Infectious Diseases and Immune Disorders -(Caution, not complete)

Infectious Diseases and Immune Disorders

Topics:

General Rating System for Infectious Diseases

Bacterial Infectious Diseases

Parasitic Infectious Diseases

Viral Infectious Diseases

Sexually Transmitted Diseases

Immune Disorders

Other Infectious and Immune Conditions

DBQs for Infectious and Immune Conditions

Principles that Apply

--The VA changed the codes and ratings for Infectious Diseases and Immune Disorders on August 11, 2019. See the Historic VASRDs page for all codes and ratings from before this date. Not all codes were changed, so if the code cannot be found on the Historic VASRDs page, the ratings did not change.--

Reminder: The VA will give a Military Disability Rating for each service-connected condition a service member has, but the DoD will only rate service-connected conditions that make a service member Unfit for Duty.

General Rating System for Infectious Diseases

A 100% rating is given for all active diseases. Once the infection is eliminated or completely suppressed, the condition must be re-evaluated and rated 0%. Any lasting side effects caused by the infection are then rated separately.

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Bacterial Infectious Diseases

Code 6300: Vibriosis (cholora and non-cholera) is an infection in the small intestine caused by Vibrio bacteria. It is rated on the General Rating System. Lasting side effects could include renal failure, skin conditions, and musculoskeletal conditions.

Code 6302: Leprosy (or “Hansen’s Disease”) is a bacterial disease that attacks the skin, nerves, and airways. It causes severe skin damage and can lead to many other conditions if left untreated. The 100% rating for this condition continues for the first 6 months after treatment for this disease ends. It is then re-evaluated, and any remaining side effects are rated separately. Side effects could include skin damage, nerve damage, or amputation.

Code 6306: Bartonellosis is a bacterial infection which can cause many other diseases including trench fever, chronic bacteremia, neurological conditions, Carrion’s disease, cat-scratch disease, bacillary angiomatosis, peliosis hepatis, and chronic lymphadenopathy. All of these conditions are rated under this code.

It is rated on the General Rating System. Side effects could include skin damage and endocarditis.

Code 6307: Plague (any kind) is a bacterial infection that can attack different parts of the body. It is rated on the General Rating System.

Code 6308: Relapsing fever is a bacterial infection that causes fevers, chills, aches, and nausea that can last between 2 and 9 days. Every couple of weeks, these symptoms return if not treated with antibiotics. It is rated on the General Rating System. Side effects could include liver damage, spleen damage, choroidopathy, or central nerve damage.

Code 6309: Rheumatic fever is a bacterial infection that affects the tissues of the body, causing them to swell. It can damage the valves of the heart, which can cause congestive heart failure. Symptoms also include rashes, twitching in the face and arms, and fevers. It is rated on the General Rating System. Side effects could include heart damage, code 7020.

Code 6312: Non-tuberculosis mycobacterial infection (“NTM”) is a lung infection, that isn’t tuberculosis, which occurs when bacteria is inhaled. This can cover a wide-range of infections caused by different types of inhaled bacteria. This condition is rated 100% while active. Once inactive, the condition is re-evaluated, and any side effects, like skin conditions, respiratory conditions, eye conditions, digestive conditions, etc., can be rated separately. If the infection recurs, it must be officially confirmed by culture, histopathology, or other lab test.

Code 6316: Brucellosis is a bacterial infection that causes fevers,headaches, depression, and weakness. Diagnosis and any recurrence must be confirmed by culture and/or serologic testing. It is rated on the General Rating System. Side effects could include liver damage, nervous system infections, spleen damage, arthritis, hearing loss, respiratory infections, and much more.

Code 6318: Melioidosis is a bacterial infection that causes pain, coughing, pneumonia, and skin infections. Diagnosis and any recurrence must be confirmed by culture or appropriate lab testing. It is rated on the General Rating System. Side effects could include arthritis, meningitis, and respiratory conditions.

Code 6330: Campylobacter jejuni is a common type of food poisoning caused by bacteria. Symptoms include diarrhea, nausea, and fever. It is rated on the General Rating System. Side effects could include eye conditions, Guillain-Barre syndrome (rated under code 8011), and reactive arthritis.

Code 6331: Coxiella burnetii infection (“Q fever”) is a bacterial infection spread by animals that causes flu-like symptoms. It is rated on the General Rating System. Side effects could include chronic hepatitis, chronic fatigue syndrome, endocarditis, vascular infection, and osteomyelitis.

Code 6333: Salmonella infections (non-typhoid) is a common type of food poisoning caused by bacteria. Symptoms include diarrhea, nausea, and fever. It is rated on the General Rating System. Side effects could include reactive arthritis and more.

Code 6334: Shigella infections (including dysentery) are the most common cause of diarrhea. It is rated on the General Rating System. Side effects could include blood conditions and reactive arthritis.

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Parasitic Infectious Diseases

Code 6301: Visceral leishmaniasis is adisease of parasites in the internal organs that can cause symptoms like weight loss, fever, and anemia. It is rated 100% while it is active. The 100% rating for this condition continues for the first 6 months after the final treatment once the disease is no longer active. It is then reevaluated, and any remaining side effects are rated separately. These side effects could include liver damage, bone marrow diseases, or leishmaniasis of the skin. If the infection recurs, it must be officially confirmed by culture, histopathology, or other lab test.

Code 6304: Malaria is a disease of parasites that infect red blood cells and cause severe fevers and other symptoms. It is rated on the General Rating System. For malaria to be properly diagnosed (initially and for any recurrence), it must be confirmed by blood smear tests or lab tests, like antigen detection, immunologic tests, and molecular tests. Side effects could include liver damage, spleen damage, renal disease, and central nervous system conditions.

Code 6305: Lymphatic filariasis (“elephantiasis”) is a disease of parasites that infect the lymphatic system, including the lymph nodes. It is rated on the General Rating System. Side effects could include epididymitis, which is rated under code 7525, and various lymphatic conditions.

Code 6317: Rickettsial infections (including scrub typhus, erlichiosis, anaplasmosis, etc.) are rated under this code. These diseases are unique in that they are bacterial, but spread by parasites (fleas, ticks, etc.). It is rated on the General Rating System. Side effects could include bone marrow conditions, skin conditions, central nervous conditions, and spleen damage.

Code 6319: Lyme disease is a bacterial disease spread by ticks (parasites). Symptoms include fever, skin rash, fatigue, and depression and can affect the joints, heart, and nerves if it is not treated properly. It is rated on the General Rating System. Side effects could include arthritis, nerve damage, eye conditions, and mental dysfunction.

Code 6325: Hyperinfection syndrome (“disseminated strongyloidiasis”) is a parasitic disease caused by roundworms. Symptoms include severe infections, diarrhea, skin rash, and weight loss. It is rated 100% while active. Once it is inactive, it is re-evaluated and rated on any remaining side effects.

Code 6326: Shistosomiasis (“Katayama syndrome”) is an extremely common parasitic disease outside of the US. Symptoms include skin rash, fever, and headaches. This condition is usually mild in most people, but some can have negative reactions to the parasite eggs that can cause long-term side effects. Since the active infection itself is mild, it is rated 0%. However, in cases that cause side effects, like liver damage, digestive conditions, genitourinary conditions, female reproductive conditions, or central nervous conditions, they can be rated separately.

Code 6320: All other diseases caused by parasites are rated under this code. The 100% rating for this condition continues only while the condition is active. After that, any remaining side effects or symptoms are rated separately. These symptoms could include liver damage.

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Viral Infectious Diseases

Code 6329: Hemorrhagic fevers (including dengue fever, yellow fever, etc.) are fevers caused by a viral infection. It is rated on the General Rating System. Side effects could include liver damage, kidney damage, and central nervous conditions.

Code 6335: West Nile virus infections are carried by birds and spread by mosquitoes. Symptoms include headache, vomiting, and fever. It is rated on the General Rating System. Side effects can include a variety of symptoms affecting the body and the brain.

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Sexually Transmitted Diseases

Code 6310: Syphilis and all other infections caused by treponemal bacteria (including bejel, pinta and yaws) are most commonly spread by sexual contact or from a mother to an unborn baby. There are numerous kinds of syphilis that can attack various bodily systems. Some of these have their own codes and rating systems:

– 7004, Syphilitic Heart Disease

– 8013, Cerebrospinal Syphilis

– 8014, Meningovascular Syphilis

– 8015, Tabes Dorsalis

– 9301, Dementia due to Central Nervous System Syphilis

If the syphilis is not one of these specific types, then it is rated under this code. This code does not have its own ratings, but the symptoms of the condition are all rated separately. These symptoms could include heart damage, damage of the eyes, which is rated on the Visual Impairment Rating System under the eye code that most closely describes the eye damage, ear damage, or nerve damage.

Code 6351: HIV (human immunodeficiency virus) is a virus mostly spread by sexual contact with an infected person, although it can also be spread from mother to child or by contact with infected blood. The virus attacks T4 cells that support the immune system of the body, thus causing the body to be very vulnerable to infections, other diseases (“secondary diseases”), and cancers.

After many years, the HIV virus can develop into AIDS (Acquired Immunodeficiency Syndrome). The diagnosis of AIDS is confirmed if the T4 cell count is less than 200 or if there is the presence of one of the following opportunistic infections in addition to HIV.

Opportunistic Infections

- Candidiasis of the bronchi, trachea, esophagus, or lungs

- Invasive cervical cancer

- Coccidioidomycosis

- Cryptococcosis

- Cryptosporidiosis

- Cytomegalovirus (including

CMV retinitis)

- Encephalopathy

- Herpes simplex-chronic

ulcers (must be present more than 1 month)

- Bronchitis

- Pneumonia

- Esophagitis

- Histoplasmosis

- Chronic intestinal

isosporiasis

- Kaposi’s sarcoma

- Lymphoma

- Mycobacterium avium

complex

- Tuberculosis

- Pneumocystis jirovecii

pneumonia

- Recurrent pneumonia

- Progressive multifocal

leukoencephalopathy

- Recurrent Salmonella

septicemia

- Toxoplasmosis of the brain

- Wasting syndrome

These opportunistic infections and other secondary diseases or infections, like diagnosed mental disorders, neoplasms, and central nervous system conditions, may be rated separately in addition to a rating under this code as long as symptoms do not overlap (Pyramiding Principle). For example, chronic bronchitis can be rated in addition to a rating under this code as the ratings cover different symptoms. However, a rating for Major Depressive Disorder cannot be given in addition for a 10% rating based on depression under this code as they both are rating the symptom of depression. In these cases, only one rating can be given.

The ratings:

If there is AIDS and an opportunistic infection or a disease that affects numerous areas of the body, it is rated 100%. A 100% rating is also given for HIV if there is a secondary disease that is present the majority of the time and causes continual weight loss.

If there is an opportunistic infection or neoplasm, then the minimum rating is 60%. This rating is also given if there are diarrhea, weight loss, and other significant symptoms throughout the body that cannot be controlled.

If the HIV is being treated by approved medication, but there are still regularly occurring symptoms throughout the body and intermittent diarrhea, then it is rated 30%. This rating is also the minimum rating given if the T4 cell count is less than 200.

If the HIV is being treated by approved medication, there are definite symptoms present, the T4 cell count is between 200 and 500, or there are clear signs of depression or memory loss that interfere with the ability to work, a rating of 10% is given.

If there are no symptoms that affect the ability of the individualto function, then it is rated 0%, even if there is a decreased T4 cell count and lymph node disease.

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Immune Disorders

There are other infectious conditions besides HIV that can affect the immune system.

Code 6350: Systematic lupus erythematosus (SLE or “lupus”) is a disease that causes the immune system to attack the good, healthy tissue cells of the body. This code is for lupus that attacks the tissues inside the body. Code 7809 is for lupus that attacks the skin. These codes cannot both be used for a lupus condition. If both tissues on the inside and the skin are affected, the code that gives the higher rating is assigned. Similarly, if the lupus attacks tissues that cause other symptoms and problems, like arthritis in the knee, then it can be rated under a single symptom if that rating would be higher than the rating under this code.

If the condition causes severe symptoms that significantly limit the functioning of the body, it is rated 100%. For example, if there was such severe disease in the knees that you were bed-ridden and couldn’t work or function, a 100% rating would be justified. If, however, severe episodes of symptoms that significantly limit the functioning of the body occur 2 or 3 times a year and last a week or more, then it is rated 60%. If there are episodes only once or twice a year or if there are at least any symptoms within the past 2 years, then it is rated 10%.

Code 6354: Chronic fatigue syndrome is a condition where there is a long-term severe loss of energy. Many different conditions can produce significant fatigue, so a diagnosis of chronic fatigue syndrome can only be made after proper testing for all other possible conditions is done. The fatigue also has to be severe enough to limit the ability to perform daily activities by half for at least 6 months. Finally, there must be at least 6 or more of the following symptoms present: fever, tender lymph nodes, muscle aches or weakness, sore throat, debilitating fatigue lasting 24 hours or more after exercise, headaches unique to the fatigue (different than headaches before the fatigue began), joint aches, and cognitive problems (bad concentration, forgetfulness, confusion, etc.).

Note: If the condition requires bed rest prescribed by the physician, then it is considered “incapacitating” during the period of bed rest.

If the symptoms are constant or so severe that it is impossible to perform daily activities, it is rated 100%.

If the symptoms do not completely limit activity, but your activity level is limited to at least half of what it was before the fatigue, or if the symptoms are not constant but there are periods of incapacitation that add up to at least 6 weeks within the past year, then it is rated 60%.

If the symptoms are fairly constant but you can still perform 50 to 75% of the normal daily activity, or if the symptoms are not constant but there are periods of incapacitation that add up to between 4 and 6 weeks within the past year, then it is rated 40%.

If the symptoms are fairly constant but you can perform 75% or more of your normal daily activity, or if the symptoms are not constant but there are periods of incapacitation that add up to between 2 and 4 weeks within the past year, then it is rated 20%.

If the symptoms are not constant but there are periods of incapacitation that add up to between 1 and 2 weeks within the past year, or if the symptoms are controlled by constant medication, then it is rated 10%.

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Other Infectious and Immune Conditions

Please see the Tuberculosis page for all conditions relating to tuberculosis and The Digestive System page for hepatitis conditions. All other infectious diseases and immune system conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom line rule is to rate any condition under the code that BEST describes it, even if it is not exact.

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DBQ for Infectious and Immune Conditions

Here are the Disability Benefits Questionnaires (DBQs) used for infectious and immune conditions: Gulf War Diseases DBQ, HIV DBQ, Lupus and Autoimmune DBQ, Chronic Fatigue Syndrome DBQ, and Infectious Diseases (other) DBQ.

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Principles that Apply

Pyramiding: A single condition can only be rated once! However, if another condition exists that is additional to the disease or immune disorder (not simply caused by it), then it can also be rated.

Probative Value: If two exams record the condition differently, the exam with the most thorough data and performed by the most qualified person in that specialty will be the exam the rating is based on.

A Tie Goes to the Veteran: If there are two equally strong exams with conflicting information, or if the condition can be equally rated under two different codes, then the one that gives the highest rating will be assigned. Every conflict should be resolved in favor of the higher rating.

Accurate Measurements: It is essential that the necessary information to rate your condition is recorded by the physician in your exam. With the information on this page, you should know what needs to be measured and recorded. Make sure this happens correctly to ensure that you receive a proper rating.

Hospital or Convalescent Ratings: Some conditions require periods of hospitalization or constant medical care (at-home nurse, etc.). Any condition that requires this is rated 100% during this intensive treatment. Once it ends, then the 100% rating will continue for a certain period. This period is 3 months unless another length (6 months, 1 year, etc.) is directly specified in the condition ratings. Some patients may need more time to recover than others, so the physician or Rating Authorities can lengthen this time period if they see fit.

Please see the VASRD Principles page for further guidance.

For tuberculosis conditions, see the Tuberculosis page.

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