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Chronic Fatigue Syndrome

A condition causing extreme tiredness that does not improve with rest and gets worse with physical or mental activity. The VA rates CFS based on how much your symptoms limit daily activities.

Code: 6354
Criteria: 38 CFR 4.88b, DC 6354
Exam length: ~45 minutes
Form: Chronic Fatigue Syndrome DBQ

Rating steps

0%
10%
20%
40%
60%
100%

The percentages this diagnostic code can be rated at. Which one applies depends on the findings — no tool here can tell you in advance.

What happens at the appointment

The examiner will ask about the onset, duration, and severity of your fatigue — specifically whether it is new onset, reduces activity by 50% or more, and is not explained by another condition.
You will be asked about the hallmark symptoms: post-exertional malaise (crash after activity), unrefreshing sleep, cognitive impairment, muscle pain, joint pain, headaches, and sore throat/lymph nodes.
The examiner will assess whether symptoms are constant, nearly constant, or intermittent and whether they restrict your routine daily activities.
You will be asked about all treatments tried and whether they have controlled your symptoms.
The examiner will determine if your symptoms require you to reduce your activity level to less than 50% of your pre-illness level.

What the examiner is actually filling in

01Whether you meet the diagnostic criteria for Chronic Fatigue Syndrome.
02Whether symptoms reduce your activity to less than 50% of pre-illness levels.
03Whether symptoms are constant, nearly constant, or intermittent.
04Whether symptoms are refractory to therapy.
05Associated symptoms: post-exertional malaise, cognitive impairment, unrefreshing sleep, muscle/joint pain, headaches.

Rated under 38 CFR 4.88b, DC 6354. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

Be precise about your functional limitations: "I can be upright and active for about 3 hours per day. After that, I must lie down."
Describe post-exertional malaise in detail: "If I walk to the grocery store, I will be bedridden for 2 days afterward."
Explain that rest does not restore energy like it does for healthy people — unrefreshing sleep is a core feature.
If you are a Gulf War veteran, note that CFS is a presumptive condition under 38 CFR 3.317.
If you had to reduce work hours, quit a job, or stop activities you once enjoyed, present that as a clear before-and-after picture.

What costs veterans points

Using the phrase "I am tired" instead of describing the debilitating exhaustion that is qualitatively different from normal fatigue.
Not explaining post-exertional malaise — the hallmark symptom where minimal activity causes a disproportionate crash lasting days.
Forgetting to mention cognitive symptoms: difficulty concentrating, word-finding problems, inability to process information as quickly as before.
Appearing energetic at the exam because you rested for days beforehand to be able to attend — explain that preparation if it occurred.

The rating criteria, in plain language

Rating levels for Chronic Fatigue Syndrome under 38 CFR 4.88b, DC 6354
Rating	Rating criteria	What that means for you
0%	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.	Your chronic fatigue syndrome is service-connected but the record shows no periods of incapacitation — the Note to DC 6354 counts incapacitation only where a licensed physician prescribes bed rest and treatment, and there is less than one week of it in the past year — and your symptoms are not controlled by continuous medication. Those are the two alternative routes to 10 percent, and failing both leaves the lowest rung unmet. DC 6354 prints no 0 percent rung of its own; 38 CFR 4.31 supplies it: no monthly payment, but the condition is on record and a later increase runs from this date. The lowest compensable level under this code is 10 percent.
0%	What supports this level No physician-prescribed bed rest and treatment recorded in the past 12 months No continuous medication prescribed for symptom control Routine daily activities documented as unrestricted compared with pre-illness level A dated record of the condition so that a later increase claim has a starting point
10%	Chronic fatigue syndrome: debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms 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. 10 percent.	Your chronic fatigue symptoms wax and wane but are generally controlled with continuous medication. You can perform most daily activities, though you may need to pace yourself.
10%	What supports this level CFS diagnosis meeting CDC criteria Symptoms controlled with medication Periods of incapacitation documented Cognitive impairment symptoms noted
20%	Chronic fatigue syndrome: 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. 20 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities by less than 25 percent of pre-illness levels.
20%	What supports this level Nearly constant symptoms documented Daily activities restricted by less than 25 percent Periods of incapacitation 2-4 weeks per year Treatment records showing ongoing symptoms
40%	Chronic fatigue syndrome: which are nearly constant and restrict routine daily activities to 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. 40 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities to 50 to 75 percent of pre-illness levels. You have significant difficulty maintaining your prior activity level.
40%	What supports this level Nearly constant symptoms restricting activities 25-50 percent Periods of incapacitation 4-6 weeks per year Significant reduction in daily activity level documented Employment or social functioning impacted Ongoing medical treatment records
60%	Chronic fatigue syndrome: 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. 60 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities to less than 50 percent of pre-illness levels. You spend significant periods unable to function normally.
60%	What supports this level Nearly constant symptoms restricting activities to less than 50 percent Periods of incapacitation 6 or more weeks per year Major reduction in daily functioning documented Unable to maintain employment or social activities Multiple provider treatment records
100%	Chronic fatigue syndrome: which are nearly constant and so severe as to restrict routine daily activities almost completely, or; which are nearly constant and restrict routine daily activities such that the veteran is essentially housebound. 100 percent.	Your chronic fatigue symptoms are nearly constant and so severe that they restrict you to bed rest and being essentially housebound nearly all the time.
100%	What supports this level Nearly constant debilitating symptoms Essentially housebound or bed-bound Routine daily activities almost completely restricted Unable to perform self-care without assistance Extensive medical documentation of severity

The middle column is our transcription of the criteria at 38 CFR 4.88b, DC 6354, condensed for reading. Read the section itself on eCFR before relying on the exact wording. The items under each level are the kinds of evidence that document it — not a VA checklist, and not a prediction of which level applies to you.

Mistakes we see most often

Not keeping a detailed symptom diary showing frequency and severity of episodes.

Not documenting that symptoms are "nearly constant" to qualify for higher ratings.

Missing secondary conditions like depression, cognitive problems, or fibromyalgia.

CFS is a Gulf War presumptive — if you served in Southwest Asia, document your service dates.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

View condition guide →View evidence checklist →

Folder readiness

Tick these off as you gather them. Nothing here is required — the exam happens either way — but each one is something the examiner cannot record if it is not in front of them.

Saved in this browser only.

Take it with you

Print the whole guide — what the examiner records, the folder list with your ticks, the criteria table and the mistakes to avoid — and bring it to the appointment.

Frequently paired

Documented secondary or co-occurring conditions. Each is examined separately and has its own guide.

Free tool · 282 guides · DBQ-aligned

C&P Exam Preparation Guides

The VA orders this exam to verify your diagnosis and measure how severe it is right now. It can shape your rating and your monthly compensation — but it does not decide your claim. A rating specialist weighs it against your full record, and if the exam does not reflect your condition, you can say so and ask the VA to correct it.

Source forms
Coverage

What happens at the appointment

The examiner will ask about the onset, duration, and severity of your fatigue — specifically whether it is new onset, reduces activity by 50% or more, and is not explained by another condition.
You will be asked about the hallmark symptoms: post-exertional malaise (crash after activity), unrefreshing sleep, cognitive impairment, muscle pain, joint pain, headaches, and sore throat/lymph nodes.
The examiner will assess whether symptoms are constant, nearly constant, or intermittent and whether they restrict your routine daily activities.
You will be asked about all treatments tried and whether they have controlled your symptoms.
The examiner will determine if your symptoms require you to reduce your activity level to less than 50% of your pre-illness level.

What the examiner is actually filling in

01Whether you meet the diagnostic criteria for Chronic Fatigue Syndrome.
02Whether symptoms reduce your activity to less than 50% of pre-illness levels.
03Whether symptoms are constant, nearly constant, or intermittent.
04Whether symptoms are refractory to therapy.
05Associated symptoms: post-exertional malaise, cognitive impairment, unrefreshing sleep, muscle/joint pain, headaches.

Rated under 38 CFR 4.88b, DC 6354. The examiner records findings on the DBQ; a rating specialist makes the decision.

A complete answer sounds like

Be precise about your functional limitations: "I can be upright and active for about 3 hours per day. After that, I must lie down."
Describe post-exertional malaise in detail: "If I walk to the grocery store, I will be bedridden for 2 days afterward."
Explain that rest does not restore energy like it does for healthy people — unrefreshing sleep is a core feature.
If you are a Gulf War veteran, note that CFS is a presumptive condition under 38 CFR 3.317.
If you had to reduce work hours, quit a job, or stop activities you once enjoyed, present that as a clear before-and-after picture.

What costs veterans points

Using the phrase "I am tired" instead of describing the debilitating exhaustion that is qualitatively different from normal fatigue.
Not explaining post-exertional malaise — the hallmark symptom where minimal activity causes a disproportionate crash lasting days.
Forgetting to mention cognitive symptoms: difficulty concentrating, word-finding problems, inability to process information as quickly as before.
Appearing energetic at the exam because you rested for days beforehand to be able to attend — explain that preparation if it occurred.

The rating criteria, in plain language

Rating levels for Chronic Fatigue Syndrome under 38 CFR 4.88b, DC 6354
Rating	Rating criteria	What that means for you
0%	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.	Your chronic fatigue syndrome is service-connected but the record shows no periods of incapacitation — the Note to DC 6354 counts incapacitation only where a licensed physician prescribes bed rest and treatment, and there is less than one week of it in the past year — and your symptoms are not controlled by continuous medication. Those are the two alternative routes to 10 percent, and failing both leaves the lowest rung unmet. DC 6354 prints no 0 percent rung of its own; 38 CFR 4.31 supplies it: no monthly payment, but the condition is on record and a later increase runs from this date. The lowest compensable level under this code is 10 percent.
0%	What supports this level No physician-prescribed bed rest and treatment recorded in the past 12 months No continuous medication prescribed for symptom control Routine daily activities documented as unrestricted compared with pre-illness level A dated record of the condition so that a later increase claim has a starting point
10%	Chronic fatigue syndrome: debilitating fatigue, cognitive impairments (such as inability to concentrate, forgetfulness, confusion), or a combination of other signs and symptoms 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. 10 percent.	Your chronic fatigue symptoms wax and wane but are generally controlled with continuous medication. You can perform most daily activities, though you may need to pace yourself.
10%	What supports this level CFS diagnosis meeting CDC criteria Symptoms controlled with medication Periods of incapacitation documented Cognitive impairment symptoms noted
20%	Chronic fatigue syndrome: 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. 20 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities by less than 25 percent of pre-illness levels.
20%	What supports this level Nearly constant symptoms documented Daily activities restricted by less than 25 percent Periods of incapacitation 2-4 weeks per year Treatment records showing ongoing symptoms
40%	Chronic fatigue syndrome: which are nearly constant and restrict routine daily activities to 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. 40 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities to 50 to 75 percent of pre-illness levels. You have significant difficulty maintaining your prior activity level.
40%	What supports this level Nearly constant symptoms restricting activities 25-50 percent Periods of incapacitation 4-6 weeks per year Significant reduction in daily activity level documented Employment or social functioning impacted Ongoing medical treatment records
60%	Chronic fatigue syndrome: 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. 60 percent.	Your chronic fatigue symptoms are nearly constant and restrict your routine daily activities to less than 50 percent of pre-illness levels. You spend significant periods unable to function normally.
60%	What supports this level Nearly constant symptoms restricting activities to less than 50 percent Periods of incapacitation 6 or more weeks per year Major reduction in daily functioning documented Unable to maintain employment or social activities Multiple provider treatment records
100%	Chronic fatigue syndrome: which are nearly constant and so severe as to restrict routine daily activities almost completely, or; which are nearly constant and restrict routine daily activities such that the veteran is essentially housebound. 100 percent.	Your chronic fatigue symptoms are nearly constant and so severe that they restrict you to bed rest and being essentially housebound nearly all the time.
100%	What supports this level Nearly constant debilitating symptoms Essentially housebound or bed-bound Routine daily activities almost completely restricted Unable to perform self-care without assistance Extensive medical documentation of severity

Mistakes we see most often

Not keeping a detailed symptom diary showing frequency and severity of episodes.

Not documenting that symptoms are "nearly constant" to qualify for higher ratings.

Missing secondary conditions like depression, cognitive problems, or fibromyalgia.

CFS is a Gulf War presumptive — if you served in Southwest Asia, document your service dates.

Before & after your exam

These apply to every C&P exam, whatever the condition.

Do not miss the appointment: Missing your C&P exam without a good reason can cost you. Under 38 CFR § 3.655, a missed exam can cause a claim for an increased rating or a reopened claim to be denied, and can cause an original claim to be decided on the evidence already in your file. If you cannot make it, call the VA or the exam company right away to reschedule — a documented good reason (illness, work conflict, no transportation, a family emergency) protects your claim.
Your examiner may be a contractor: Many C&P exams are performed by VA-contracted companies — QTC, Optum Serve (LHI), VES, or MSLA — not at a VA hospital. They will call, text, or mail you to schedule. Do not ignore an unknown number or letter while your claim is pending, and confirm the exam location and time before you go.
The examiner does not decide your claim: The examiner's job is to record findings on the Disability Benefits Questionnaire (DBQ). A rating specialist at the Regional Office makes the actual decision, using the exam together with your full record — service records, medical records, and lay statements. One appointment does not settle everything.
Get a copy of your exam report: After the exam you can request the report (often called the DBQ or C&P exam results) through VA.gov, the Blue Button tool, or your accredited representative. Reading it lets you catch errors while you still have time to respond.
If the exam was inadequate, you have options: If the examiner rushed you, evaluated the wrong condition, or the report is inaccurate, you can submit a statement and new evidence, and — after a decision — request a review (a Supplemental Claim or Higher-Level Review). A single bad exam is not the end of your claim.

Chronic Fatigue Syndrome

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam

Chronic Fatigue Syndrome

Rating steps

What happens at the appointment

What the examiner is actually filling in

A complete answer sounds like

What costs veterans points

The rating criteria, in plain language

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

What supports this level

Mistakes we see most often

Before & after your exam