--- title: "Part VIII, Subpart ii, Chapter 1, Section D Presumptive Service Connection (SC) for Infectious Disease Under 38 CFR 3.317" document: "M-21-1" section: "Part VIII, Subpart ii, Chapter 1, Section D" canonical: "https://veteranai.co/va-regulations/m21-1/viii.ii.1.d-presumptive-service-connection-sc-for-infectious-disease" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000259721/M21-1-Part-VIII-Subpart-ii-Chapter-1-Section-D-Presumptive-Service-Connection-SC-for-Infectious-Disease-Under-38-CFR-3317" updated: "2026-09-07T14:37:32.645687Z" --- January 29, 2024 ### VIII.ii.1.D.1.a. Qualifying Service for Presumptive SC of Infectious Diseases Under 38 CFR 3.317 Qualifying service for the purpose of presumptive service connection (SC) for infectious diseases, means the Veteran served on active duty * in the Southwest Asia theater of operations during the Gulf War, as defined in [38 CFR 3.317(e)](), or * in Afghanistan on or after September 19, 2001. **Important:** While some of the service locations overlap, qualifying service for the purposes of presumptive SC for infectious diseases is not equivalent to Persian Gulf Veteran service outlined in [38 U.S.C. 1117]() for presumptive SC of undiagnosed illnesses and medically unexplained chronic multi-symptom illness (MUCMIs). _Public Law 117-168_ , Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022, did not change qualifying service or the other regulatory requirements for infectious diseases. **References:** For more information on * qualifying service for presumptive SC of infectious diseases, see [38 CFR 3.317(c)(3)(ii)](), and * definition of Persian Gulf war, see [38 CFR 3.2(i)](). ### VIII.ii.1.D.1.b. Presumptive SC for Infectious Diseases Under 38 CFR 3.317(c) Effective September 29, 2010, presumptive SC is established under [38 CFR 3.317(c)]() for the specified infectious diseases if * the Veteran had qualifying service as detailed in M21-1, Part VIII, Subpart ii, 1.D.1.a, and * the disease becomes manifest to a compensable degree within the time limit specified in [38 CFR 3.317(c)(3)(i)]() and [M21-1, Part VIII, Subpart ii, 1.A.2.c](). ### VIII.ii.1.D.1.c. Manifestation Period for Infectious Diseases Under 38 CFR 3.317 For each of the recognized presumptive infectious diseases, [38 CFR 3.317(c)(3)(i)]() prescribes a specific manifestation period as detailed in the table below._**Note**_ : The one-year time period specified in the table below means within one year from the date of separation from a qualifying period of service as specified in [38 CFR 3.317 (c)(3)(ii)]().| **Infectious Disease**| **Time Limit for Manifestation** Brucellosis| one year Campylobacter jejuni| one year Coxiella burnetii (Q fever)| one year Malaria| * one year, or * at a time when standard or accepted treatises indicate that the incubation period began during a qualifying period of service Mycobacterium tuberculosis| no time limit Nontyphoid Salmonella| one year Shigella| one year Visceral leishmaniasis| no time limit West Nile virus| one year _**References**_ : For more information on * developing infectious disease claims, see M21-1, Part VIII, Subpart ii, 1.D.2, and * establishing onset of a presumptive disability during a required manifestation period, see [M21-1, Part V, Subpart ii, 2.B.1.g](). ### VIII.ii.1.D.1.d. Considering Long-Term Health Effects Potentially Associated With Infectious Diseases As specified in [38 CFR 3.317(d)](), if a Veteran who is presumed SC for a disease listed in column A of the table is diagnosed with a disease in column B within the time period specified in the table (if no time period is specified, at any time), the Department of Veterans Affairs (VA) will request a medical opinion as to whether it is at least as likely as not that the condition was caused by the Veteran having had the associated disease in column A. **Note:** This does not preclude a finding that other manifestations of disability or secondary conditions were caused by an infectious disease.| **Column A – Infectious Disease**| **Column B – Associated Condition(s)** Brucellosis| * arthritis * cardiovascular, nervous, and respiratory system infections * chronic meningitis and mengocephalitis * deafness * demyelinating meningovascular syndromes * episcleritis * fatigue, inattention, amnesia, and depression * Guillain-Barre syndrome * hepatic abnormalities, including granulomatous hepatitis * multifocal choroiditis * myelitis-radiculoneuritis * nummular keratitis * papilledema * optic neuritis * orchioepididymitis and infections of the genitourinary system * sensorineural hearing loss * spondylitis * uveitis Campylobacter jejuni| * Guillain-Barre syndrome if manifest within two months of the infection * reactive arthritis if manifest within three months of the infection * uveitis if manifest within one month of the infection Coxiella burnetti (Q fever)| * chronic hepatitis * endocarditis * osteomyelitis * post-Q-fever chronic fatigue syndrome * vascular infection Malaria| * demyelinating polyneuropathy * Guillain-Barre syndrome * hematologic manifestations (particularly anemia after falciparum malaria and splenic rupture after vivax malaria) * immune-complex glomerulonephritis * neurologic disease, neuropsychiatric disease, or both * ophthalmologic manifestations, particularly retinal hemorrhage and scarring * _Plasmodium falciparum_ * _Plasmodium malariae_ * _Plasmodium ovale_ * _Plasmodium vivax_ * renal disease, especially nephrotic syndrome Mycobacterium tuberculosis| * active tuberculosis * long-term adverse health outcomes due to irreversible tissue damage from severe forms of pulmonary and extrapulmonary tuberculosis and active tuberculosis Nontyphoid Salmonella| reactive arthritis if manifest within three months of the infection Shigella| * hemolytic-uremic syndrome if manifest within one month of the infection * reactive arthritis if manifest within three months of the infection Visceral leishmaniasis| * delayed presentation of the acute clinical syndrome * post-kala-azar dermal leishmaniasis if manifest within two years of the infection * reactivation of visceral leishmaniasis in the context of future immunosuppression West Nile virus| variable physical, functional, or cognitive disability _**Reference**_ : For more information on requesting medical opinions in claims for infectious diseases, see M21-1, Part VIII, Subpart ii, 1.D.2.c. 2. Developing Claims for Infectious Disease Under 38 CFR 3.317 This topic contains information on developing claims of infectious disease under 38 CFR 3.317, including * Section 5103 notice for infectious disease claims * developing claims for infectious diseases, and * requesting examinations in claims for infectious diseases. January 29, 2024 ### VIII.ii.1.D.2.a. Section 5103 Notice for Infectious Disease Claims It is unnecessary to issue Section 5103 notice when a Veteran files a new claim for SC for an infectious disease on a form that provides, or otherwise indicates the claimant received, the notice, such as _[VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits]()_._**References**_ : For more information on * circumstances under which it is necessary to issue Section 5103 notice, see * [M21-1, Part III, Subpart i, 2.B.1.b](), and * [M21-1, Part X, Subpart ii, 2.A.1.c]() * requesting evidence from the claimant, see [M21-1, Part III, Subpart i, 2.D](), and * clarifying contentions, see [M21-1, Part III, Subpart i, 2.D.1.c](). ### VIII.ii.1.D.2.b. Developing Claims for Infectious Diseases In addition to the usual evidence-gathering procedures for claims, follow the procedures below when processing a claim for SC of an infectious disease under [38 CFR 3.317](). | Step| Action 1| Does the Veteran have qualifying service as defined in [38 CFR 3.317(c)(3)(ii)]() and as detailed in M21-1, Part VIII, Subpart ii, 1.D.1.a? * If _yes_ , go to next step. * If _no_ , send the claim for a decision. 2| Is there credible lay or medical evidence of a qualifying infectious disease within the time limit, if applicable, specified in [38 CFR 3.317(c)(3)(i)]()? * If _yes_ , go to the next step. * If _no_ , send the claim for a decision. 3| Is the Veteran claiming one of the long-term health effects listed in [38 CFR 3.317(d)(2)]() due to the infectious disease? * If _yes_ , go to the next step. * If _no_ , go to Step 5. 4| Is there credible lay or medical evidence of the long-term health effect, and if applicable, within the time limit specified in [38 CFR 3.317(d)(2)]()? * If _yes_ , * request a medical opinion as outlined in M21-1, Part VIII, Subpart ii, 1.D.2.c, and * go to the next step. * If _no_ , go to the next step. 5| Request an examination for the infectious disease, if needed to decide the claim, following the guidance in M21-1, Part VIII, Subpart ii, 1.D.2.c. _**Reference**_ : For more information on infectious diseases under [38 CFR 3.317]() and potential long-term health effects, see M21-1, Part VIII, Subpart ii, 1.D.1.d. ### VIII.ii.1.D.2.c. Requesting Examinations in Claims for Infectious Diseases Use the table below when an examination and/or medical opinion is needed to decide a claim for infectious disease under [38 CFR 3.317]().| If the claim involves a(n) ...| Then ... infectious disease listed in [38 CFR 3.317(c)]()| request the appropriate infectious diseases DBQ to evaluate current severity. **Note:** As presumptive SC applies to the infectious disease under [38 CFR 3.317](), a medical opinion is not required. long-term health effect potentially associated with an infectious disease as noted in [38 CFR 3.317(d)]() | request a medical opinion as to whether it is at least as likely as not that the condition was caused by the Veteran having had the infectious disease. _**Important**_ : * Do not request a Gulf War general medical examination for infectious disease claims. * The Acceptable Clinical Evidence (ACE) examination process may be used when processing these claims, when deemed appropriate. _**Reference**_ : For more information on ACE examinations, see [M21-1, Part IV, Subpart i, 2.A.4](). ## 3. Rating Claims for Infectious Disease Under 38 CFR 3.317 June 30, 2025 ### VIII.ii.1.D.3.a. Proper Coding for Infectious Disease Decisions Under 38 CFR 3.317 In order to properly identify and track infectious disease claims for which SC is awarded or denied under [38 CFR 3.317](), regional offices must properly code the disabilities in the Veterans Benefits Management System - Ratings (VBMS-R) by assigning the * _Gulf War Presumptive \- Infectious Disease (3.317(c)) _special issue, and * special issue basis specific to the infectious disease. _**Reference**_ : For more information on assigning a special issue in VBMS-R, see the _VBMS-R User Guide_.