Infection, immune and nutrition: CFS, HIV, lupus and the exam

How VA rates infectious, immune and nutritional conditions

38 CFR 4.88b

This schedule covers infections such as malaria, Lyme disease, brucellosis and Q fever, plus lupus, HIV-related illness, chronic fatigue syndrome and vitamin deficiency diseases. For most infections, the General Rating Formula applies: 100% for active disease. After the active disease has resolved, the infection is rated 0%, and any residual disability is rated within the appropriate body system.

The regulation also tells VA to consider the long-term health effects listed in 38 CFR 3.317(d) for brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), malaria, Mycobacterium tuberculosis, nontyphoid salmonella, Shigella, visceral leishmaniasis and West Nile virus.

Infectious diseases and their residuals

38 CFR 4.88b, DC 6300 to 6335

These codes use the General Rating Formula, with a note naming the residuals to rate under other body systems:

• Malaria (6304): diagnosis, at first and in relapse, depends on identifying parasites in blood smears or other specific tests. Residuals include liver or spleen damage and central nervous system conditions.
• Lyme disease (6319): residuals include arthritis, Bell’s palsy, radiculopathy, eye problems and cognitive dysfunction.
• Brucellosis (6316): culture, serologic testing, or both must confirm diagnosis and recurrence. Residuals include meningitis and liver, spleen and musculoskeletal conditions.
• Q fever (6331): residuals include chronic hepatitis, endocarditis, osteomyelitis, post-Q-fever chronic fatigue syndrome and vascular infections.
• West Nile virus (6335), nontyphoid salmonella (6333), Shigella (6334), Campylobacter jejuni (6330), hemorrhagic fevers including dengue (6329), melioidosis (6318), rickettsial, ehrlichia and anaplasma infections (6317), lymphatic filariasis (6305), bartonellosis (6306), plague (6307), relapsing fever (6308), rheumatic fever (6309), vibriosis (6300) and other parasitic diseases (6320) are listed with notes on the residuals to rate.
• Visceral leishmaniasis (6301), leprosy (6302), miliary tuberculosis (6311), nontuberculosis mycobacterium infection (6312) and hyperinfection syndrome from strongyloidiasis (6325): 100% as active disease, continuing past treatment in most cases, with a mandatory exam six months after treatment for leishmaniasis and leprosy. Inactive tuberculosis is rated under 38 CFR 4.88c or 4.89.
• Schistosomiasis (6326): 0% when acute or asymptomatic chronic, with residuals rated by body system. Syphilis (6310) has no percentage of its own and is rated on residuals, such as nervous system, vascular, eye or ear disease.

Systemic lupus and HIV-related illness

38 CFR 4.88b, DC 6350 and 6351

• Systemic lupus erythematosus (6350): 100% for acute disease with frequent exacerbations producing severe impairment of health; 60% for exacerbations lasting a week or more, two or three times a year; 10% for exacerbations once or twice a year or symptomatic during the past two years. VA rates lupus either by combining the residuals under the appropriate body systems or under 6350, whichever is higher. It is not combined with a rating under 7809.
• HIV-related illness (6351): 100% for AIDS with recurrent opportunistic infections or secondary diseases in multiple body systems, or HIV-related illness with debility and progressive weight loss. 60% for refractory constitutional symptoms, diarrhea and pathological weight loss, or a minimum after an AIDS-related opportunistic infection or neoplasm. 30% for recurrent constitutional symptoms, intermittent diarrhea and approved medication, or a minimum with a T4 count under 200. 10% following HIV-related constitutional symptoms, a T4 count between 200 and 500, approved medication, or depression or memory loss with employment limits. 0% if asymptomatic after the initial diagnosis.
• For HIV, psychiatric illness, central nervous system manifestations, opportunistic infections and neoplasms may be rated separately if a higher overall result follows and the symptoms do not overlap. The regulation lists the AIDS-defining infections.

Chronic fatigue syndrome

38 CFR 4.88b, DC 6354

Chronic fatigue syndrome is rated on debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness or confusion) or a combination of other signs and symptoms:

• 100%: nearly constant and so severe as to restrict routine daily activities almost completely, and may occasionally preclude self-care.
• 60%: nearly constant and restrict routine daily activities to less than 50% of the pre-illness level; or wax and wane with incapacitation of at least six weeks total per year.
• 40%: nearly constant and restrict daily activities to 50% to 75% of the pre-illness level; or incapacitation of at least four but under six weeks per year.
• 20%: nearly constant and restrict daily activities by less than 25%; or incapacitation of at least two but under four weeks per year.
• 10%: symptoms that wax and wane with incapacitation of at least one but under two weeks per year; or symptoms controlled by continuous medication.

For this rating, incapacitation exists only when a licensed physician prescribes bed rest and treatment.

Vitamin deficiency diseases

38 CFR 4.88b, DC 6313 to 6315

• Avitaminosis (6313) and pellagra (6315): 100% for marked mental changes, moist dermatitis, inability to retain adequate nourishment, exhaustion and cachexia. 60% with all the symptoms below plus mental symptoms and impaired bodily vigor. 40% with stomatitis, diarrhea and symmetrical dermatitis. 20% with stomatitis, achlorhydria or diarrhea. 10% for a confirmed diagnosis with nonspecific symptoms such as decreased appetite, weight loss, abdominal discomfort, weakness, inability to concentrate and irritability.
• Beriberi (6314), as active disease: 100% with congestive heart failure, anasarca or Wernicke-Korsakoff syndrome. 60% with cardiomegaly, or peripheral neuropathy with footdrop or thigh or calf atrophy. 30% with peripheral neuropathy with absent knee or ankle jerks and loss of sensation, or symptoms such as weakness, fatigue, anorexia, dizziness, heaviness and stiffness of the legs, headache or sleep disturbance. After that, rate residuals by body system.

What VA’s exam forms cover

VA Chronic Fatigue Syndrome DBQ (2024-08-02), HIV-Related Illness DBQ (2024-07-18), Infectious Diseases DBQ (2024-07-18)

• Chronic fatigue syndrome form: diagnosis criteria, whether continuous medication is needed, a checklist of physical signs (fever, sore throat, tender lymph nodes, muscle aches, post-exercise fatigue, headaches, joint pain, sleep disturbance) and cognitive signs, whether symptoms are nearly constant or wax and wane, the percentage restriction of routine activities, and the total yearly duration of physician-prescribed bed rest.
• HIV form: medication and complications, constitutional symptoms, diarrhea and weight loss with baseline and current weights, secondary diseases by body system, opportunistic infections and cancers, CD4 count and nadir.
• Infectious diseases form: whether each disease is active or inactive, when treatment ended, whether symptoms or residuals are due to it, and how diagnosis or relapse was confirmed. It does not mention lupus.

See Preparing for Your C&P Exam.

What I could not verify

• Rating levels come from the eCFR text of 38 CFR 4.88b, current as of October 16, 2026. eCFR is unofficial, and the official text wins over me.
• I did not read 38 CFR 4.88c or 4.89, which govern inactive tuberculosis, or 38 CFR 3.317, so I do not restate how Gulf War and other long-term health effects work.
• I listed the codes with residual notes in short form. The schedule lists more residuals for each infection.
• I did not read VA’s tuberculosis exam form, and I did not research which of these conditions are presumptive for particular exposures. See presumptive conditions by era.
• I checked the exam forms through a text reader, not line by line. The forms themselves are the authority.