SYSTEMIC CONDITIONS

$4.88 Malaria.

In rating disability from malaria, once identified by clinical and laboratory methods, or by clinical methods alone where the disease is endemic, the clinical course of the disease, the frequency and severity of recurrences, the necessity for and the reaction to medication, should be the basis of evaluation, not the presence or absence of parasites. When there have been relapses following the initial course of treatment, further relapses are to be expected and for some time the veteran must be given the benefit of the doubt as to unexplained fever of short duration, controlled by medication specific for malaria.

[29 FR 6718, May 22, 1964, as amended at 43 FR 45361, Oct. 2, 1978]

§ 4.88a Chronic fatigue syndrome.

(a) For VA purposes, the diagnosis of chronic fatigue syndrome requires:

(1) new onset of debilitating fatigue" severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and

(2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and

(3) six or more of the following: (i) acute onset of the condition, (ii) low grade fever,

(iii) nonexudative pharyngitis,

(iv) palpable or tender cervical or axillary lymph nodes,

(v) generalized muscle aches or weakness,

(vi) fatigue lasting 24 hours or longer after exercise,

(vii) headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state),

(viii) migratory joint pains,

(ix) neuropsychologic symptoms, (x) sleep disturbance.

(b) [Reserved]

[59 FR 60902, Nov. 29, 1994]

§ 4.88b Schedule of ratings—systemic

diseases.

17

NOTE: Anatomical or pathological basis required for the ratings under diagnostic codes 6275 and 6276.

6300 Cholera, Asiatic:

Rat

ing

NOTE (1): The evaluations under Code 6304 are to be assigned on the basis of dates and frequency of recurrences and relapses and severity of significant residuals, if any, based on the clinical records of the service department or other acceptable evidence relating to the period of service, or on medical evidence relating to the period after discharge, recording sufficient clinical findings, when considered in accordance with all other data of record, to support the conclusion that there exists a compensable or higher degree of disability from malaria. Hereafter, service connection will not be conceded based on notation in service records of history alone furnished by the veteran, nor will compensable ratings be assigned based on the veteran's unsupported claim or statement; however, determinations heretofore made will not be reversed on the basis of this change in policy. The evidence of others under oath may be accepted to establish frequency of relapses or recurrences over a period of 1 year only, from date of last medically confirmed relapse or recurrence in service or subsequently.

NOTE (2): When evaluations are based on frequency of recurrences or relapses only, they will be assigned for a period of 1 year only from date of discharge or date established by medical evidence of record. At the expiration of this period, if medical evidence warranting an extension is not of record, the veteran will be notified that his compensation will be discontinued unless he submits evidence from a physician showing recurrent attacks or other disabling effects of malaria. After a malaria rating has run 24 months, an extension, if warranted, will carry ending date at expiration of 36 months from initial date of compensable rating. When this rating is assigned, veteran will be notified of ending date and of requirement that, to have rating continued or resumed after that date, he must report to De partment of Veterans Affairs hospital, or outpatient clinic, or to a Department of Veterans Affairs fee-basis physician during an actual relapse of the disease. Following the expiration of the 36 months' period and the veteran's compliance with the requirement to report as indicated in this note, a prepared slide of the veteran's blood smear will be read in the local Department of Veterans Affairs laboratory, and, if the interpretation is positive, the prepared slide will be mailed in a suitable container addressed to the Director, Compensation and Pension Service, with proper identification of the veteran, including C-number and time and place of smear, before further acceptance of the diagnosis of malaria for rating purposes.

6305 Filariasis:

Less than totally incapacitating, but in symptom combinations productive of severe impairment of health Chronic with frequent exacerbations and multiple joint and organ manifestations productive of moderately severe impairment of health Exacerbations of a week or more 2 or 3 times a year; or symptomatology productive of moderate impairment of health

Exacerbations once or twice a year or symptomatic during the past 2 years

NOTE: Rate residuals such as joint, renal, pleural, etc., under the appropriate system, not to be combined with ratings under code 6350. Assign the higher evaluation.

6351 HIV-Related Illness:

AIDS with recurrent opportunistic infections or
with secondary diseases afflicting multiple
body systems; HIV-related illness with debility
and progressive weight loss, without remis-
sion, or few or brief remissions
Refractory constitutional symptoms, diarrhea,
and pathological weight loss; or minimum rat-
ing following development of AIDS-related op-
portunistic infection or neoplasm
Recurrent constitutional symptoms, intermittent
diarrhea, and on approved medication(s); or
minimum rating with T4 cell count less than
200, or Hairy Cell Leukoplakia, or Oral
Candidiasis

Moderately severe; with stomatitis, persistent diarrhea, and symmetrical dermatitis

Moderate; with presence of stomatitis, or achlorhydria, or recurring diarrhea

6354 Chronic Fatigue Syndrome (CFS):

Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms:.