Lyme Disease

Lyme disease is rated under 38 CFR § 4.88b, Diagnostic Code 6319. If you look up what that code says, most sources will tell you it assigns 100 percent for active Lyme disease and rates residuals when the disease is inactive.

That describes the code as it read before August 11, 2019. The current entry is two sentences long and contains no percentage table at all. It reads: "6319 Lyme disease: Evaluate under the General Rating Formula." Every accessible page I reviewed for this condition quotes the older formulation, usually by way of Board decisions from 2011, 2019, and 2020. The practical outcome is close to the same, but two details change, and one of them is the detail veterans most often misread.

TL;DR

• DC 6319 evaluates under the General Rating Formula for Infectious Diseases, added to § 4.88b effective August 11, 2019.
• The formula assigns 100 percent for active disease.
• After active disease resolves, the formula assigns 0 percent for the infection itself.
• Residual disability is rated within the appropriate body system, separately from that 0 percent.
• The note to DC 6319 names the residual categories: arthritis, Bell's palsy, radiculopathy, ocular, and cognitive dysfunction.
• DC 6319 has no six-month continuation note. Neighboring codes DC 6301 and DC 6302 do. Lyme does not.
• There is no presumptive service-connection route for Lyme disease.
• Neither the rating schedule nor the regulations define "active" Lyme disease, which is where these claims are actually contested.

What the Code Says Now

The General Rating Formula for Infectious Diseases sits at the top of § 4.88b and reads in full:

For active disease ... 100

After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system.

DC 6319 then reads:

6319 Lyme disease: Evaluate under the General Rating Formula.

Note: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, Bell's palsy, radiculopathy, ocular, or cognitive dysfunction.

Appendix A records the change for DC 6319 as "Added August 30, 1996; criterion, note August 11, 2019," and records the General Rating Formula itself as added to § 4.88b on the same date.

The 0 Percent Is the Part People Misread

The formula does not simply stop paying when the infection clears. It assigns 0 percent for the infection. That is an evaluation, not a termination of service connection.

This matters because a veteran who was rated 100 percent during active Lyme disease and then receives a rating decision showing 0 percent frequently reads it as having lost the claim. The service connection survives. What changed is that the infection itself is no longer compensable, and compensation now flows from the residuals, each rated under its own code in its own body system.

That is a mechanical change in where the money comes from, not a judgment that you are well.

No Six-Month Cushion

This is the difference between codes that nobody explains, and it is visible only by reading § 4.88b straight through.

Several infectious disease codes in the same section carry an explicit continuation note. DC 6301, visceral leishmaniasis, and DC 6302, leprosy, both read: "Continue a 100 percent evaluation beyond the cessation of treatment for active disease. Six months after discontinuance of such treatment, determine the appropriate disability rating by mandatory VA examination."

DC 6319 has no such note. Neither does DC 6325's protective structure apply to it. When active Lyme disease resolves, the 100 percent ends without a statutory cushion and without a mandatory examination requirement built into the code.

The practical consequence is that the residual record has to be built while the active rating is still in place. There is no six-month grace period during which to gather it.

What Counts as "Active"

Here is the honest answer: the regulation does not say.

The Board addressed this directly in a 2020 decision, noting that neither the rating schedule nor the regulations define "active" Lyme disease. That silence is the battleground in these claims. VA tends to treat completion of a standard antibiotic course as the end of active disease. Veterans with persistent symptoms after treatment, sometimes described as post-treatment Lyme disease syndrome, argue the disease remains active.

I would not build a claim on winning that argument. The stronger position is usually to accept the conversion to 0 percent for the infection and rate every residual thoroughly, because the residual codes have no such definitional ambiguity and no expiration.

Where you do contest activity, the evidence that carries weight is objective: laboratory confirmation, documented ongoing treatment, and a treating physician's specific statement about disease activity rather than symptom severity.

Rating the Residuals

The note to DC 6319 names five categories, and the phrase "includes, but is not limited to" means the list is a floor rather than a ceiling. Each residual is rated under its own body system:

• Lyme arthritis. Most commonly the knee. Rated under the musculoskeletal joint codes, with DC 5003 applying where limitation of motion is noncompensable but objectively confirmed.
• Bell's palsy and other cranial nerve involvement. Rated under the cranial nerve codes in § 4.124a, based on the degree of paralysis.
• Radiculopathy. Rated under the peripheral nerve codes, most often DC 8520 for sciatic nerve involvement, by the severity of incomplete paralysis.
• Ocular involvement. Rated under the eye codes in § 4.79.
• Cognitive dysfunction. Rated under the mental disorders or neurocognitive codes, depending on the diagnosis in the record.
• Lyme carditis. Not on the regulation's list, but heart block and other cardiac residuals are documented outcomes and are rated under the cardiovascular codes.

Inventory every residual separately. Each carries its own rating, and a residual that nobody claimed is compensation left unclaimed. This is the single largest recoverable error in Lyme disease claims: a veteran rated for Lyme arthritis alone whose record also documents facial palsy and a cardiac finding that were never made issues.

One boundary worth naming: § 4.88b's opening note points to § 3.317(d) for long-term health effects associated with certain infections, listing brucellosis, campylobacter jejuni, coxiella burnetii, malaria, mycobacterium tuberculosis, nontyphoid salmonella, shigella, visceral leishmaniasis, and West Nile virus. Lyme disease is not among them. Do not claim that pathway.

Service Connection

There is no presumption for Lyme disease. The claim rises or falls on documented exposure and diagnosis.

Direct incurrence. Tick exposure during field training at an installation in an endemic region, with a documented tick bite, erythema migrans rash, or acute Lyme diagnosis in the service treatment records, supports direct service connection under 38 CFR § 3.303.

Diagnosed after separation. Where in-service exposure and early symptoms are documented but the diagnosis came later, § 3.303(d) allows service connection for a disease first diagnosed after service when the evidence establishes it was incurred in service. Examiners sometimes apply a stricter standard than the regulation requires and demand an in-service diagnosis. That is worth challenging.

Duty station and field exercise records substantiate exposure even when no tick bite reached the treatment records, so request unit training records early. Ask the treating physician to distinguish Lyme residuals from lookalike diagnoses in writing, because fibromyalgia and chronic fatigue syndrome are the two alternative attributions that most often defeat these claims.

Common Failure Modes

• Relying on the pre-2019 version of DC 6319.
• Reading the 0 percent evaluation as a loss of service connection.
• Expecting a six-month protected period that DC 6319 does not provide.
• Building the residual record after the active rating ends rather than during it.
• Claiming Lyme disease itself and never inventorying the residuals.
• Letting an examiner attribute residuals to fibromyalgia or chronic fatigue syndrome without addressing the Lyme history.
• Claiming a § 3.317(d) long-term health effects pathway that does not list Lyme disease.
• Accepting a denial that required an in-service diagnosis without applying § 3.303(d).

Bottom Line

DC 6319 points to the General Rating Formula: 100 percent while the disease is active, 0 percent for the infection afterward, and residuals rated separately under their own body systems. There is no presumption and no six-month cushion, so the work that determines your long-term rating is the residual inventory, and it has to be built while the active rating still holds. The regulation itself names arthritis, Bell's palsy, radiculopathy, ocular, and cognitive dysfunction. Claim each one you have.

Related Conditions and Tools

Compare arthritis, radiculopathy, fibromyalgia, and chronic fatigue, which are the diagnoses most often substituted for Lyme residuals. Review DC 8520 and DC 5003 for two of the residual routes, and build the residual inventory with the Secondary Conditions tool and the Statement Builder.

Legal sources: 38 CFR § 4.88b, § 3.303, and § 3.317, checked against the eCFR snapshot for August 14, 2026.