenous drug abuse, ensure that the authorization activity has conducted a willful misconduct/line-of-duty (LOD) administrative decision prior to rating.
• There is no presumptive SC provision for HIV.  Veterans must establish SC under other provisions, such as direct SC under 38 CFR 3.303 by establishing an in-service event, injury, or disease as the cause of HIV.

• willful misconduct and LOD determinations, see M21-1, Part X, Subpart iv, 1.C, and
• establishing direct SC, see M21-1, Part V, Subpart ii, 2.A.

V.iii.3.4.f.  Definition: Approved Medication(s)

V.iii.3.4.g.  Rating Considerations for HIV-related Illness

V.iii.3.4.h.  Rating AIDS

• rating evaluations, see 38 CFR 4.88b Schedule of Ratings-Infectious Diseases, Immune Disorders and Nutritional Deficiencies, and
• treatment options, see
  • HIV Basics | HIV/AIDS | CDC, and
  • VA HIV/AIDS.

Introduction

• definition of chronic fatigue syndrome, and
• rating considerations for chronic fatigue syndrome.

Change Date

V.iii.3.5.a. Definition: Chronic Fatigue Syndrome

V.iii.3.5.b.  Rating Considerations for CFS

• new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months, and
• the exclusion, by way of a thorough evaluation, of all other clinical conditions that may produce similar symptoms based on history, physical examination, and laboratory tests.

• acute onset of the condition
• low grade fever
• sore throat with no secretions (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
• neuropsychological symptoms, and
• sleep disturbance.

• 38 CFR 4.88a
• 38 CFR 4.88b, and
• M21-1, Part VIII, Subpart ii, 1.A.1.i.

Introduction

Change Date

V.iii.3.6.a.  Definition:  COVID-19

• coronavirus, or
• coronavirus disease.

• presumptive SC for COVID-19, see
  • 38 U.S.C. 1164, and
  • M21-1, Part VIII, Subpart iii, 10, and
• considering unclaimed theories of SC, see M21-1, Part II, Subpart iii, 1.A.2.e.

V.iii.3.6.b.  Use of the COVID-19 Special Issue Indicator

V.iii.3.6.c.  Active vs. Acute COVID-19

• considering acute and transitory conditions, see M21-1, Part V, Subpart ii, 2.A.1.g, and
• handling allegations of exposure to COVID-19, see
  • M21-1, Part VIII, Subpart iii, 10.3.b, and
  • M21-1, Part II, Subpart iii, 1.C.2.b and c.

V.iii.3.6.d.  Residuals of COVID-19

• respiratory
• genitourinary (residuals of acute kidney injury)
• cardiovascular (inflammation of the heart muscle, heart attack, stroke, blood clots)
• skin (rash, hair loss)
• audiological (hearing problems)
• loss of sense of smell and/or taste
• neurological, and
• psychiatric (depression, anxiety, changes in mood).

• Since the long-term effects of this disease are still being studied, decision makers must rely on the expertise of medical professionals to determine whether the chronic residual is due to COVID-19.  A medical nexus opinion will generally be required to determine whether a disability is a chronic residual of COVID-19.
• Evaluations for pension purposes must be based on permanent residuals of COVID-19.

V.iii.3.6.e.  Delayed Onset of COVID-19 Residuals

• the definitions of
  • new claim, see M21-1, Part I, Subpart i, 1.A.4.i, and
  • supplemental claim, see M21-1, Part I, Subpart i, 1.A.4.j, and
• new and relevant evidence, see M21-1, Part X, Subpart ii, 2.A.2.c.

V.iii.3.6.f.  Disabilities Resulting From COVID-19 Vaccination

V.iii.3.6.g.  Hospitalization and Convalescent Ratings for COVID-19 Residuals

• Assign the hospital rating for the primary condition that warranted hospitalization.
• If the primary cause of the hospitalization is unknown, consider reported symptoms and other evidence of record to determine the most appropriate disability for which to assign the hospitalization rating.
• If the Veteran remains hospitalized at the time the claim is considered, assign an open-ended hospital evaluation as warranted.
• Following the hospitalization, assign an appropriate schedular evaluation for any chronic residual, applying 38 CFR 4.31 when appropriate.

• hospitalization ratings, see M21-1, Part VIII, Subpart iv, 8.B, and
• convalescent ratings, see M21-1, Part VIII, Subpart iv, 8.C.

V.iii.3.6.h.  Applicable Theories of SC for COVID-19 Residuals

• considering unclaimed theories of SC, see M21-1, Part II, Subpart iii, 1.A.2.e
• effective date considerations specific to presumptive SC for COVID-19, see M21-1, Part VIII, Subpart iii, 10.6.f, and
• maximizing effective date determinations, see M21-1, Part V, Subpart ii, 4.A.1.i.