What secondary conditions are linked to Chronic Fatigue Syndrome?

Common secondary conditions for Chronic Fatigue Syndrome include Major Depressive Disorder, Fibromyalgia, Orthostatic Intolerance, Sleep Disorders, Cognitive Dysfunction. Secondary service connection is established under 38 C.F.R. 3.310 when a condition is caused or aggravated by an already service-connected disability.

What happens during a C&P exam for Chronic Fatigue Syndrome?

Bring all relevant medical records and a written list of symptoms. Report your worst days, not your best. The VA rates based on overall impairment.

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Chronic Fatigue Syndrome

Q: What are the VA rating percentages for Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (DC 6354) is rated at 10%, 20%, 40%, 60%, 100% under 38 CFR § 4.88b, DC 6354. Signs and symptoms of CFS that wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication.

Q: What rates 10% for Chronic Fatigue Syndrome under 38 CFR § 4.88b, DC 6354?

Under 38 CFR § 4.88b, DC 6354 (DC 6354), a 10% rating for Chronic Fatigue Syndrome requires: Signs and symptoms of CFS that wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication.

Q: What rates 20% for Chronic Fatigue Syndrome under 38 CFR § 4.88b, DC 6354?

Under 38 CFR § 4.88b, DC 6354 (DC 6354), a 20% rating for Chronic Fatigue Syndrome requires: Signs and symptoms are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or; incapacitating episodes of at least two but less than four weeks total duration per year.

Q: What rates 40% for Chronic Fatigue Syndrome under 38 CFR § 4.88b, DC 6354?

Under 38 CFR § 4.88b, DC 6354 (DC 6354), a 40% rating for Chronic Fatigue Syndrome requires: Signs and symptoms are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or; incapacitating episodes of at least four but less than six weeks total duration per year.

Q: What rates 60% for Chronic Fatigue Syndrome under 38 CFR § 4.88b, DC 6354?

Under 38 CFR § 4.88b, DC 6354 (DC 6354), a 60% rating for Chronic Fatigue Syndrome requires: Signs and symptoms are nearly constant and so severe as to restrict routine daily activities to less than 50 percent of the pre-illness level, or; incapacitating episodes of at least six weeks total duration per year.

Q: What rates 100% for Chronic Fatigue Syndrome under 38 CFR § 4.88b, DC 6354?

Under 38 CFR § 4.88b, DC 6354 (DC 6354), a 100% rating for Chronic Fatigue Syndrome requires: Signs and symptoms are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care.

Q: What evidence do I need for a Chronic Fatigue Syndrome VA claim?

Key evidence for a Chronic Fatigue Syndrome claim includes: Service treatment records; Current medical diagnosis and treatment records; Buddy/lay statements; Prescription history; Employment impact documentation. All evidence should document both the condition and its impact on daily functioning.

DC 635438 C.F.R. § 4.88b

Diagnostic Code

DC 6354

38 C.F.R. § 4.88b

Rating Range

10–100%

5 severity tiers

Source

Referenced

38 C.F.R. Part 4

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 (10% / 20% / 40% / 60% / 100%). 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.

Educational tool only. Not legal or medical advice. Not affiliated with the VA.

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

10%

Signs and symptoms of CFS that wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or; symptoms controlled by continuous medication.

20%

Signs and symptoms are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or; incapacitating episodes of at least two but less than four weeks total duration per year.

40%

Signs and symptoms are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or; incapacitating episodes of at least four but less than six weeks total duration per year.

60%

Signs and symptoms are nearly constant and so severe as to restrict routine daily activities to less than 50 percent of the pre-illness level, or; incapacitating episodes of at least six weeks total duration per year.

100%

Signs and symptoms are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care.

03Key Evidence

—Service treatment records

—Current medical diagnosis and treatment records

—Buddy/lay statements

—Prescription history

—Employment impact documentation

—Any relevant diagnostic testing

04C&P Exam Tips

1Bring all relevant medical records and a written list of symptoms.

2Report your worst days, not your best. The VA rates based on overall impairment.

3Document how the condition affects daily activities, work, and relationships.

4Mention all medications and their side effects.

5Bring buddy statements from people who observe your symptoms.

05Secondary Conditions

Major Depressive DisorderMODERATE

Chronic illness burden and functional limitations

FibromyalgiaMODERATE

Overlapping central sensitization syndromes

Orthostatic IntoleranceMODERATE

Autonomic dysfunction common in CFS

Sleep DisordersMODERATE

Non-restorative sleep is core symptom

Cognitive DysfunctionMODERATE

Brain fog is hallmark symptom

IBSMODERATE

GI dysfunction common in CFS

HeadachesMODERATE

Chronic headaches are common symptom

More in Chronic Fatigue

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Tools

Rating Calculator →Secondaries Explorer →C&P Exam Prep →PACT Act Scanner →2026 Rates →

Sources & Editorial

Rating criteria reference 38 C.F.R. Part 4 (Schedule for Rating Disabilities). This entry has not yet undergone editorial review against the live regulation text — consult the authoritative source directly before relying on the criteria shown.

View 38 C.F.R. Part 4 on eCFR →Editorial Standards →Suggest a correction →

EDUCATIONAL TOOL ONLY. NOT LEGAL OR MEDICAL ADVICE.
NOT AFFILIATED WITH THE U.S. DEPARTMENT OF VETERANS AFFAIRS.
CLAIM RECON 2026

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