Body system: Infectious Diseases, Immune Disorders, and Nutritional DeficienciesRegulation: 38 CFR § 4.88b
Visceral leishmaniasis is a serious parasitic infection transmitted by sandfly bites, primarily affecting the spleen, liver, and bone marrow. Common in parts of the Middle East, Africa, South Asia, and South America. The VA rates this condition at 100% during active disease, and the 100% rating CONTINUES past the end of treatment. Six months after treatment ends, the VA conducts a MANDATORY examination to determine the new rating, any reduction is subject to the due-process rules of 38 CFR § 3.105(e). After that exam, any lasting damage (liver damage, bone marrow disease, etc.) is rated separately under the appropriate body-system codes and combined under § 4.25.
Rating levels
- 100% — You qualify for 100% during active visceral leishmaniasis (a parasitic infection from sandfly bites affecting the spleen, liver, and bone marrow). The 100% rating continues beyond the cessation of treatment for active disease (see Note 1 below). Active disease typically presents with prolonged fever, splenomegaly (enlarged spleen), hepatomegaly, weight loss, anemia, leukopenia, and thrombocytopenia from bone marrow involvement.
- -1% — Two important timing rules apply after active treatment ends. RULE 1: the 100% rating CONTINUES past the cessation of treatment, even after the active phase is gone, the rating does NOT immediately drop. RULE 2: six months after treatment ends, the VA must perform a MANDATORY examination to determine the new rating going forward. Any rating reduction from that exam (or later exams) is subject to the due-process protections of 38 CFR § 3.105(e), the veteran gets advance notice and an opportunity to submit evidence before any reduction takes effect. After that point, any lasting damage (residuals) is rated SEPARATELY under whichever body-system code best captures the deficit, liver damage under the digestive system codes (cirrhosis, hepatitis residuals), bone marrow damage under the hemic and lymphatic codes (anemia, leukopenia, thrombocytopenia), and so on, then combined under § 4.25.