Infectious Diseases, Immune Disorders, and Nutritional Deficiencies Overview (38 CFR 4.88b)

Infectious Diseases

Throughout life, one is exposed to a variety of organisms and substances that are endless in number and capable of causing disease.  Infectious diseases may be caused by bacteria, viruses, fungi, and parasites.  Manifestations of these diseases range from acute (rapid onset, short duration) episodes of fever, diarrhea, fatigue, muscle aches, and coughing. These acute manifestations may become chronic and even result in death if the infection is not treated.

Within this section, the general systems affected by infectious diseases are the skin, special senses, musculoskeletal, genitourinary, gastrointestinal (digestive organs) and the digestive accessory organs (liver, pancreas, gallbladder).

Immune Disorders

The immune disorders occur when the immune system is unable to recognize, inactivate, or destroy foreign substances that invade the body. Disorders, diseases, and malignancies may occur if the immune system is compromised. If the immune system overreacts, then allergies develop and tolerance to disease-causing substances (antigens) disappear causing autoimmune diseases to arise. This section covers three immune disorders: systemic lupus erythematosus (SLE), human immunodeficiency virus (HIV) related illness and chronic fatigue syndrome (CFS).

Nutritional Deficiencies

Foods supply the nutrition needed to provide the body with energy, growth, maintenance, and repair of body tissues. Carbohydrates, fats, proteins, vitamins, and minerals are contained in the foods we eat on a daily basis. A person's body build, age, gender, physical activity, and level of physical and emotional health influence the daily nutritional requirement.

A state of deficiency exists when a substance or substances essential for metabolism and health are lacking. These deficiencies may occur from excess loss, inadequate intake, or inability to absorb the necessary substances. The area of the body affected depends on the vitamin that is lacking. For example, major abnormalities that result from specific vitamin deficiencies include:

• Vitamin A deficiency causes interference with the eyes, trachea, hair follicles, and renal pelvis.

• Vitamin B complex deficiencies can cause disturbances in digestion, and function of the thyroid and the nervous system as well as problems in the liver. Deterioration of sex glands also can occur as well as untoward effects on the heart, spleen, and kidneys; enlargement of the adrenals; and dysfunction in the pituitary and salivary glands.

• Vitamin C deficiency causes problems in skeletal and teeth formation, injury to bone, cells, and blood vessels.

• Vitamin D deficiency also affects the bones and may lead to irregularities within the bones.

• Vitamin E deficiency decreases the ability of the red blood cells to resist rupture.

• Vitamin K deficiency causes prolonged clotting time that can result in bleeding.

Complex Issues

• Chronic Fatigue Syndrome (CFS)

• 38 CFR 4.88b: Schedule of ratings - infectious diseases, immune disorders and nutritional deficiencies.

Notes

Rate any residual disability of infection within the appropriate body system as indicated by the notes in the evaluation criteria. As applicable, consider the long-term health effects potentially associated with infectious diseases as listed in § 3.317(d) of this chapter, specifically Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium Tuberculosis, Nontyphoid Salmonella, Shigella, Visceral Leishmaniasis, and West Nile virus.

General Rating Formula for Infectious Diseases

• For active disease warrants an evaluation of 100 percent.

• After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system.

Infectious diseases, Immune disorders, and Nutritional deficiencies

Special Considerations

Consider presumptive service connection (SC) for infectious diseases listed in

• 38 CFR 3.309(b) based on tropical service

• 38 CFR 3.309(c) based on confirmed former prisoner of war (FPOW) status, and

• 38 CFR 3.317(c) based on service in the Southwest Asia theater of operations during the Gulf War or on or after September 19, 2001, in Afghanistan.

Consider presumptive SC for immune disorders listed in 38 CFR 3.309(a).

Consider presumptive SC for disabilities listed in SC 38 CFR 3.309(c) based on based on confirmed FPOW status.