An inflammatory disease spread by ticks which starts as erythema chronicum migrans (ECM). Neurologic, joint, or cardiac abnormalities may become evident weeks to months later.

The disease is caused by the spirochete, Borrelia burgdorferi, and transmitted by ticks. The white-footed mouse is the reservoir for larval forms, and deer carry the adult tick. Infection occurs most often when persons are outside, e.g., spring and fall. The tick must be in place on the skin for 36 to 48 hours where they engorge on blood. The spread is through the lymph and blood.

Signs and symptoms depend on the stage of the disease.

• Stage I - early localized infection (1 to 4 weeks after the bite) characterized by erythema migrans, fever, chills and malaise.

• Stage II - early disseminated infection (1 to 6 months after the bite) characterized by persistent malaise, fatigue, pain in joints and tendons, intermittent headache, and occasional palpitations.

• Stage III - late persistent (months to years after the bite) characterized by prolonged arthritis, joint subluxations or tenderness, neurologic deficits, and bluish-red skin lesions with evidence of atrophy.

ECM is the most significant finding for the diagnosis of Lyme disease, and laboratory confirmation is not required. Culture of the organism is diagnostic, but rarely successful. Specific antibodies may be present in persons having the disease for more than six weeks. Enzyme-linked immunosorbent assay (ELISA) or Western blot are utilized for diagnostic purposes.

The treatment depends on the clinical findings and stage of the disease. Treating the disease early is most successful in eradicating the spirochete. Oral antibiotics are the primary choice. Vaccines are under study.

Some develop fibromyalgia, or chronic central nervous system (CNS) abnormalities, or chronic skin lesions or both.

1. This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under §3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR 3.309 [Disease subject to presumptive service connection], §3.309(a) [chronic disease].

2. 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).

Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, Bell's palsy, radiculopathy, ocular, or cognitive dysfunction.