38 CFR Part 4 — 38 CFR § 4.88b

Chronic fatigue syndrome (CFS) — VA Diagnostic Code 6354

Infectious / immune

Diagnostic code

6354

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38 CFR § 4.88b lists Diagnostic Code 6354 as “Chronic fatigue syndrome (CFS).” The lead-in is debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms. Five lines follow: 100, 60, 40, 20, and 10. The diagnosis rule for VA purposes is in § 4.88a, not on those percentage lines. Section 3.317(a)(2)(i)(B)(1) names chronic fatigue syndrome as a medically unexplained chronic multisymptom illness. That presumption is not a percentage.

Reviewed 2026-10-05. Text checked against the eCFR versioner full-text XML for 2026-10-01 on 2026-10-05. Title 38 was up to date as of 2026-10-01 and last amended on 2026-08-27. The § 4.88b source note prints 61 FR 39875, July 31, 1996, as amended at 84 FR 28230, June 18, 2019. The versioner lists a substantive amendment date of 2019-08-11. The § 4.88a source note prints 59 FR 60902, Nov. 29, 1994. The § 3.317 source note prints amendments through 86 FR 51001, Sept. 14, 2021. The versioner lists § 3.317’s latest substantive amendment date as 2021-09-14.

The rating criteria at each level

Chronic fatigue syndrome (CFS) — DC 6354

Rating %: 100

Criteria (verbatim). Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms: Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care

Rating %: 60

Criteria (verbatim). Which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year

Rating %: 40

Criteria (verbatim). Which are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year

Rating %: 20

Criteria (verbatim). Which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year

Rating %: 10

Criteria (verbatim). Which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year; or symptoms controlled by continuous medication

Rating %	Criteria (verbatim)
100	Debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms: Which are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care
60	Which are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year
40	Which are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year
20	Which are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or which wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year
10	Which wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year; or symptoms controlled by continuous medication

Note: For the purpose of evaluating this disability, incapacitation exists only when a licensed physician prescribes bed rest and treatment.

The 100, 60, 40, and 20 percent lines follow the lead-in about debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms. The 60, 40, 20, and 10 percent criteria are printed in the table as the “which” clauses.

38 CFR § 4.88a says that, for VA purposes, the diagnosis of chronic fatigue syndrome requires: (1) new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months; and (2) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and (3) six or more of the following: (i) acute onset of the condition, (ii) low grade fever, (iii) nonexudative pharyngitis, (iv) palpable or tender cervical or axillary lymph nodes, (v) generalized muscle aches or weakness, (vi) fatigue lasting 24 hours or longer after exercise, (vii) headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, (x) sleep disturbance.

DC 6354 does not print a 0 percent line. 38 CFR § 4.31 says: “In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met.”

38 CFR § 4.7 assigns the higher rating when the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 CFR § 4.6 requires each element affecting the evidence to be studied so that decisions will be equitable and just.

Source: 38 CFR § 4.88b, Diagnostic Code 6354, and 38 CFR § 4.88a, eCFR full-text XML for 2026-10-01. The § 4.88b source note prints 61 FR 39875, July 31, 1996, as amended at 84 FR 28230, June 18, 2019. The versioner lists a later substantive amendment date of 2019-08-11. The § 4.88a source note prints 59 FR 60902, Nov. 29, 1994.

What the words mean in your records

Nearly constant, and wax and wane

The 100 percent line uses “nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care.” The 60 percent line uses “to less than 50 percent of the pre-illness level,” or wax and wane with at least six weeks total duration per year. The 40 percent line uses “from 50 to 75 percent.” The 20 percent line uses “by less than 25 percent.” Those prepositions are the schedule’s words.

Incapacitation

The note says incapacitation exists only when a licensed physician prescribes bed rest and treatment. The 10 percent line is the only line that also says “or symptoms controlled by continuous medication.”

Section 4.88a is the diagnosis rule

The percentage lines do not repeat the six-of-ten list. That list is in § 4.88a. The rating lines and the diagnosis rule are different sentences.

When two lines are close

Evidence that speaks to each level

Diagnosis

What the rater needs to see. The three requirements in § 4.88a, including six or more of the ten listed findings, and exclusion of other clinical conditions that may produce similar symptoms.

Where that usually lives. The history, physical examination, and laboratory tests § 4.88a names.

100, 60, 40, 20, or 10

What the rater needs to see. The activity restriction or the periods of incapacitation on that line. Incapacitation exists only when a licensed physician prescribes bed rest and treatment.

Where that usually lives. The physician’s bed-rest and treatment instructions, and the record of routine daily activity compared with the pre-illness level.

Level	What the rater needs to see	Where that usually lives
Diagnosis	The three requirements in § 4.88a, including six or more of the ten listed findings, and exclusion of other clinical conditions that may produce similar symptoms.	The history, physical examination, and laboratory tests § 4.88a names.
100, 60, 40, 20, or 10	The activity restriction or the periods of incapacitation on that line. Incapacitation exists only when a licensed physician prescribes bed rest and treatment.	The physician’s bed-rest and treatment instructions, and the record of routine daily activity compared with the pre-illness level.

VA’s public DBQ list, checked October 5, 2026, names “Chronic Fatigue Syndrome” under Infectious Diseases. A different form is “Infectious Diseases (other than HIV-related illness chronic fatigue syndrome and tuberculosis).”

The exam form

The chronic-fatigue file is Chronic Fatigue Syndrome. The percentage lines and the § 4.88a diagnosis rule are the schedule text. The form does not replace them.

The DC 6331 note, for Coxiella burnetii infection (Q fever), names “post Q-fever chronic fatigue syndrome” as one residual of that infection. That sentence is not the DC 6354 percentage table.

Related codes and how they interact

The other examples in § 3.317(a)(2)(i)(B)

The same paragraph names fibromyalgia and functional gastrointestinal disorders, excluding structural gastrointestinal diseases. The public pages are the fibromyalgia guide and the IBS guide. They are not DC 6354.

Other codes in this schedule are on the infectious-disease diagnostic-code index.

Secondary conditions and presumptions

38 CFR § 3.317(a)(2)(i)(B)(1) names “Chronic fatigue syndrome” as an example of a medically unexplained chronic multisymptom illness. Paragraph (a)(2)(ii) says that term means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Paragraph (a)(1) pays compensation, except as paragraph (a)(7) provides, to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that the disability became manifest either during active service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2026, and that by history, physical examination, and laboratory tests it cannot be attributed to any known clinical diagnosis. Paragraph (a)(4) says disabilities that have existed for 6 months or more, and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period, will be considered chronic. Paragraph (a)(7) says compensation shall not be paid under this section if there is affirmative evidence that the disability was not incurred during active service in the Southwest Asia theater of operations, or was caused by a supervening condition or event between the most recent departure from active duty in that theater and the onset of the disability, or is the result of the veteran’s own willful misconduct or the abuse of alcohol or drugs.

Section 3.317(e)(1) says: “The term Persian Gulf veteran means a veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War.” Paragraph (e)(2) refers to Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. Paragraph (e) does not name Afghanistan. Afghanistan on or after September 19, 2001 appears in paragraph (c)(3), for the infectious-disease rules in paragraph (c), not in paragraph (e).

The rating lines in § 4.88b do not mention § 3.317. A percentage under DC 6354 is the schedule. Service connection under § 3.317 is a different section.

38 CFR § 3.309(e) does not name chronic fatigue syndrome. 38 CFR § 3.309(f) does not name it. 38 CFR § 3.320 and § 3.320a do not name it. 38 CFR § 3.316 does not name it. Section 3.309(a) does not name it.

A separate question, when a presumption does not decide it, is a medical question on the facts under 38 CFR § 3.310. Paragraph (a) covers disability proximately due to or the result of a service-connected disease or injury. Paragraph (b) covers increase in severity and requires a medical baseline.

Short answers

What is the VA rating for DC 6354?

Under 38 CFR § 4.88b, chronic fatigue syndrome is rated 100, 60, 40, 20, or 10 percent on the activity and incapacitation lines. Incapacitation exists only when a licensed physician prescribes bed rest and treatment. The diagnosis rule is in § 4.88a. Education only. VA decides on the evidence.

Does the herbicide list include chronic fatigue syndrome?

Section 3.309(e) does not name chronic fatigue syndrome. The Gulf War section that names it is § 3.317(a)(2)(i)(B)(1).

FAQ

How does VA rate chronic fatigue syndrome under DC 6354?

38 CFR § 4.88b prints 100, 60, 40, 20, and 10 percent. The note says incapacitation exists only when a licensed physician prescribes bed rest and treatment. Section 4.88a is the diagnosis rule, including six or more of the ten listed findings. Education only.

What is the 60 percent line?

Nearly constant symptoms that restrict routine daily activities to less than 50 percent of the pre-illness level, or symptoms that wax and wane and result in periods of incapacitation of at least six weeks total duration per year.

Is chronic fatigue syndrome a Gulf War presumption?

Section 3.317(a)(2)(i)(B)(1) names it as a medically unexplained chronic multisymptom illness for a Persian Gulf veteran, as § 3.317(e) defines that term. The paragraph does not name Afghanistan. Herbicide § 3.309(e), Camp Lejeune § 3.309(f), § 3.320, and § 3.320a do not name chronic fatigue syndrome.

Next steps

Read the decision for DC 6354, the activity level it describes, and whether a licensed physician prescribed bed rest and treatment.
The free worksheet is a place to write the code, the findings, and the records you already have. It does not file a claim or protect a filing date. C&P prep (Founding Pass) is a separate worksheet. An accredited representative is at find a VSO.
Other codes in this schedule are on the infectious-disease diagnostic-code index.

Education only. Not legal or medical advice. My Claim Packet is not a VA-accredited representative and does not file claims. VA decides every claim on its own evidence.

Other codes in this body system

Nearby catalog entries in Infectious / immune, ordered by diagnostic code number. All Infectious / immune codes

Also: DC code lookup (tools) lists the same index in a compact layout.

Source: 38 CFR Part 4, Diagnostic Code 6354 • va.gov

⚠️ Important Disclaimer

This page provides general educational information based on public VA regulations and VA.gov resources. It is not legal or medical advice, and My Claim Packet is not a VA-accredited representative. Any worksheets or draft documents produced by the tools must be reviewed for accuracy and are not filed with VA for you. Ratings and service connection are decided case-by-case from the individual record. Consult a VA-accredited VSO, claims agent, attorney, or qualified clinician for help with your situation, and verify current rules using the linked official source.