Body system: Infectious Diseases, Immune Disorders, and Nutritional DeficienciesRegulation: 38 CFR § 4.88b
Pellagra is a condition caused by severe niacin (vitamin B3) deficiency that can affect your skin, digestive system, and mental health. The VA rates pellagra from 10% to 100% based on how severe your symptoms are - ranging from basic digestive issues and skin problems at lower ratings, to serious mental changes and inability to maintain proper nutrition at 100%. This is relatively rare today but can still occur in veterans with certain medical conditions or dietary restrictions.
Rating levels
- 100% — You would qualify if you have severe mental symptoms like confusion or memory problems, wet skin rashes or sores, cannot keep food down or absorb nutrients properly, feel completely exhausted, and have extreme weight loss with muscle wasting (cachexia). These symptoms must be so severe that you're essentially unable to function normally due to severe vitamin deficiency.
- 60% — You must have all the physical symptoms from the lower rating levels, plus you're experiencing mental health symptoms (like depression, anxiety, or confusion) and your overall physical strength and energy are significantly reduced. Your body's ability to function normally is impaired, meaning you feel weak, tired, and unable to perform activities with the same vigor you had before the infection.
- 40% — You qualify for the 40% rating if you have three specific symptoms occurring together as ongoing effects of pellagra: stomatitis (painful mouth sores or inflammation), diarrhea (frequent loose or watery bowel movements), and symmetrical dermatitis (skin inflammation or rash on matching areas of both sides of the body). All three must be present.
- 20% — You qualify for the 20% rating if your pellagra produces ongoing stomatitis (painful mouth sores or inflammation), achlorhydria (lack of stomach acid), or persistent diarrhea attributable to the niacin deficiency.
- 10% — You qualify for the 10% rating if you have a confirmed diagnosis of pellagra (niacin / vitamin B3 deficiency) along with nonspecific symptoms — decreased appetite, weight loss, abdominal discomfort, weakness, difficulty concentrating, and irritability — directly attributable to the deficiency.