EDUCATIONAL TOOL ONLY. Not legal or medical advice. Not affiliated with the VA.
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Chronic Fatigue Syndrome
DC 6354 | 38 CFR § 4.88b, DC 6354 |
Chronic Fatigue Syndrome is rated by the U.S. Department of Veterans Affairs under DC 6354 of 38 CFR § 4.88b, DC 6354 across 5 severity tiers (100% -- Nearly constant, restricts activities to <50% / 60% -- Nearly constant, restricts to 50-75% / 40% -- Wax and wane, 4-6 weeks incapacitation/year / 20% -- Controlled by medication / 10% -- Mild, intermittent). Service connection requires (1) a current diagnosis, (2) an in-service event, injury, or exposure, and (3) a medical nexus opinion linking the two under 38 C.F.R. § 3.303. This condition is frequently rated as secondary to Major Depressive Disorder or Fibromyalgia under 38 C.F.R. § 3.310.
OVERVIEW
Extreme fatigue not explained by any underlying medical condition, not improved by rest, and worsened by physical or mental activity. Also known as myalgic encephalomyelitis (ME). A qualifying condition for Gulf War illness claims.
RATING CRITERIA (5 LEVELS)
100% -- Nearly constant, restricts activities to <50%
Debilitating symptoms nearly constant, restricting daily activities to less than 50% of pre-illness level.
60% -- Nearly constant, restricts to 50-75%
Symptoms nearly constant, restricting to 50-75% of pre-illness level.
40% -- Wax and wane, 4-6 weeks incapacitation/year
Symptoms wax and wane with 4-6 weeks incapacitation per year.
20% -- Controlled by medication
Symptoms controlled by continuous medication.
10% -- Mild, intermittent
Symptoms wax and wane, 1-2 weeks incapacitation per year.
KEY EVIDENCE TO GATHER
-Service treatment records
-Current medical diagnosis and treatment records
-Buddy/lay statements
-Prescription history
-Employment impact documentation
-Any relevant diagnostic testing
SECONDARY CONDITIONS (7 MAPPED)
DC
Chronic illness burden and functional limitations
DC
Overlapping central sensitization syndromes
DC
Autonomic dysfunction common in CFS
DC
Non-restorative sleep is core symptom
DC
Brain fog is hallmark symptom
DC
GI dysfunction common in CFS
DC
Chronic headaches are common symptom
C&P EXAM TIPS (5)
1.Bring all relevant medical records and a written list of symptoms.
2.Report your worst days, not your best. The VA rates based on overall impairment.
3.Document how the condition affects daily activities, work, and relationships.
4.Mention all medications and their side effects.
5.Bring buddy statements from people who observe your symptoms.
SECONDARY CONDITIONS
MORE IN CHRONIC FATIGUE
EDUCATIONAL TOOL ONLY. NOT LEGAL OR MEDICAL ADVICE.
NOT AFFILIATED WITH THE U.S. DEPARTMENT OF VETERANS AFFAIRS.
CLAIM RECON 2026