A disease caused by deficient vitamin intake.

Etiologic factors related to the following vitamin deficiencies:

• Initial Vitamin A (retinol) - Deficiency is usually caused by long-standing lack of vitamin A in the diet. It occurs most frequently in areas where rice is the staple, such as southern and eastern Asia.

• Secondary Vitamin A (retinol) - Deficiency may be caused by inadequate conversion of carotene to vitamin A. It may also be caused by an interference with absorption, storage, or transport of vitamin A.

• Folate (folic acid) - Deficiency may be caused by inadequate intake, absorption, or utilization of folate, as well as, an increase in the requirement for, or increased excretion of folate.

• Vitamin B1 (thiamine) - Deficiency is caused by inadequate intake of the vitamin, especially in people whose diets consist of highly-polished rice.

• Vitamin B2 (riboflavin) - Deficiency is associated with lack of adequate consumption of milk and other animal products. Secondary deficiencies occur most commonly in chronic diarrhea, liver disease, chronic alcoholism, and postoperative situations when infusions lack sufficient amounts of vitamins.

• Vitamin B6 (pyridoxine) - Deficiency is rare as a primary deficiency because most foods contain vitamin B6. However, a secondary deficiency may occur due to malabsorption, alcoholism, use of oral contraceptives, or chemical inactivation by drugs.

• Vitamin B12 (cobalamin) - Deficiency results in pernicious anemia. Vitamin B12 is used to prevent the occurrence of the deficiency and other conditions that result from defective red cell formation.

• Niacin (nicotinic acid) - Primary deficiency usually occurs where maize (Indian corn) is a major part of the diet. Bound niacin, found in Indian corn, is not transformed in the intestinal tract unless it has been previously treated with alkalis. Diarrheas, cirrhosis, and alcoholism, as well as an increased need during postoperative periods due to a lack of nutrients in infusions, may result in a secondary deficiency. In addition, pellagra may occur during prolonged isoniazid therapy.

• Vitamin C (ascorbic acid) - Primary deficiency is usually due to improper diet. Deficiencies occur in gastrointestinal disease, especially when the patient is on a bland diet. Vitamin C requirements are increased during pregnancy, lactation, thyrotoxicosis, acute and chronic inflammatory diseases, surgery, and burns.

• Vitamin D (calciferol) - Lack of sunlight and low dietary intake are usually necessary for the development of the deficiency.

• Vitamin E (tocopherol) - Malabsorption and inadequate transport are generally causes of vitamin E deficiency.

• Vitamin K (menadione) - Healthy individuals rarely encounter primary vitamin K deficiency. Vitamin K is distributed widely in plant and animal tissues. However, it does occur when there is limited dietary intake. Additional causes include: trauma; extensive surgery; medications such as anticoagulants, salicylates and anticonvulsants; and long-term parenteral nutrition with or without treatment with broad-spectrum antibiotics.

Manifestations of the following deficiencies:

• Vitamin A - The deficiency causes interference with growth and resistance to infections. It causes interference with nutrients to areas of the cornea, conjunctiva, trachea, hair follicles, and renal pelvis. Vitamin A deficiency also interferes with functions of the eyes. It affects the ability to see in the dark, and impairs visual acuity.

• Vitamin B Complex (B1, B2, Niacin, B6, Folic Acid, B12) - The deficiencies can cause beriberi and pellagra; disturbances in digestion, and function of the thyroid and the nervous system as well as hepatomegaly. Deterioration of sex glands can occur. The condition also causes swelling and untoward effects on the heart, liver, spleen, and kidneys; enlarges the adrenals; and causes dysfunction of the pituitary and salivary glands.

• Vitamin C - The deficiency causes scurvy, defects in prenatal skeletal formation and teeth, pyorrhea, anorexia, and anemia. It also leads to injury to bone, cells, and blood vessels.

• Vitamin D - Results of the deficiency in terms of degree:

  • Mild deficiency causes interference with the utilization of calcium and phosphorus in bone and tooth formation. Irritability and weakness are also manifestations.

  • Severe deficiency causes osteomalacia in adults.

• Vitamin E - The deficiency decreases the ability of the red blood cell to resist rupture. Except for premature infants and people with chronic fat malabsorption the deficiency is uncommon.

• Vitamin K - The deficiency causes prolonged clotting time that can result in bleeding. The prolonged clotting time is considered to be abnormal in individuals who are not taking anticoagulant drugs. The deficiency is also common in persons experiencing fat malabsorbtion.

Tests used to identify the following deficiencies:

• Vitamin A - The deficiency is not easily identified during the preclinical stage unless a history of inadequate intake is known. Retinol levels in plasma fall after the liver stores are depleted.

• Vitamin B Complex

• Vitamin B1 (thiamine) - Deficit blood and urine tests are usually done. (See Diagnostic Code: 6314 Beriberi)

• Vitamin B2 - History and presence of suggestive lesions are not suitable to make a diagnosis of riboflavin deficiency. Laboratory tests and possible therapeutic trials, as well as, elimination of other causes are necessary.

• Niacin (nicotinic acid) - Diagnosis is easy when skin and mouth lesions, diarrhea, delirium, and dementia are manifested. However, if the condition has not developed to this point, a history of a diet lacking in niacin and tryptophan are important.

• Vitamin B6 - There is no general test identified now for this deficiency.

• Folate - Measurable folate depletion is the indicator that differentiates folate deficiency from other forms of megaloblastic anemia.

• Vitamin B12 - Blood tests are available to detect a vitamin B12 (pernicious anemia) deficiency.

• Vitamin C - Depletion of vitamin C causes little to be present in the urine after a test dose of vitamin C is given. A positive capillary fragility test almost always occurs in the deficiency, and anemia is a common finding.

• Vitamin D - Plasma samples are used to measure vitamin D metabolites. Low serum phosphorus, low or normal serum calcium, and a high serum alkaline phosphatase are also found.

• Vitamin E - Vitamin E deficiency can cause the plasma tocopherol level to decrease to levels less than 5 ?/mL (low), and result in large amounts of creatine in the urine. Increased blood phosphocreatine levels may occur in persons with vitamin E deficiency on a creatine-free diet.

• Vitamin K - Reduced activity of prothrombin and other vitamin K dependent factors is indicative of vitamin K deficiency or antagonism. The prothrombin time (PT) and the activated partial thromboplastin time (PTT) are usually prolonged.

Treatments used for the following deficiencies:

• Vitamin A - The cause of the deficiency should be corrected, and vitamin A should be given in therapeutic doses instantly.

• Vitamin B Complex - A balanced diet and vitamin supplements are used in the treatment.

• Vitamin C - For scurvy in adults, ascorbic acid 100 mg by mouth, three times a day, is given for 1 to 2 weeks until signs of scurvy have disappeared. Then a nutritious diet supplying one to two times the recommended dietary allowances for vitamin C is given.

• Vitamin D - Adequate calcium and phosphorus intake are required to avoid and cure osteomalacia and uncomplicated rickets.

• Vitamin E - Large doses of alpha-tocopherol by mouth in divided doses are needed to treat neuropathy early, or to treat the defect of malabsorption and transport.

• Vitamin K - Administration of phytonadione (Phylloquinone) is the desired treatment. Positive effects from treatment usually occur within 6 to 10 hours.

Residuals for the following vitamins are:

• Vitamin A - Age is a determining factor in how this deficiency affects the individual. The inadequate intake or use of vitamin A can cause impaired adaptation to the dark and night blindness; dryness of the conjunctiva and cornea; inflammation of the eye and softening of the cornea; toughening of the lung, gastrointestinal tract, and urinary tract epithelia; increased susceptibility to infections; and sometimes death. Overgrowth of the horny layer of the epidermis is also common.

• Vitamin B Complex - (See Diagnostic Code: 6315 Pellagra, Diagnostic Code: 6314 Beriberi, and Pernicious anemia.)

• Vitamin C - Manifestations usually disappear about 1 to 2 weeks with treatment. Chronic gingivitis involving extensive subcutaneous hemorrhage may take somewhat longer.

• Vitamin D - Softening of the bones occurs, particularly in the spine, pelvis, and lower extremities; the fibrous lamellae become visible on x-rays as incomplete, ribbon-like areas of pseudofractures. The softened bones may become bowed from the weight especially the long bones. Vertical shortening of the vertebrae and flattening of the pelvic bones may also occur.

• Vitamin E - Absence of reflexes, gait disturbance, decreased proprioceptive and vibratory sensation, and paresis of gaze, can be associated with deterioration of posterior columns of the spinal cord.

• Vitamin K - Even when phytonadione is properly diluted and administered, severe episodes resembling hypersensitivity reactions, including shock and cardiac or respiratory arrest, are known to have occurred. (Residual in relation to treatment.)

1. May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% and/or other requirements/qualifications under 38 CFR §3.350 [Special monthly compensation ratings]. Also reference 38 CFR 3.155(d)(2)

2. If the veteran is a former prisoner of war and was interned or detained for not less that 30 days, this disease shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR 3.309 (c) Disease subject to presumptive service connection].