Evidence Checklist: Chronic Fatigue Syndrome
DC 6354
Significant gaps — claim likely to be denied or underrated
Specialist Opinion (Highest Value)
Comprehensive medical evaluation meeting CDC diagnostic criteriaCritical
Evaluation documenting the three required symptoms: (1) profound fatigue lasting 6+ months, (2) post-exertional malaise, (3) unrefreshing sleep; plus cognitive impairment ("brain fog") or orthostatic intolerance. Other medical causes must be ruled out.
Nexus opinion linking CFS to service ("at least as likely as not")Critical
A medical opinion connecting chronic fatigue syndrome to military service, including viral illness during service, immune stressors, burn pit or toxic exposure, or onset during or shortly after service.
Treating Physician
Exhaustive laboratory and diagnostic workup ruling out other conditionsCritical
Records of laboratory testing (CBC, CMP, thyroid, ANA, ESR, HIV, EBV titers, sleep study) used to rule out other causes of fatigue. Documentation of negative workup supports the CFS diagnosis.
Treatment Records
Documentation of functional capacity and occupational impact
Records showing reduction in pre-illness activity level, inability to maintain employment, or reduced work hours due to CFS. The VA rates CFS under DC 6354 based on functional levels.
Treatment records showing management attempts
Records of cognitive behavioral therapy (CBT), graded exercise therapy (GET), symptom management medications (sleep aids, pain management, beta-blockers for POTS), and specialist referrals.
Lay Statements & Personal Documentation
Symptom diary documenting post-exertional malaise episodesCritical
A personal log tracking fatigue episodes, post-exertional malaise (worsening of all symptoms 12-48 hours after exertion), sleep quality, and cognitive difficulties. This is critical evidence for rating severity.
Buddy statement from spouse, family, or fellow service member
A written statement from someone who can describe observable symptoms and how your condition affects daily life.
Personal statement describing symptoms and functional impact
Your own written account of how this condition affects your daily activities, work, and relationships. Describe your worst days.
Disability Benefits Questionnaire (DBQ)
Completed DBQ Chronic Fatigue SyndromeCritical
Standardized form capturing fatigue severity, post-exertional malaise, sleep disturbance, cognitive symptoms, and functional activity level.
Service Records
Service treatment records (STRs)Critical
Military medical records showing in-service treatment, complaints, or injuries related to this condition.