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VA Rating Assistant

DC 6313 · 38 CFR 3.317 / 4.88b

Malaria C&P Exam Prep

To document the current severity, active or inactive status, diagnostic confirmation, residual disabilities, and service connection nexus for malaria under 38 CFR - 4.88b DC 6304 and/or - 3.317 (Persian Gulf War presumptive). The examiner will evaluate whether malaria is currently active or has produced lasting residuals affecting other body systems.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Persian_Gulf_Afghanistan_Infectious_Diseases (Persian_Gulf_Afghanistan_Infectious_Diseases)
Examiner:
Infectious Disease Physician or Internist

What the examiner evaluates

  • Confirmation of malaria diagnosis via blood smear identification of malarial parasites, antigen detection, immunochromatographic testing, or PCR molecular testing
  • Whether the condition is currently active or inactive/resolved
  • Frequency, severity, and duration of febrile episodes and relapses
  • Presence and extent of residual disabilities including liver damage, splenic damage, anemia, or central nervous system involvement
  • History of treatment, dates of cessation of active treatment, and response to antimalarial therapy
  • Impact of the condition and its residuals on daily functioning and occupational performance
  • Exposure history consistent with Persian Gulf War service or other qualifying theater of operations
  • Additional infectious diseases contracted during qualifying service that may be claimed concurrently
  • Whether any long-term health effects are attributable to the malarial infection per 38 CFR - 3.317

The exam will likely be conducted in a clinical outpatient setting at a VA medical center or contracted vendor facility (e.g., LHI, QTC, VetFed). The examiner will conduct both an interview and a focused physical examination. Bring all documentation of prior malaria treatment, lab results, and any records showing parasitological confirmation. If your exam is conducted via telehealth or records review, note that on your copy of the exam notification and confirm with your VSO.

Measurements and tests

Blood Smear Parasitology

What it measures: Identification of malarial parasites (Plasmodium species) in peripheral blood smears - the gold standard for malaria diagnosis per DC 6304 Note 1

What to expect: The examiner will review existing lab records showing blood smear results. Active exams may not repeat this test unless active infection is suspected. Ensure you have copies of any positive smears from in-service or post-service diagnoses.

Critical thresholds

  • Positive blood smear or confirmatory PCR/antigen test Required to establish diagnosis; without confirmed parasitological or molecular evidence, the diagnosis may not meet DC 6304 criteria - the rater must have this to evaluate under the General Rating Formula
  • Species identification (P. vivax, P. falciparum, P. malariae, P. ovale) Species affects relapse potential; P. vivax and P. ovale can relapse years later due to hypnozoite liver stage, which is relevant to ongoing active vs. inactive status

Tips

  • Request copies of all positive blood smear reports from your service treatment records and any VA or private medical records
  • If diagnosed in-service, the lab report confirming species identification is critical evidence
  • PCR testing and rapid antigen (immunochromatographic) tests are equally acceptable under DC 6304 Note 1 - provide any available results
  • If you were treated presumptively in-service without formal lab confirmation, note that and describe the clinical circumstances to the examiner

Pain considerations: Not applicable for this test - this is a laboratory review, not a painful procedure.

Abdominal Examination (Hepatomegaly/Splenomegaly Assessment)

What it measures: Physical palpation and review of imaging to assess liver and spleen enlargement or damage as residuals of malaria per DC 6304 Note 2

What to expect: The examiner will palpate your abdomen to assess for an enlarged liver or spleen. Bring any ultrasound, CT, or MRI reports documenting hepatomegaly, splenomegaly, or organ damage. Communicate any pain, tenderness, or fullness you experience in the left upper quadrant (spleen) or right upper quadrant (liver).

Critical thresholds

  • Splenomegaly confirmed by imaging or palpation Splenic enlargement as a residual of malaria should be rated separately under the digestive system, potentially increasing overall combined rating
  • Elevated liver enzymes (AST, ALT, bilirubin) or imaging-confirmed hepatomegaly Liver damage as a residual of malaria is ratable separately under DC 7345 (hepatitis) or analogous liver codes, potentially warranting a separate claim

Tips

  • Report any persistent left-sided abdominal fullness, early satiety, or left shoulder pain (referred splenic pain)
  • Report any jaundice history, dark urine, or elevated liver function test results
  • Bring copies of any liver or spleen imaging studies
  • Describe your worst-day abdominal symptoms, not just how you feel on exam day

Pain considerations: Inform the examiner if palpation causes pain or discomfort; this is clinically relevant and should be documented.

Neurological/CNS Assessment

What it measures: Evaluation of central nervous system involvement as a residual of malaria (especially cerebral malaria from P. falciparum), per DC 6304 Note 2

What to expect: The examiner may assess cognitive function, coordination, headache patterns, and neurological symptoms. Cerebral malaria can cause lasting cognitive impairment, seizure disorders, or mood disturbances. Report any persistent neurological symptoms since your malaria episode.

Critical thresholds

  • Documented history of cerebral malaria (altered consciousness, seizures, coma during acute episode) Cerebral malaria residuals are ratable under the neurological system and may significantly increase the combined rating; file separate claims for each residual
  • Persistent cognitive complaints (memory, concentration, processing speed) May be ratable under DC 9304 (dementia due to head trauma/toxic) or similar cognitive codes as secondary to malaria

Tips

  • Describe any history of loss of consciousness, seizures, confusion, or coma during your malarial episode
  • Report any lingering cognitive difficulties: word finding, memory lapses, difficulty concentrating
  • Note any mood changes, depression, or anxiety that developed after your malaria diagnosis
  • If you had cerebral malaria, bring any in-service or treating physician records documenting CNS involvement

Pain considerations: Report any persistent headaches, including frequency, duration, and severity on your worst days.

General Febrile Episode / Relapse Frequency Assessment

What it measures: Frequency and severity of febrile paroxysms and documented relapses, used to apply the General Rating Formula under DC 6304

What to expect: The examiner will ask about the pattern of fever episodes, chills, sweating, and systemic symptoms. They will document whether the disease is currently active or inactive and the date treatment was completed. Be prepared to describe episodes in detail.

Critical thresholds

  • Active malaria with ongoing febrile episodes Rated under the General Rating Formula based on functional impairment; active disease typically warrants higher temporary ratings during acute phase
  • Inactive malaria with confirmed residuals Residuals rated under appropriate body systems per DC 6304 Note 2; ongoing impairment from residuals must be specifically documented to maintain a compensable rating
  • Relapse confirmed by repeat positive diagnostic testing Relapse re-activates rating eligibility; each relapse documented with parasitological confirmation supports continued service connection and may increase ratings during active phase

Tips

  • Describe the classic malarial triad if experienced: cyclical fever (every 48 or 72 hours), rigors/shaking chills, and drenching sweats
  • Note how many documented relapses you have had and the approximate dates
  • Describe how episodes affect your ability to work, exercise, care for yourself, and maintain relationships
  • Report the worst episode in detail - maximum fever temperature, duration, associated symptoms (nausea, vomiting, myalgia, headache, altered mental status)

Pain considerations: Describe the severity of myalgias, arthralgia, and headaches during febrile episodes on your worst days.

Rating criteria by percentage

100%

Active, severe malaria with high functional impairment; applies under the General Rating Formula when the veteran has active infection with severe systemic symptoms causing total occupational and social impairment, or when residuals affect multiple body systems at a high combined level.

Key symptoms

  • Active febrile paroxysms occurring frequently with severe systemic debilitation
  • Cerebral malaria with significant neurological or cognitive impairment
  • Severe anemia requiring transfusion or hospitalization
  • Multi-organ involvement (liver failure, renal failure, pulmonary edema)
  • Total inability to perform gainful employment due to malarial disease or its residuals
  • Recurrent hospitalizations for malarial relapses

From 38 CFR: Under 38 CFR - 4.88b DC 6304 and the General Rating Formula, 100% applies when active malarial infection or its residuals result in total occupational and social impairment. Residuals such as severe hepatic damage (DC 7345 at 100%) or severe CNS conditions may each be separately rated under the appropriate body system per DC 6304 Note 2.

50%

Moderate to moderately severe active or relapsing malaria; or residuals producing moderate impairment of one or more body systems. Under the General Rating Formula, reflects substantial occupational and social impairment with reduced reliability and productivity.

Key symptoms

  • Recurrent febrile episodes requiring medical intervention
  • Moderate hepatomegaly or splenomegaly with functional limitation
  • Moderate anemia (hemoglobin 10-12 g/dL) attributable to malarial disease
  • Fatigue and weakness significantly limiting work capacity and daily activities
  • Moderate cognitive or neurological residuals from cerebral malaria
  • Frequent relapses requiring repeated antimalarial treatment courses

From 38 CFR: Under the General Rating Formula, 50% reflects occupational and social impairment with reduced reliability and productivity. Residual splenic or hepatic disease rated separately may also contribute to this level. Malarial relapses with confirmed positive diagnostics support continued active rating.

30%

Mild to moderate impairment from active or residual malaria. Under the General Rating Formula, occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.

Key symptoms

  • Occasional febrile episodes or relapses with recovery between episodes
  • Mild splenomegaly without significant functional limitation
  • Mild anemia or fatigue affecting work endurance
  • Intermittent gastrointestinal symptoms attributable to hepatic or splenic residuals
  • Mild cognitive complaints (concentration difficulties, mild memory issues)
  • Periodic need for antimalarial medication or prophylaxis due to relapse risk

From 38 CFR: Under the General Rating Formula applied to DC 6304, 30% reflects periodic impairment with intact baseline function between episodes. Veterans with P. vivax or P. ovale species face ongoing relapse risk from dormant liver hypnozoites, which may support ongoing active status even years after initial infection.

10%

Minimal symptomatic disease; inactive malaria with mild residuals or low-frequency relapse. Under the General Rating Formula, occupational and social impairment due to mild or transient symptoms that decrease work efficiency and ability to perform occupational tasks only during periods of significant stress.

Key symptoms

  • Rare febrile episodes with full recovery
  • Minimal splenomegaly or hepatomegaly without functional impairment
  • Mild fatigue that does not significantly limit activities
  • Documented history of malaria with confirmed diagnosis but minimal current symptoms
  • Mild laboratory abnormalities (slightly elevated liver enzymes) without clinical symptoms

From 38 CFR: Under the General Rating Formula, 10% reflects mild impairment. Even with inactive disease, if confirmed residuals exist (e.g., mild splenic enlargement, mild anemia) these are documented under DC 6304 Note 2 and rated under the appropriate body system. Veterans should ensure residuals are separately claimed.

0%

Inactive malaria with no significant residuals and no current functional impairment. Condition is resolved but service connection is established. A 0% rating preserves service connection and protects against future claims for reactivation or newly identified residuals.

Key symptoms

  • Confirmed prior diagnosis with no current active disease
  • No identifiable residual disabilities
  • Full resolution of splenomegaly and hepatomegaly
  • Normal laboratory values
  • No history of relapse after treatment completion

From 38 CFR: Under 38 CFR - 4.88b DC 6304, inactive malaria with no residuals is rated as 0% (noncompensable) but service connection is still established. This is critically important because P. vivax and P. ovale malaria can relapse years later, and established service connection means future relapses will be covered without needing to re-establish entitlement.

Describing your symptoms accurately

Febrile Episodes and Cyclical Fever Pattern

How to describe it: Describe the classic malarial cycle accurately: the periodicity (every 48 or 72 hours), the cold stage (shaking chills, rigors lasting 15-60 minutes), the hot stage (fever up to 104-106-F, severe headache, vomiting), and the sweating stage (drenching sweats, exhaustion). Note how long each episode lasts, how debilitated you are during and after each cycle, and how many days you are unable to function.

Example: On my worst days during a malarial episode, I experience uncontrollable shaking and chills so severe I cannot hold a glass of water, followed by a fever of 105-F with splitting headache, nausea, and vomiting that lasts 6-8 hours. I am completely bedridden for 1-2 days after each episode and too weak to work for an additional 2-3 days during recovery. During active disease periods, this cycle repeats every 48-72 hours.

Examiner listens for: Specificity of the fever pattern, severity of systemic symptoms, functional incapacity during episodes, frequency of relapses, and time to recovery between episodes.

Avoid: Do not say 'I just get fevers sometimes' or 'it's not that bad.' Describe the full incapacitating nature of each paroxysm. Veterans often minimize symptoms in a clinical setting; the examiner needs your worst-day presentation, not your best-day presentation.

Fatigue and Post-Episode Weakness

How to describe it: Describe the profound fatigue that follows malarial episodes and any chronic fatigue that persists even between episodes. Distinguish between normal tiredness and the debilitating exhaustion of post-malarial fatigue. Quantify the impact: how many hours per day are you functional, how far can you walk, can you complete a full work shift?

Example: After a malarial episode, I am so exhausted that I cannot leave the house for 3-4 days. Even on relatively good days, I have approximately 4-5 hours of productive energy before I must rest. I have missed work repeatedly due to fatigue following relapses, and my employer has documented several absences. Simple tasks like grocery shopping require a rest period afterward.

Examiner listens for: Duration of post-episode fatigue, impact on work attendance and performance, activities of daily living limitations, and whether fatigue is constant or episodic.

Avoid: Do not say 'I'm tired but I manage.' Quantify specifically how fatigue limits you. Mention work absences, inability to complete tasks, and required rest periods. Chronic fatigue is a recognized residual and should be described in detail.

Abdominal Symptoms (Hepatic and Splenic Involvement)

How to describe it: Describe any persistent left upper quadrant fullness, pain, or discomfort (spleen) and right upper quadrant pain, tenderness, or fullness (liver). Note any jaundice episodes, dark urine, pale stools, nausea, loss of appetite, or difficulty eating large meals. Describe how these symptoms affect your diet, activity level, and comfort.

Example: I have a persistent feeling of fullness and pressure in my left side under my ribs that becomes sharp pain when I bend over or eat a large meal. On my worst days, the pain rates a 7/10 and radiates to my left shoulder. I have also had episodes of jaundice where my skin and eyes turned yellow, and my urine turned dark brown. These episodes are frightening and significantly affect my ability to eat, work, and sleep comfortably.

Examiner listens for: Location, quality, and severity of abdominal pain; presence of jaundice; impact on diet and nutrition; and correlation with documented organomegaly on imaging.

Avoid: Do not omit any abdominal complaints as 'just stomach issues.' Hepatic and splenic residuals of malaria are separately ratable under DC 6304 Note 2 and can significantly increase your overall combined rating.

Neurological and Cognitive Symptoms (Cerebral Malaria Residuals)

How to describe it: If you experienced cerebral malaria (loss of consciousness, seizures, confusion, or coma during the acute infection), describe those events in detail and report any persistent neurological or cognitive symptoms that followed. Include memory problems, difficulty concentrating, word-finding difficulties, headaches, mood changes, or seizure activity.

Example: Since my cerebral malaria episode in which I was hospitalized and briefly lost consciousness, I have had persistent difficulty remembering names and words, trouble concentrating for more than 20-30 minutes, and frequent severe headaches occurring 4-5 times per week. On my worst days, the headaches are incapacitating and prevent me from reading, driving, or working. My family has noticed I am not the same person I was before the infection.

Examiner listens for: History of neurological involvement during acute infection, specific cognitive complaints with functional examples, presence of headaches or seizures, and comparison to pre-illness baseline.

Avoid: Do not dismiss cognitive changes as 'just getting older' or 'normal stress.' Cerebral malaria can cause permanent neurological residuals that are separately ratable and should be fully documented. Bring any neurological or neuropsychological testing records.

Relapse History and Ongoing Risk

How to describe it: Document each documented relapse with approximate dates, confirmatory testing, and treatment received. If you have P. vivax or P. ovale infection, explain to the examiner that hypnozoite reactivation means your malaria can relapse years or even decades after initial infection, and that this ongoing risk affects your life planning, ability to travel, and emotional wellbeing.

Example: I have had three confirmed relapses of P. vivax malaria since my initial in-service diagnosis, the most recent occurring in [year]. Each relapse required a full course of antimalarial treatment including primaquine and put me out of work for approximately two weeks. I live with constant anxiety that another relapse could occur at any time, which affects my sleep, my ability to accept demanding work assignments, and my peace of mind.

Examiner listens for: Number of relapses, confirmatory testing for each relapse, treatment received, functional impact of each relapse period, and whether Plasmodium species poses ongoing relapse risk.

Avoid: Do not present your condition as permanently resolved simply because you are currently asymptomatic. P. vivax and P. ovale malaria is never truly 'cured' without radical cure therapy, and even then relapse is possible. Describe the ongoing burden of living with relapse risk.

Common mistakes to avoid

Failing to bring parasitological confirmation records to the exam

Why: DC 6304 Note 1 explicitly states that diagnosis of malaria 'depends on the identification of the malarial parasites in blood smears or other specific diagnostic laboratory tests.' Without this documentation, the examiner cannot confirm the diagnosis under the rating criteria, and the rater may be unable to assign a rating.

Do this instead: Request copies of all positive blood smear reports, PCR results, rapid antigen test results, or other confirmatory lab reports from your service treatment records, VA medical records, and any private providers. Submit these as evidence with your claim and bring copies to the exam.

Impact: All rating levels - affects whether any compensable rating is assigned

Describing only active symptoms and failing to report residuals

Why: DC 6304 Note 2 explicitly requires rating residual disabilities under the appropriate body system. Veterans who present only active malaria symptoms may receive a rating that drops to 0% when the disease becomes inactive, even if they have permanent organ damage or cognitive impairment from the infection.

Do this instead: Identify and describe all residual conditions at the exam: liver damage (elevated enzymes, hepatomegaly), splenic damage (splenomegaly, left upper quadrant pain), anemia, neurological deficits, and cognitive impairment. File separate secondary claims for each documented residual condition under the appropriate body system diagnostic code.

Impact: All post-active-disease rating levels; critical for maintaining compensable ratings after disease becomes inactive

Understating symptom severity during the exam because you are having a relatively good day

Why: C&P examinations capture a single snapshot in time. VA rating is supposed to reflect your average level of impairment, but the examiner's observations and your verbal report heavily influence the DBQ. Minimizing symptoms leads to artificially low ratings that do not reflect your actual disability burden.

Do this instead: Explicitly tell the examiner 'I am having a better day today than average' if that is true. Describe your worst-day symptoms in detail. Report the frequency and severity of your worst episodes. Bring a symptom journal or a buddy statement from someone who has witnessed your worst episodes.

Impact: All rating levels - most commonly causes a 10-30% underrating

Not reporting the species of malaria or failing to discuss relapse potential

Why: P. vivax and P. ovale malaria have dormant liver-stage parasites (hypnozoites) that can cause relapses years after initial infection. If the examiner marks the condition as 'inactive/resolved' without noting species-specific relapse risk, a future relapse may require the veteran to re-establish the condition as service connected, which can be administratively burdensome.

Do this instead: Know your malaria species from your diagnostic records. If you had P. vivax or P. ovale, explicitly tell the examiner that the disease has relapse potential due to hypnozoites and ask that this be documented. Ensure the DBQ reflects the ongoing nature of the condition even during asymptomatic periods.

Impact: Affects active/inactive determination and continuity of service connection for future relapses

Failing to mention Persian Gulf War or qualifying theater service when relevant

Why: 38 CFR - 3.317 provides presumptive service connection for Persian Gulf War veterans for qualifying chronic disabilities. Veterans who served in Southwest Asia may be entitled to presumptive coverage without needing to establish direct in-service nexus, which is a significantly lower evidentiary threshold.

Do this instead: Confirm your qualifying service dates and theater with your DD-214. Inform the examiner of your Persian Gulf War or Southwest Asia service. Ensure the DBQ section regarding Persian Gulf War service and Section 5 (additional Gulf War/OIF/OEF diseases) is completed accurately. This may entitle you to additional presumptive conditions.

Impact: Affects service connection establishment; critical for veterans without clear in-service diagnosis documentation

Accepting a conclusion of 'no residuals' without specifically discussing each body system

Why: Examiners who are not infectious disease specialists may overlook the broad range of malarial residuals enumerated in DC 6304 Note 2. Without proactively raising each body system, permanent damage may go undocumented.

Do this instead: Proactively raise each potentially affected body system with the examiner: liver (enzyme levels, imaging), spleen (size, pain), hematologic (anemia history, current CBC), neurological (headaches, cognitive issues, seizures), cardiovascular (malaria-associated cardiac complications in P. falciparum). Ask the examiner to document findings or lack thereof for each system in the DBQ.

Impact: 10-100% depending on residuals - each unrated residual represents a missed rating increment

Prep checklist

  • critical

    Gather all parasitological confirmation records

    Request copies of positive blood smear reports, PCR results, rapid antigen (immunochromatographic) test results, and any serology confirming malaria from your service treatment records (STRs), VA medical records, and private providers. These are legally required for diagnosis under DC 6304 Note 1. Submit via VBMS or bring to the exam.

    before exam

  • critical

    Identify your malaria species from records

    Know whether your malaria was P. vivax, P. falciparum, P. ovale, or P. malariae. P. vivax and P. ovale carry lifelong relapse risk. P. falciparum is associated with cerebral malaria and organ complications. Species identification affects the active/inactive determination and future relapse coverage.

    before exam

  • critical

    Document all relapses with dates and confirmatory tests

    Compile a chronological list of all malaria episodes including date, symptoms, confirmatory test results, treatment received, and recovery time. Include any relapses that occurred after service. This establishes ongoing active disease and supports higher rating during relapse periods.

    before exam

  • critical

    File secondary claims for all residual conditions

    DC 6304 Note 2 requires residuals to be rated under the appropriate body system. Before or concurrent with your C&P exam, file secondary claims for: liver damage (DC 7345 or analogous), splenic damage, anemia (DC 7700 or analogous), neurological residuals (cognitive impairment, headaches, seizures), and any other documented complications. Do not wait for the malaria exam to address residuals.

    before exam

  • critical

    Obtain liver and spleen imaging records

    Gather any ultrasound, CT, or MRI reports documenting hepatomegaly, splenomegaly, liver lesions, or other abdominal pathology. Obtain copies of liver function tests (AST, ALT, bilirubin, albumin, PT/INR) from your most recent blood work. Also gather CBC results showing any anemia (hemoglobin, hematocrit, RBC count).

    before exam

  • recommended

    Prepare a written symptom journal

    Document the frequency, severity, and duration of your worst malarial episodes and current residual symptoms over the past 6-12 months. Include work absences, emergency room visits, hospitalizations, and medication changes. Rate your symptoms on a 0-10 pain/severity scale. Bring this to the exam.

    before exam

  • recommended

    Gather buddy statements and lay evidence

    Obtain written statements from family members, coworkers, or friends who have witnessed your malarial episodes, relapses, or residual limitations. These lay statements are admissible evidence under 38 CFR - 3.303 and can powerfully corroborate your reported symptom severity.

    before exam

  • recommended

    Review your DD-214 and deployment records for qualifying service

    Confirm your Southwest Asia, OIF, OEF, or other qualifying theater service dates on your DD-214 for potential 38 CFR - 3.317 Persian Gulf War presumptive coverage. Note any records of antimalarial prophylaxis (mefloquine, doxycycline, chloroquine) prescribed in-service, as this documents exposure risk.

    before exam

  • recommended

    Gather neurological and cognitive assessment records

    If you had cerebral malaria or have cognitive complaints, gather any neuropsychological testing records, neurology consultation notes, brain imaging (CT, MRI), or EEG results. These document CNS residuals that are separately ratable under DC 6304 Note 2.

    before exam

  • recommended

    Review your VA claims file (C-file) for prior ratings and nexus opinions

    Request your C-file through eBenefits or your VSO to review any prior C&P exams, nexus opinions, or rating decisions related to your malaria claim. Understanding what has already been documented helps you identify gaps to address at your upcoming exam.

    before exam

  • critical

    Arrive prepared to describe your worst-day symptoms

    If you are having a good day on exam day, explicitly tell the examiner: 'Today is a better day than average for me. My worst days involve [describe worst symptoms].' Do not let a relatively symptom-free exam day result in an underrated DBQ. Bring your written symptom journal.

    day of

  • critical

    Bring all documentary evidence in an organized folder

    Organize your evidence by category: (1) diagnosis confirmation - blood smears, PCR, antigen tests; (2) relapse history; (3) organ imaging and labs; (4) neurological records; (5) treatment records. Provide a copy to the examiner and retain your originals. A well-organized folder signals thoroughness and ensures key evidence is not overlooked.

    day of

  • recommended

    Check your state's exam recording law and request to record if permitted

    Most states permit one-party consent audio recording of your C&P exam. Confirm your state's law. If permitted, inform the examiner you will be recording for your records. The VA has directed examiners to accommodate recording in compliant states. A recording protects you if the DBQ contains inaccuracies.

    day of

  • critical

    Do not minimize or understate symptoms due to stoicism

    The C&P exam is not the time for military stoicism. Accurately describe the full impact of your condition. Many veterans are conditioned to project strength; in this context, accurate symptom reporting - including how bad things get - is essential to a fair rating outcome.

    day of

  • critical

    Raise each body system affected by malaria proactively

    If the examiner does not ask about liver, spleen, blood counts, or neurological symptoms, proactively raise each one. Say: 'I also want to make sure my [liver/spleen/cognitive/hematologic] symptoms are documented as they are related to my malaria.' DC 6304 Note 2 requires documentation of all residuals.

    during exam

  • critical

    Confirm the examiner documents whether the disease is active or inactive

    The DBQ field RG_2B_ActiveInactive is critical. If your disease is currently inactive but you have residuals, ensure the examiner documents: (1) the date disease became inactive, (2) the date treatment was completed, and (3) a description of all residuals. 'Inactive' does not mean 'no rating' when residuals are present.

    during exam

  • critical

    Provide the examiner with your species identification and relapse history

    Verbally confirm the malaria species with the examiner and ensure it is documented. If P. vivax or P. ovale, note the ongoing relapse risk from hypnozoites. Provide your chronological relapse list and confirmatory test dates. This is essential for the DBQ section on disease history and course.

    during exam

  • recommended

    Ask the examiner what they are documenting if unclear

    You have the right to understand what is being recorded in the DBQ. If the examiner says something that seems inaccurate or incomplete, politely clarify: 'I want to make sure that's documented accurately - can you confirm what you're writing for that section?' Being engaged and accurate is appropriate and professional.

    during exam

  • critical

    Request a copy of the completed DBQ

    You are entitled to a copy of the DBQ completed at your C&P exam. Request it directly from the examiner or through your VSO. Review it carefully for errors, omissions, or inaccurate characterizations of your symptoms. If errors are found, report them to your VSO or submit a written statement to correct the record.

    after exam

  • critical

    Review the DBQ against your known symptoms and flag discrepancies

    Compare the completed DBQ to your symptom journal and evidence folder. Common errors include: marking disease as inactive when relapses are ongoing; failing to document residuals in separate body systems; underestimating severity of reported symptoms; or omitting your parasitological confirmation. Flag any discrepancies in writing.

    after exam

  • critical

    Follow up on any secondary claims for residual conditions

    Ensure all secondary conditions identified during the exam (hepatic damage, splenomegaly, anemia, neurological conditions) have active claims filed or are being developed. Track the status of each claim through eBenefits or VA.gov. Work with your VSO to ensure residuals are rated under the appropriate body system codes as required by DC 6304 Note 2.

    after exam

  • recommended

    Submit additional evidence if the DBQ is deficient

    If the DBQ is inadequate for rating purposes (e.g., examiner provided insufficient rationale, failed to address all residuals, or reached unsupported conclusions), you can request a new exam under 38 CFR - 3.159(c)(4), submit a Supplemental Claim with new and relevant evidence, or work with your VSO to challenge the exam's adequacy.

    after exam

Your rights during a C&P exam

  • You have the right to request a copy of the completed DBQ (Disability Benefits Questionnaire) after your C&P examination. Review it for accuracy and report any discrepancies to your VSO or directly to the VA.
  • You have the right to audio record your C&P examination in most states under one-party consent laws. Confirm your state's recording law before the exam. Inform the examiner you are recording for your personal records.
  • You have the right to have a VSO, accredited claims agent, or accredited attorney represent you throughout the claims process, including accompanying you to C&P exams in some circumstances.
  • You have the right to request a new C&P examination if the original exam is inadequate for rating purposes, including if the examiner failed to address all claimed conditions or residuals, provided an unsupported opinion, or conducted an exam that does not reflect your current level of impairment.
  • You have the right to submit lay evidence (buddy statements, personal statements, family member statements) describing your symptoms and functional limitations. This evidence is admissible and may be highly probative, particularly for describing the frequency and severity of malarial episodes.
  • You have the right to request a higher-level review or Board of Veterans' Appeals hearing if you disagree with a rating decision. You have one year from the date of the decision to file an appeal under the Appeals Modernization Act lanes.
  • Under 38 CFR - 3.317, Persian Gulf War veterans may be entitled to presumptive service connection for qualifying chronic disabilities, including malaria contracted during qualifying service, without the need to establish a direct in-service nexus through medical evidence.
  • You have the right to claim service connection for all residual conditions flowing from your malaria diagnosis as secondary conditions under 38 CFR - 3.310. DC 6304 Note 2 explicitly directs rating residuals under the appropriate body system, meaning each residual condition may be separately rated and contribute to your combined disability rating.
  • You have the right to a de novo review of your claim. C&P examiners do not rate your claim - that is done by a VA rater. The examiner's role is to provide factual medical findings. You can request clarification or correction of factual errors in the DBQ before the rating decision is made.
  • You have the right to continuity of service connection once established. A 0% rating for inactive malaria with no residuals still preserves your service connection, which means future relapses (especially relevant for P. vivax and P. ovale) will be covered without needing to re-establish entitlement.

Related conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.