Chronic fatigue syndrome (CFS) VA Rating
How VA rates Chronic fatigue syndrome (CFS) under diagnostic code 6354, what evidence decides the percentage, and the reasons these claims get denied or under-rated.
Chronic fatigue syndrome (CFS) is rated under diagnostic code 6354. In the VA Schedule for Rating Disabilities it appears as Chronic fatigue syndrome (CFS), within the Infectious Diseases section of 38 CFR Part 4.
The essentials
| Diagnostic code | 6354 |
|---|---|
| Rating schedule name | Chronic fatigue syndrome (CFS) |
| Body system | Infectious Diseases |
| Examination form | RHEUM Chronic fatigue syndrome |
How VA rates chronic fatigue syndrome (cfs)
These are the rating levels VA assigns under diagnostic code 6354, quoted from the rating schedule. A rater compares the findings in your examination against each level and assigns the highest one your evidence supports.
| Rating | Criteria |
|---|---|
| 100% | Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care |
| 60% | 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% | 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% | 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% | 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 |
- Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.
Criteria quoted from 38 CFR Part 4, Subpart B (eCFR edition 2026-01-01). Where a rating depends on measurements, the figures in your examination report are what decide it — which is why an examination that skipped a required measurement is worth challenging.
What evidence decides the rating
For infectious diseases conditions, these are the findings VA weighs when assigning a percentage. If your examination did not address them, the examination may be inadequate for rating purposes — which is itself an argument on appeal.
- Whether the disease is active or resolved, and what residuals remain
- For chronic fatigue syndrome: debilitating fatigue that reduces daily activity to less than 50% of pre-illness level, and whether it is incapacitating
Why these claims get denied or under-rated
These are the failure patterns we see most often on chronic fatigue syndrome (cfs) and related infectious diseases claims:
- Residuals were never separately rated after the active disease resolved
- Undiagnosed illness and Gulf War presumptive pathways were not considered
Secondary service connection
Under 38 CFR §3.310, a condition caused or aggravated by an already service-connected condition is itself service-connected. Secondary claims are where most veterans are leaving compensation on the table — and where most denials turn on the nexus opinion rather than the diagnosis.
Chronic fatigue syndrome (CFS) is commonly claimed secondary to
- Gulf War undiagnosed illness presumptives
- Post-infectious sequelae
Chronic fatigue syndrome (CFS) commonly causes or aggravates
- Depression
- Cognitive impairment
If you are already service-connected for chronic fatigue syndrome (cfs) and any of these apply to you, they may be claimable as secondary conditions.
If your claim was denied or under-rated
A denial is not the end of the claim. Which route is right depends on why VA decided the way it did:
- Higher-Level Review — when the evidence already in the file supports a grant and VA got the decision wrong, or the examination was inadequate.
- Supplemental Claim — when you have new and relevant evidence, such as a private nexus opinion.
- Board Appeal — when you need a Veterans Law Judge to decide, or want a hearing.
- Clear and Unmistakable Error — when a decision more than a year old contains an undebatable error, which can recover retroactive pay.
Effective dates matter as much as the percentage. See effective dates and back pay for how far back an award can reach.
Sources
Related conditions
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This page is educational information, not legal advice. VA rules and deadlines change — always confirm details with the official source (38 CFR, M21-1) or your accredited claims agent. Borne Accredited Claims is an accredited VA claims agent under 38 CFR §14.629 and is not part of, or endorsed by, the Department of Veterans Affairs. We do not guarantee any specific outcome.