Infectious, Immune, and Nutritional Conditions Rating Guide

The Rules That Decide These Claims

Infectious diseases, immune disorders, and nutritional deficiencies are rated under 38 CFR § 4.88b and 4.89. Instead of one fixed rating table, this group runs on a pattern: score the disease highly while it is doing active damage, then re-score it on the lasting harm once the active phase ends. A few rules shape how that plays out, and they decide far more of these claims than any single number does.

1. Active disease is often rated 100 percent

Many infectious diseases, for example active tuberculosis and certain other infections, are rated 100 percent while the disease is active. The rating then moves to the disease's residuals once the active phase resolves, usually after a mandatory review examination that confirms the disease is no longer active.

2. When the active phase clears, the rating shifts to residuals

Once the active disease is gone, the rating is based on the lasting damage it caused, for example lung, liver, or kidney residuals. Each residual is rated under the body system it affects, not under the infectious-disease code. A cleared infection that scarred the lungs, for instance, is then rated under the respiratory schedule.

3. Some conditions are rated on ongoing symptoms, not an active-versus-residual split

Not everything in this group follows the active-then-residual pattern. Some conditions are rated on ongoing symptoms and functional loss. Chronic fatigue syndrome (DC 6354), for example, is rated on how often and how severely the symptoms restrict your daily activity, not on whether a disease is "active."

4. Nutritional deficiencies are rated on their effects

Nutritional deficiencies are rated on their measurable effects on the body. The rating follows the damage the deficiency causes, so the objective findings, not the deficiency label alone, drive the level.

5. Several conditions here are Gulf War and burn-pit presumptives

A number of conditions in this group are Gulf War and burn-pit presumptives. For covered veterans with qualifying service, the VA presumes the link to service, so you often do not have to prove the medical connection yourself. See the PACT Act guide and the Gulf War illness guide for who and what qualifies.

Find the Guide for Your Condition

The rules above apply across the board. For the exact rating table, the C&P exam, and the Board data for your specific condition, open the dedicated guide:

For any code not listed here, including a specific infection, immune disorder, or nutritional deficiency, open its condition lookup page for the rating levels and Board data.

Common Secondary Conditions

Infections and immune disorders rarely stay contained to one system. Because they can damage organs and wear a person down over time, one service-connected condition often opens the door to several secondary claims:

• Organ residuals. After an infection resolves, the lung, liver, or kidney damage it left behind is rated under its own body system as a separate condition.
• Chronic fatigue and pain. Lasting fatigue and pain can overlap with a mental-health condition, and each can be claimed in its own right.
• Conditions from long-term immunosuppression. Treatments that suppress the immune system can lead to further conditions that may be claimed as secondary.
• Depression secondary to a chronic condition. Living with a chronic infectious or immune condition can drive depression and anxiety, which can be claimed as secondary to the physical condition. See secondary conditions.

Each dedicated guide above shows the live Board grant rates for that condition's most common secondary pairings.

Evidence That Wins

• Laboratory confirmation of the infection or immune disorder, the objective proof the diagnosis rests on.
• Records dating the active phase and the residuals, so the file clearly shows when the disease was active and what damage remained afterward.
• A symptom log for chronic fatigue syndrome, a dated record of how often and how severely symptoms restrict your daily activity, which is what sets the rating.
• Proof of qualifying Gulf War or burn-pit service for the presumptive path, so the VA can presume the link instead of asking you to prove it.
• The matching DBQ for the condition, which prompts the examiner to capture the findings the rating depends on. See the DBQ guide.

Common Mistakes

Frequently Asked Questions