For Gulf War veterans and other service members, chronic fatigue syndrome (CFS) can be a debilitating condition that significantly impacts daily life. The Department of Veterans Affairs (VA) provides disability ratings for CFS based on its severity and how much it limits daily activities.
This guide will help you understand eligibility, the rating process, and steps to secure a CFS VA rating.
Military Causes and Risk Factors for CFS
Chronic fatigue syndrome often stems from various factors veterans may encounter during military service. Identifying these risk factors can help establish a service connection.
- Chemical warfare agents: Exposure to chemical warfare agents during the Gulf War has been linked to long-term health effects, including chronic fatigue syndrome.
- Depleted uranium exposure: Depleted uranium, used in military munitions, may contribute to long-term fatigue and related symptoms.
- Oil well fire smoke: Prolonged exposure to oil well fire smoke can cause respiratory and immune system issues, potentially leading to chronic fatigue.
- Endemic diseases in deployment regions: Deployment regions often expose service members to infectious diseases, increasing the risk of CFS.
- Endemic diseases in deployment regions: Deployment regions often expose service members to infectious diseases, increasing the risk of CFS.
- Vaccinations and preventive medications: Medications and vaccines given to Gulf War veterans may trigger chronic fatigue in some individuals.
Want to know more about the toxic exposures that may have impacted your health during military service? Use our interactive Toxic Exposure Map to explore exposures at US military bases and gain valuable insights into potential health effects.
Other Military Service Factors
Chronic fatigue syndrome may also result from:
- Environmental toxins exposure
- Traumatic brain injuries
- Post-traumatic stress disorder (PTSD)
- Infectious diseases encountered during deployment
A study published in Fatigue: Biomedicine, Health & Behavior highlights that women veterans with CFS are more likely to experience conditions like fibromyalgia, depression, and anxiety compared to men. This suggests that gender-specific factors may influence how CFS affects veterans. Read the study here.
What Is the VA Rating for Chronic Fatigue Syndrome?
The VA disability rating for Chronic Fatigue Syndrome is 10%, 20%, 40%, 60% or 100% depending on the symptoms and other factors under diagnostic code 6354. Your VA rating for chronic fatigue syndrome will be higher the worse, or more severe, your symptoms are.
- 100% Rating: Symptoms are constant and so severe they restrict nearly all routine activities and may sometimes prevent self-care. Veterans at this level often cannot work or manage daily life without significant assistance.
- 60% Rating: Symptoms are constant and restrict daily activities to less than 50% of pre-illness levels. These veterans may experience at least six weeks of incapacitation in a year, requiring bed rest and treatment prescribed by a doctor.
- 40% Rating: Daily activities are reduced to 50–75% of pre-illness levels, with incapacitating episodes lasting 4–6 weeks per year. Veterans at this level may still perform some activities but with significant limitations.
- 20% Rating: Activities are reduced by less than 25% of pre-illness levels, or symptoms cause 2–4 weeks of incapacitation annually.
- 10% Rating: Symptoms come and go, causing 1–2 weeks of incapacitation per year, or they are managed with continuous medication.
Note: The VA uses the exact verbiage from the eCFR when determining claims. Our simplified descriptions are meant to help veterans and their families understand the criteria. See the official ratings on the eCFR website.
How to Claim VA Disability for Chronic Fatigue
To file a claim for CFS, you’ll need the following:
- Medical Diagnosis: A current diagnosis of chronic fatigue syndrome that meets VA criteria.
- Service Connection: Evidence linking your condition to military service, such as service records documenting exposure to risk factors and a medical nexus opinion from a healthcare provider.
- Evidence of Symptoms: Medical documentation showing how CFS impacts your daily life.
Is Chronic Fatigue Syndrome a Presumptive Disability?
The VA recognizes chronic fatigue syndrome as a presumptive condition for Gulf War veterans who served in the Southwest Asia theater of operations. This means veterans do not need to prove a direct service connection if their CFS developed during active duty or by December 31, 2026, active for at least 6 months and is rated at least 10% disabling.
Qualifying Service Locations and Time Periods
To qualify for presumptive service connection, veterans must have served in the Southwest Asia theater of military operations on or after August 2, 1990. This includes the following locations:
- Iraq
- Kuwait
- Saudi Arabia
- The neutral zone between Iraq and Saudi Arabia
- Bahrain
- Qatar
- The United Arab Emirates (U.A.E.)
- Oman
- Afghanistan
- Israel
- Egypt
- Turkey
- Syria
- Jordan
- Gulf of Aden
- Gulf of Oman
- Waters of the Persian Gulf, the Arabian Sea, and the Red Sea
- The airspace above these locations
Veterans may also qualify if they participated in operations such as Operation Iraqi Freedom (2003–2010) or Operation New Dawn (2010–2011).
Chronic Fatigue Syndrome and the PACT Act
The PACT Act expands health care and benefits for veterans exposed to toxic substances, including burn pits and airborne hazards. While the PACT Act does not specifically name chronic fatigue syndrome, it addresses Gulf War-era exposures that may overlap with conditions like chronic fatigue. Veterans concerned about toxic exposures or Gulf War-related illnesses are encouraged to apply for benefits under the PACT Act.
Eligible Gulf War veterans can access resources such as the Gulf War Registry health exam to identify potential long-term health effects related to service. For more information, visit the VA Gulf War Veterans page.
Secondary Service Connection and Related Conditions
Chronic fatigue syndrome often develops alongside other conditions, and in some cases, it may result from or be aggravated by service-connected disabilities. Veterans may qualify for secondary service connection if CFS is linked to another condition already recognized by the VA. Establishing this connection can increase the overall disability rating and monthly compensation.
Common Conditions Linked to CFS
- Chronic Fatigue Syndrome Secondary to PTSD: The mental and physical toll of PTSD can contribute to chronic fatigue through persistent stress, anxiety, and disrupted sleep patterns.
- Chronic Fatigue Syndrome Secondary to Sleep Apnea and Other Sleep Disorders: Conditions like obstructive sleep apnea can result in poor sleep quality and daytime fatigue, which may exacerbate or lead to CFS.
- Fibromyalgia co-occurring with CFS: Fibromyalgia causes widespread pain and fatigue, often complicating the veteran’s health picture.
- Irritable Bowel Syndrome: Digestive issues like IBS can overlap with CFS, contributing to discomfort and fatigue.
- Depression and Anxiety: These mental health conditions can affect energy levels, motivation, and cognitive function, potentially worsening CFS symptoms.
- Chronic Pain: Pain conditions such as arthritis or neuropathy can lead to increased fatigue and physical limitations.
- Cognitive Impairments: Problems with memory, focus, or concentration, often referred to as “brain fog,” are common in veterans with CFS and may stem from or be worsened by other conditions.
Applying for a secondary service connection recognizes how intertwined conditions can impact a veteran’s life. For example, if a veteran has PTSD that leads to insomnia and chronic fatigue, the VA can grant an additional rating for CFS as a secondary condition.
Support and Resources for Securing a CFS VA Rating
Navigating the VA claims process can be challenging, especially if your case is complex or involves an appeal. A VA-accredited attorney can make a significant difference by helping you gather evidence, prepare your claim, and advocate on your behalf. This is particularly beneficial if you’re seeking a rating increase, filing for Total Disability based on Individual Unemployability (TDIU), or challenging a denied claim.
Were You Underrated?
If your claim is denied or the rating increase granted isn’t sufficient, you have several appeal options:
- Supplemental Claim: Submit new and relevant evidence for the VA to reconsider your case.
- Higher-Level Review: Request a senior reviewer to reassess your claim without adding new evidence.
- Board of Veterans’ Appeals: For more complex cases, appeal directly to the Board, with the option to provide additional evidence or attend a hearing.
See our comprehensive appeals guide
How We Can Help
Since 1986, Hill & Ponton has been helping veterans nationwide secure the benefits they deserve. If you’re facing a denial or seeking a rating increase, contact us for a free case evaluation. Let us fight for you.
Content Reviewed by
Attorney Shelly M. Mark
Shelly is an attorney passionate about serving underserved communities, including veterans, homeless individuals, and those in need. With experience in VA disability claims and social security law, she has worked with non-profits and as an Equal Justice Works Fellow.
