• Tuberculosis (TB) is an infectious disease of man and animals caused by species of mycobacterium, and characterized by the formation of nodules and cheesy-like (caseous) necrotic areas of tissue.

• Miliary tuberculosis is a type of TB characterized by slow, infectious processes that cause weakness progressing to a rapid onset of an acute and overwhelming disease. It is caused by the infection of blood or blood and lymph with a cheesy-like material. These caseous particles then travel into the organs with numerous millet seed-like nodules.

As the TB lesions make their way into a blood vessel, they may scatter the organisms in large amounts causing millions of 1 to 3 mm metastatic lesions. This spreading or scattering is named miliary because the lesions look like millet seeds. If bone marrow is involved, production of refractory anemia, thrombocytopenia, leukemoid reaction, and other peripheral blood patterns may result.

Fever, often with previous complaint of a chill, weakness, malaise, and progressive dyspnea, are common symptoms of the disease.

The occurrence of distributive TB without a miliary pattern in the chest x-ray makes diagnosis difficult. When the condition is suspected, a repeat chest x-ray is necessary in a few days, because the nodules may then be apparent. However, when a large dissemination occurs resulting in thousands of tubercles (nodules) being evenly distributed through the lungs, diagnosis is easy.

Diagnosis may also be made by bronchial washings, protected brush scrapings or by biopsy of the bronchi or bronchial wall. Biopsies of the bone marrow and liver are indicated if all else fails. The tuberculin skin test is usually positive, but cannot be definitive because it may be suppressed, especially in the febrile and elderly.

A full course of chemotherapy is extremely effective and usually curative. Antibiotics are included in the treatment of the condition.

Dissemination of nodular bacilli that occur intermittently may result in a chronic illness, characterized by extended fever of unknown origin. TB involving the blood in HIV-infected persons results in a serious, often confusing illness, that encompasses symptoms of both infections.

If miliary tuberculosis goes without recognition, it is lethal. However, with proper treatment, it is curable.

1. This disease, (condition), only in its active form, has a three year presumptive period and 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], but not for cases first entitled after August 19, 1968 under 38 CFR 4.88 (b) [Schedule of ratings-systemic diseases] and 38 CFR 4.89 [Ratings for inactive nonpulmonary tuberculosis in effect on August 19, 1968].

3. Consider service connection on a presumptive basis as a chronic condition (38 CFR §3.307; §3.309 (a)). 

• Inactive disease: See 38 CFR 4.88 (c) and 4.89.

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

• Rate under the appropriate body system any residual disability of infection which includes, but is not limited to, skin conditions and conditions of the respiratory, central nervous, musculoskeletal, ocular, gastrointestinal, and genitourinary systems and those residuals listed in § 4.88c.