M21-1 Manual  /  Part VIII, Subpart ii, Chapter 1, Section D

Presumptive Service Connection (SC) for Infectious Disease Under 38 CFR 3.317

M21-1, Part VIII, Subpart ii, Chapter 1, Section D

Overview

In This Section

This section contains the following topics:
TopicTopic Name
1General Information on Presumptive SC for Infectious Diseases Under 38 CFR 3.317(c)
2Developing Claims for Infectious Disease Under 38 CFR 3.317
3Rating Claims for Infectious Disease Under 38 CFR 3.317

1. General Information on Presumptive SC for Infectious Diseases Under 38 CFR 3.317(c)

Introduction

This topic contains general information on presumptive SC for infectious diseases under 38 CFR 3.317(c), including
  • qualifying service for presumptive SC of infectious diseases under 38 CFR 3.317
  • presumptive SC for infectious diseases under 38 CFR 3.317(c)
  • manifestation period for infectious diseases under 38 CFR 3.317, and
  • considering long-term health effects potentially associated with infectious diseases.

Change Date

January 29, 2024

VIII.ii.1.D.1.a. Qualifying Service for Presumptive SC of Infectious Diseases Under 38 CFR 3.317

Qualifying service for the purpose of presumptive service connection (SC) for infectious diseases, means the Veteran served on active duty
  • in the Southwest Asia theater of operations during the Gulf War, as defined in 38 CFR 3.317(e), or
  • in Afghanistan on or after September 19, 2001.
Important: While some of the service locations overlap, qualifying service for the purposes of presumptive SC for infectious diseases is not equivalent to Persian Gulf Veteran service outlined in 38 U.S.C. 1117 for presumptive SC of undiagnosed illnesses and medically unexplained chronic multi-symptom illness (MUCMIs). Public Law 117-168, Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022, did not change qualifying service or the other regulatory requirements for infectious diseases. References: For more information on

VIII.ii.1.D.1.b. Presumptive SC for Infectious Diseases Under 38 CFR 3.317(c)

Effective September 29, 2010, presumptive SC is established under 38 CFR 3.317(c) for the specified infectious diseases if

VIII.ii.1.D.1.c. Manifestation Period for Infectious Diseases Under 38 CFR 3.317

For each of the recognized presumptive infectious diseases, 38 CFR 3.317(c)(3)(i) prescribes a specific manifestation period as detailed in the table below.Note: The one-year time period specified in the table below means within one year from the date of separation from a qualifying period of service as specified in 38 CFR 3.317 (c)(3)(ii).
Infectious DiseaseTime Limit for Manifestation
Brucellosisone year
Campylobacter jejunione year
Coxiella burnetii (Q fever)one year
Malaria
  • one year, or
  • at a time when standard or accepted treatises indicate that the incubation period began during a qualifying period of service
Mycobacterium tuberculosisno time limit
Nontyphoid Salmonellaone year
Shigellaone year
Visceral leishmaniasisno time limit
West Nile virusone year
References: For more information on
  • developing infectious disease claims, see M21-1, Part VIII, Subpart ii, 1.D.2, and
  • establishing onset of a presumptive disability during a required manifestation period, see M21-1, Part V, Subpart ii, 2.B.1.g.

VIII.ii.1.D.1.d. Considering Long-Term Health Effects Potentially Associated With Infectious Diseases

As specified in 38 CFR 3.317(d), if a Veteran who is presumed SC for a disease listed in column A of the table is diagnosed with a disease in column B within the time period specified in the table (if no time period is specified, at any time), the Department of Veterans Affairs (VA) will request a medical opinion as to whether it is at least as likely as not that the condition was caused by the Veteran having had the associated disease in column A. Note: This does not preclude a finding that other manifestations of disability or secondary conditions were caused by an infectious disease.
Column A – Infectious DiseaseColumn B – Associated Condition(s)
Brucellosis
  • arthritis
  • cardiovascular, nervous, and respiratory system infections
  • chronic meningitis and mengocephalitis
  • deafness
  • demyelinating meningovascular syndromes
  • episcleritis
  • fatigue, inattention, amnesia, and depression
  • Guillain-Barre syndrome
  • hepatic abnormalities, including granulomatous hepatitis
  • multifocal choroiditis
  • myelitis-radiculoneuritis
  • nummular keratitis
  • papilledema
  • optic neuritis
  • orchioepididymitis and infections of the genitourinary system
  • sensorineural hearing loss
  • spondylitis
  • uveitis
Campylobacter jejuni
  • Guillain-Barre syndrome if manifest within two months of the infection
  • reactive arthritis if manifest within three months of the infection
  • uveitis if manifest within one month of the infection
Coxiella burnetti (Q fever)
  • chronic hepatitis
  • endocarditis
  • osteomyelitis
  • post-Q-fever chronic fatigue syndrome
  • vascular infection
Malaria
  • demyelinating polyneuropathy
  • Guillain-Barre syndrome
  • hematologic manifestations (particularly anemia after falciparum malaria and splenic rupture after vivax malaria)
  • immune-complex glomerulonephritis
  • neurologic disease, neuropsychiatric disease, or both
  • ophthalmologic manifestations, particularly retinal hemorrhage and scarring
  • Plasmodium falciparum
  • Plasmodium malariae
  • Plasmodium ovale
  • Plasmodium vivax
  • renal disease, especially nephrotic syndrome
Mycobacterium tuberculosis
  • active tuberculosis
  • long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary tuberculosis and active tuberculosis
Nontyphoid Salmonellareactive arthritis if manifest within three months of the infection
Shigella
  • hemolytic-uremic syndrome if manifest within one month of the infection
  • reactive arthritis if manifest within three months of the infection
Visceral leishmaniasis
  • delayed presentation of the acute clinical syndrome
  • post-kala-azar dermal leishmaniasis if manifest within two years of the infection
  • reactivation of visceral leishmaniasis in the context of future immunosuppression
West Nile virusvariable physical, functional, or cognitive disability
Reference: For more information on requesting medical opinions in claims for infectious diseases, see M21-1, Part VIII, Subpart ii, 1.D.2.c.



2. Developing Claims for Infectious Disease Under 38 CFR 3.317


Introduction

This topic contains information on developing claims of infectious disease under 38 CFR 3.317, including
  • Section 5103 notice for infectious disease claims
  • developing claims for infectious diseases, and
  • requesting examinations in claims for infectious diseases.

Change Date

January 29, 2024

VIII.ii.1.D.2.a. Section 5103 Notice for Infectious Disease Claims

It is unnecessary to issue Section 5103 notice when a Veteran files a new claim for SC for an infectious disease on a form that provides, or otherwise indicates the claimant received, the notice, such as VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.References: For more information on

VIII.ii.1.D.2.b. Developing Claims for Infectious Diseases

In addition to the usual evidence-gathering procedures for claims, follow the procedures below when processing a claim for SC of an infectious disease under 38 CFR 3.317.
StepAction
1Does the Veteran have qualifying service as defined in 38 CFR 3.317(c)(3)(ii) and as detailed in M21-1, Part VIII, Subpart ii, 1.D.1.a?
  • If yes, go to next step.
  • If no, send the claim for a decision.
2Is there credible lay or medical evidence of a qualifying infectious disease within the time limit, if applicable, specified in 38 CFR 3.317(c)(3)(i)?
  • If yes, go to the next step.
  • If no, send the claim for a decision.
3Is the Veteran claiming one of the long-term health effects listed in 38 CFR 3.317(d)(2) due to the infectious disease?
  • If yes, go to the next step.
  • If no, go to Step 5.
4Is there credible lay or medical evidence of the long-term health effect, and if applicable, within the time limit specified in 38 CFR 3.317(d)(2)?
  • If yes,
    • request a medical opinion as outlined in M21-1, Part VIII, Subpart ii, 1.D.2.c, and
    • go to the next step.
  • If no, go to the next step.
5Request an examination for the infectious disease, if needed to decide the claim, following the guidance in M21-1, Part VIII, Subpart ii, 1.D.2.c.
Reference: For more information on infectious diseases under 38 CFR 3.317 and potential long-term health effects, see M21-1, Part VIII, Subpart ii, 1.D.1.d.

VIII.ii.1.D.2.c. Requesting Examinations in Claims for Infectious Diseases

Use the table below when an examination and/or medical opinion is needed to decide a claim for infectious disease under 38 CFR 3.317.
If the claim involves a(n) ...Then ...
infectious disease listed in 38 CFR 3.317(c)request the appropriate infectious diseases DBQ to evaluate current severity. Note: As presumptive SC applies to the infectious disease under 38 CFR 3.317, a medical opinion is not required.
long-term health effect potentially associated with an infectious disease as noted in 38 CFR 3.317(d)request a medical opinion as to whether it is at least as likely as not that the condition was caused by the Veteran having had the infectious disease.
Important:
  • Do not request a Gulf War general medical examination for infectious disease claims.
  • The Acceptable Clinical Evidence (ACE) examination process may be used when processing these claims, when deemed appropriate.
Reference: For more information on ACE examinations, see M21-1, Part IV, Subpart i, 2.A.4.

3. Rating Claims for Infectious Disease Under 38 CFR 3.317

Change Date

June 30, 2025

VIII.ii.1.D.3.a. Proper Coding for Infectious Disease Decisions Under 38 CFR 3.317

In order to properly identify and track infectious disease claims for which SC is awarded or denied under 38 CFR 3.317, regional offices must properly code the disabilities in the Veterans Benefits Management System - Ratings (VBMS-R) by assigning the
  • Gulf War Presumptive - Infectious Disease (3.317(c)) special issue, and
  • special issue basis specific to the infectious disease.
Reference: For more information on assigning a special issue in VBMS-R, see the VBMS-R User Guide.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart ii, Chapter 1, Section D (U.S. government work, reproduced for reference). Browse all sections →