Regulation changes

Changes to Rating Schedule for Chronic Fatigue Sydrome

VA has finalized regulations which change the Rating Schedule relating to Infectious Diseases, Immune Disorders and Nutritional Deficiencies. This schedule includes the rating criteria for Chronic Fatigue Syndrome (CFS).

VA proposed major changes to these diagnostic criteria, to include adding a list of diagnoses (current or past) that would exclude the diagnosis of Chronic Fatigue Syndrome (CFS), including sleep apnea, hypothyroidism, narcolepsy, certain cancers, hepatitis B or C, depression, bipolar disorder, schizophrenia, dementias, and severe obesity (BMI 45 or greater). Fortunately, veterans advocates responded to these proposed regulations, pointing out that VA’s proposals were not in line with current research on CFS. VA chose not to make the majority of the proposed changes, instead opting to convene a working group to discuss changes that will “ensure that the full range of relevant factors is adequately addressed.” The only change that will take effect is the addition of a requirement that a licensed physician prescribe bed rest and treatment to meet the definition of an incapacitating episode. This requirement will be effective August 11, 2019. The rating criteria as of that date will be as follows:

§ 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.

6354 Chronic fatigue syndrome (CFS):

Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms: Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care ................…......100

Which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year .........................................……………………………………………………………………………………………………………... 60

Which are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year ...........……………………………………………………………………………………………………………….. 40

Which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year .......………………………………………………………………………………………………………...... 20

Which 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 …………................................... 10

Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.