SKIN CONDITIONS

Summary

The Veteran, who served from January 1998 to August 1998 and September 1999 to September 2004, appeals a September 2024 rating decision concerning chronic fatigue syndrome (CFS). The Veteran sought a compensable rating for CFS, contending its debilitating impact on daily life. The Board reviewed the evidence of record at the time of the agency of original jurisdiction's decision, plus evidence submitted within 90 days of the appeal. The primary evidence considered was a July 2024 VA examination, where the Veteran reported debilitating fatigue, muscle and joint pain, insomnia, difficulty concentrating, memory loss, and brain fog, reducing her daily activity level to less than 50 percent of her pre-illness level. The Board found this evidence met the criteria for a 60 percent rating under Diagnostic Code 6354, noting the fatigue and cognitive impairments were nearly constant and significantly restricted daily activities. However, the Board determined the evidence did not support the higher criteria for a 100 percent rating, as the Veteran was not precluded from self-care and was still able to work, albeit with limitations. Therefore, the Board granted an initial rating of 60 percent for CFS, finding this rating appropriate based on the current symptomatology and its impact on daily functioning.

Rationale

Symptoms meet criteria for 60% rating; Debilitating fatigue and cognitive impairments restrict daily activities to less than 50% of pre-illness level; 100% criteria not met as Veteran is not precluded from self-care and is still working

Full Decision Text

Citation Nr: A26007504
Decision Date: 01/27/26	Archive Date: 01/27/26

DOCKET NO. 250707-560345
DATE: January 27, 2026

ORDER

An initial rating of 60 percent, but no higher, for chronic fatigue syndrome (CFS) is granted. 

FINDING OF FACT

The Veteran's service-connected chronic fatigue syndrome has manifested in debilitating fatigue and cognitive impairments that are nearly constant and restrict her routine daily activities to less than 50 percent of her pre-illness level. 

CONCLUSION OF LAW

The criteria for an initial rating of 60 percent, but no higher, for chronic fatigue syndrome have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.41, 4.7, 4.88, 4.88b, Diagnostic Code 6354.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1998 to August 1998 and from September 1999 to September 2004. 

This matter is before the Board following her appeal of a September 2024 rating decision.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the VA Form 10182 was received, or (2) evidence submitted more than 90 days after the VA Form 10182 was received. 38 C.F.R. § 20.303.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in this decision. See 38 C.F.R. § 20.300. 

An initial rating of 60 percent, but no higher, for chronic fatigue syndrome (CFS) is granted.

The Veteran contends that her chronic fatigue syndrome should be assigned a compensable rating because it has a daily impact on her life. VA Form 10182, received September 2024. 

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects their ability to function under the ordinary conditions of daily life, including employment, by comparing their symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.10. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41. However, where an increase in the disability rating, rather than the propriety of the initial rating, is at issue, the present level of disability is of primary importance, and past medical reports should not take precedence over current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Regardless of whether an appeal stems from disagreement with the initial rating assigned following an award of service connection or from disagreement with the rating assigned following a claim for increase, separate ratings can be assigned for separate periods of time based on the facts found. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)).

In this case, the Veteran's condition is rated under diagnostic code 6354, which allows a compensable rating for a diagnosis of chronic fatigue syndrome if the medical evidence shows debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms. 38 C.F.R. § 4.88b. 

A 10 percent rating is available if those symptoms wax and wane but result in periods of incapacitation of at
. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (citing Fenderson v. West, 12 Vet. App. 119, 126 (1999)).

In this case, the Veteran's condition is rated under diagnostic code 6354, which allows a compensable rating for a diagnosis of chronic fatigue syndrome if the medical evidence shows debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, or confusion), or a combination of other signs and symptoms. 38 C.F.R. § 4.88b. 

A 10 percent rating is available if those symptoms wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year; or if the symptoms require continuous medication for control.

A 20 percent rating is available if the chronic fatigue symptoms are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level; or if the symptoms wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year.

A 40 percent rating is available if the signs and symptoms are nearly constant and restrict routine daily activities from 50 to 75 percent of the pre-illness level; or if they wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year.

A 60 percent rating is available if the signs and symptoms are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level; or if they wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year. 

Finally, a 100 percent rating is available if the chronic fatigue syndrome signs and symptoms are nearly constant and so severe as to restrict routine daily activities almost completely and occasionally preclude self-care. See 38 C.F.R. § 4.88b, diagnostic code 6354. 

In this case, the Veteran attended a VA examination in July 2024, during which she stated that her symptoms consisted of "debilitating fatigue and fatigue that lasts several days after exercise, muscle pain and weakness, joint pain, generalized body aches like she has the flu, insomnia, trouble focusing on tasks, difficulty concentrating, memory loss, [and] brain fog." C&P Examination, July 2024. The examination report states that the Veteran's debilitating fatigue has reduced her daily activity level to less than 50 percent of her pre-illness level for a period of 6 months or longer. Id. 

During that examination, the Veteran also stated, "I feel like everything [takes] 1000% effort cause I get so exhausted." Additionally, the Veteran complained of forgetfulness, inability to concentrate, and other cognitive impairments, such as brain fog and needing to write everything down. She also stated that the symptoms wax and wane, but that they do not result in incapacitation. The Board notes that incapacitation due to chronic fatigue syndrome is not required for a compensable rating under diagnostic code 6354; it is only one of many symptoms that can qualify a Veteran for a rating greater than 0 percent. 

Turning back to the case at hand, the 60 percent rating criteria are met if the Veteran has debilitating fatigue, cognitive impairments, or a combination of other signs and symptoms that "are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level." 38 C.F.R. § 4.88b. The Veteran's July 2024 examination notes not only debilitating fatigue, but also cognitive problems, such as an inability to concentrate and forgetfulness. Those symptoms reduced her daily activity level to less than 50 percent of her pre-illness level. See C&P Examination, July 2024. 

The medical documentation from the Veteran's contemporary treatment records does not counter that finding. Accordingly, the evidence persuasively weighs in favor of a finding that the criteria for a compensable rating are met, and a 60 percent rating is warranted. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

However, the evidence as a whole falls short of meeting the criteria for a 100 percent rating. Again, a 100 percent rating is only warranted if the signs and symptoms of chronic fatigue syndrome are nearly constant and so severe as to restrict routine daily activities almost completely and occasionally preclude self-care. 38 C.F.R. § 4.88b. That is not the case here, as the medical documentation does not support a finding that the Veteran is precluded from performing self-care tasks or other activities of daily living. 

Moreover, the Veteran is currently working, albeit with limitations due to
. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

However, the evidence as a whole falls short of meeting the criteria for a 100 percent rating. Again, a 100 percent rating is only warranted if the signs and symptoms of chronic fatigue syndrome are nearly constant and so severe as to restrict routine daily activities almost completely and occasionally preclude self-care. 38 C.F.R. § 4.88b. That is not the case here, as the medical documentation does not support a finding that the Veteran is precluded from performing self-care tasks or other activities of daily living. 

Moreover, the Veteran is currently working, albeit with limitations due to her disabling condition. See Veteran's statement received July 2025. Overall, the 100-percent criteria are not met, so a rating higher than 60 percent is not warranted. 

Accordingly, a 60 percent rating, but no higher, is warranted throughout the rating period on appeal.   

 

S. Merrick

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Musgrave, Stan M.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.