Bartonellosis (Trench Fever)

DC 6354Infectious Diseases38 CFR 4.88a, DC 6354

A bacterial infection caused by Bartonella that has been linked to military service since World War I. It can cause chronic fatigue, bone pain, and heart valve infection. The VA rates bartonellosis on lasting symptoms and organ damage.

How the VA rates this condition

The VA rates this condition based on how much it affects your ability to work and carry out daily activities. The examiner will focus on the functional limitations your condition causes, not just the diagnosis itself.

Diagnostic code

DC 6354

Rating range

0% – 60%

Rating levels

Rating criteria are defined in 38 CFR 4.88a, DC 6354. This guide presents a plain-language summary and is not a substitute for the full regulatory text. Always consult a VSO or VA-accredited attorney for case-specific advice.

Rating Levels

You have severe lasting effects from bartonellosis such as endocarditis, bacillary angiomatosis, or debilitating chronic symptoms that prevent you from working full time.

What the VA looks for

Bartonella endocarditis confirmed by echocardiogram
Bacillary angiomatosis or peliosis hepatis
Daily activities restricted to less than 50%
Long-term antibiotic therapy required
Significant impact on employment

Common Pitfalls

⚠Not getting Bartonella-specific serology or PCR testing — standard blood cultures often miss Bartonella, so you need specialized tests to confirm the diagnosis.
⚠Failing to document living conditions during service — crowded barracks, field conditions, and louse or flea exposure are risk factors that support your claim.
⚠Not getting an echocardiogram — chronic bartonellosis can damage heart valves silently, and early detection of endocarditis is critical.
⚠Assuming the infection cleared after one course of antibiotics — Bartonella can persist intracellularly and cause relapsing disease.

Related DBQ Forms

DBQ Infectious Diseases

View evidence checklist →See secondary conditions →

Condition Rating Guides

Understand what the VA looks for at each rating level — loading conditions…

How the VA rates this condition

Diagnostic code

DC 6354

Rating range

0% – 60%

Rating levels

Rating Levels

You have severe lasting effects from bartonellosis such as endocarditis, bacillary angiomatosis, or debilitating chronic symptoms that prevent you from working full time.

What the VA looks for

Bartonella endocarditis confirmed by echocardiogram
Bacillary angiomatosis or peliosis hepatis
Daily activities restricted to less than 50%
Long-term antibiotic therapy required
Significant impact on employment

Common Pitfalls

⚠Not getting Bartonella-specific serology or PCR testing — standard blood cultures often miss Bartonella, so you need specialized tests to confirm the diagnosis.

⚠Failing to document living conditions during service — crowded barracks, field conditions, and louse or flea exposure are risk factors that support your claim.

⚠Not getting an echocardiogram — chronic bartonellosis can damage heart valves silently, and early detection of endocarditis is critical.

⚠Assuming the infection cleared after one course of antibiotics — Bartonella can persist intracellularly and cause relapsing disease.