The term leishmaniasis refers to a group of syndromes caused by the protozoa within the cells of the genus leishmania (L). Humans contract the visceral, cutaneous, and mucosal types. Infections occur in white blood cells (WBC) that have left the circulation and established themselves in the tissues. In visceral leishmaniasis, the infection occurs in body organs.

Visceral leishmaniasis is commonly caused by the L. donovani organisms. Transmission of leishmaniasis organisms occurs from the bite of infected female sandflies.

Visceral infection can occur with or without symptoms. The skin can have a grayish appearance, known as kala-azar. The incubation can range from weeks to months, but can possibly last years. A state of ill health, malnutrition, and wasting may occur, as well as fever and splenomegaly. Hepatomegaly can also occur, but is less likely. Some U.S. soldiers who served in Desert Storm in the Persian Gulf have been recognized to have viscerotropic leishmaniasis caused by L. tropica. The disease is usually related to the skin. However, Persian Gulf Veterans have reportedly had mild symptoms of tiredness, fever, and gastrointestinal (GI) problems.

Laboratory tests include those that reveal the parasite on stained slides, cultures of tissue or biopsy specimens obtained from the spleen, liver, bone marrow or lymph nodes.

Highly effective therapy is essential to treat the disease. Specific chemical compounds are required intravenously (IV) or intramuscularly (IM). Treatment continues daily for approximately a month.

Patients may develop skin lesions, predominately on the face during or months after therapy. In India, these lesions may appear years later. Visceral infection can revert , and persons with the lesions can serve as sources of infection.

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. 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 Book B §3.309 [Disease subject to presumptive service connection], §3.309(a) [chronic disease].

3. This disease shall be granted service connection as a result of tropical service, although not otherwise established as incurred in service if manifested to a compensable degree within the applicable time limits under §3.307 or §3.308 following service in a period of war or following peacetime service provided the rebuttable presumption provisions of §3.307 are also satisfied [38 CFR Book B §3.309 (b) Disease subject to presumptive service connection].

• Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. Thereafter, rate under the appropriate body system any residual disability of infection, which includes, but is not limited to liver damage and bone marrow disease

• Confirm the recurrence of active infection by culture, histopathology, or other diagnostic laboratory testing.