VA Diagnostic Code 6354Chronic fatigue syndrome (CFS)
Rated from 10% to 100% under § 4.88b. Here is what the VA requires at each level.
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What each rating requires
The VA assigns the highest level your evidence actually supports. Read up the stack until your records stop matching.
- 100%
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
- 60%
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 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
- 40%
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 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
- 20%
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 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
- 10%
Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms: 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
Notes on this code
These notes are part of the regulation. They change how the levels above are applied.
- Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.
Chronic Fatigue Syndrome (CFS) — VA Disability Rating Guide
Diagnostic Code 6354 · 38 CFR § 4.88b Body system: Infectious Diseases, Immune Disorders and Nutritional Deficiencies
Understanding Chronic Fatigue Syndrome
Chronic fatigue syndrome (CFS) is rated by the VA under Diagnostic Code 6354. When evaluating this condition, the VA focuses on the presence of debilitating fatigue, cognitive impairments (such as an inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms — and, importantly, how much these symptoms interfere with your daily life.
Two key concepts run through every rating level:
- How constant your symptoms are and how much they restrict your routine daily activities compared to your pre-illness level.
- Periods of incapacitation, when symptoms wax and wane. Under this diagnostic code, incapacitation exists only when a licensed physician prescribes bed rest and treatment.
Rating Levels
The VA assigns a disability percentage based on the severity, constancy, and impact of your symptoms:
100%
Symptoms that are nearly constant and so severe as to restrict routine daily activities almost completely, and which may occasionally preclude self-care.
60%
Symptoms that 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.
40%
Symptoms that 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.
20%
Symptoms that 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.
10%
Symptoms 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.
What the VA Looks For
When rating CFS under Diagnostic Code 6354, the VA considers:
- The presence of debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms.
- Whether symptoms are nearly constant and how much they restrict routine daily activities relative to your pre-illness level.
- Whether symptoms wax and wane, and the total duration of incapacitation over the course of a year.
- Whether symptoms are controlled by continuous medication.
Important note on incapacitation: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.
These criteria are a rendering of § 4.88b, diagnostic code 6354. The official version is the one that governs your rating.
View official sourceHow to claim this
Knowing the criteria is the first half. Getting your file to show them is the second.
Find your level in the stack
Read each rung against what your medical records already say. The level your records document today is the one the VA can support today.
Name the gap
Look at the rung above yours and write down exactly what it asks for that your file does not show yet — a diagnosis, a measurement, a prescribed brace, a doctor’s opinion linking it to service.
Claim it by code
File under diagnostic code 6354 and attach the evidence for the level you are asking for. Other Infectious Diseases, Immune Disorders and Nutritional Deficiencies codes may cover your secondary conditions.
Find out which rating your evidence supports.
Six reads your records against these exact criteria and tells you what the VA is still missing.
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