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C&P Exam Prep: Avitaminosis (General Vitamin Deficiency)
DBQ Overview
Interview + Physical- Form Name
- Nutritional_Deficiencies
- Form Code
- Nutritional_Deficiencies
- Page Count
- 6
- Examiner Type
- Internal Medicine or Nutrition Specialist
- Estimated Duration
- 30-45 minutes
- Exam Format
- Interview + Physical
What to Expect During Your Exam
Exam Overview
To document the current severity, symptom profile, functional impact, and nexus of avitaminosis (general vitamin deficiency) for VA disability rating purposes under Diagnostic Code 6313, 38 CFR 4.88b.
What the examiner evaluates:
- Confirmed diagnosis of avitaminosis with ICD code documentation
- Specific vitamin(s) deficient and associated clinical findings
- Presence and severity of nonspecific symptoms such as decreased appetite, weight loss, and malaise
- Presence of stomatitis, achlorhydria, or diarrhea
- Peripheral neuropathy findings including absent knee or ankle jerks, loss of vibration or position sense
- Peripheral neuropathy with foot drop or atrophy of thigh or leg muscles
- Symptoms such as weakness, fatigue, anorexia, dizziness, and headache
- Cardiomegaly
- Congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome
- Residual findings if avitaminosis has been previously treated
- Mental symptoms, impaired bodily vigor, and symmetrical dermatitis
- Marked mental changes, moist dermatitis, inability to retain food (severe pellagra-spectrum)
- Impact of nutritional deficiency on occupational and daily functioning
- Current medications used for the diagnosed condition
- Relevant medical history including onset, course, and prior treatment
Exam typically conducted in a clinic setting. If conducted via telehealth or records review, the examiner must note how the examination was conducted. Bring all relevant lab results showing vitamin levels, physician notes, and a written symptom summary. The examiner will review your service treatment records and any post-service medical evidence before or during the exam.
Typical duration: 30-45 minutes
Serum Vitamin Level Laboratory Testing
Blood concentrations of specific vitamins (e.g., B1/thiamine, B3/niacin, B12, D, A, C, folate) to confirm deficiency diagnoses
What to expect:
The examiner may review existing lab results rather than draw new blood. Bring copies of all lab work showing deficient vitamin levels. Values below the laboratory reference range confirm deficiency.
Key thresholds:
- Thiamine (B1) < 70 nmol/L — Supports beriberi/avitaminosis diagnosis; severity of neurological or cardiac involvement drives rating level
- Niacin (B3) severely deficient — Supports pellagra diagnosis; presence of dermatitis, diarrhea, dementia drives higher ratings
- Any vitamin below laboratory reference range — Establishes confirmed diagnosis; clinical symptom burden determines rating percentage
Tips:
- Bring printed copies of all labs showing low vitamin levels - do not assume the examiner has them
- Note the dates of each deficient lab result to help establish when the deficiency began
- If levels have been corrected with supplementation, note any residual symptoms that persist despite treatment
- Ask your treating physician to document in your records which specific vitamin(s) are deficient
Pain considerations: Vitamin deficiency itself is not painful in the traditional sense, but peripheral neuropathy from deficiency (especially B1 and B12) can cause significant burning pain, tingling, and sensory loss - describe these symptoms fully.
Neurological Reflex and Sensory Examination
Presence or absence of deep tendon reflexes (knee and ankle jerks), vibration sense, position sense, and signs of peripheral neuropathy secondary to vitamin deficiency
What to expect:
The examiner will tap your knees and ankles with a reflex hammer to check reflexes. They may use a tuning fork for vibration sense and ask you to identify position of your toes with eyes closed. Foot drop testing involves walking and dorsiflexion assessment.
Key thresholds:
- Absent knee or ankle jerks with loss of vibration or position sense — Maps to a higher-severity finding on the DBQ, associated with 30% or higher ratings
- Foot drop or atrophy of thigh or leg muscles — Indicates severe peripheral neuropathy, associated with highest rating tiers
Tips:
- Tell the examiner specifically which body parts have numbness, tingling, burning, or weakness
- Mention if you have difficulty walking, climbing stairs, or maintaining balance due to neuropathy symptoms
- Note if symptoms are worse at night or after activity
- Describe any falls or near-falls you have had due to balance or coordination problems
Pain considerations: Peripheral neuropathy pain from vitamin deficiency can be constant or intermittent. Describe your worst days, including burning sensations, electric shock feelings, and inability to walk or stand for extended periods.
Cardiovascular Assessment
Signs of cardiac involvement including cardiomegaly (enlarged heart) and congestive heart failure, which can result from severe thiamine (B1) deficiency (wet beriberi)
What to expect:
The examiner may auscultate your heart, review any echocardiogram or chest X-ray results, and assess for edema (swelling in legs/ankles). Bring any cardiac imaging results if available.
Key thresholds:
- Cardiomegaly documented on imaging — Elevates severity on DBQ; associated with higher rating levels for beriberi
- Congestive heart failure or anasarca (generalized edema) — Highest severity finding on DBQ; associated with maximum rating criteria
Tips:
- Bring any echocardiogram, EKG, or chest X-ray reports documenting cardiac abnormalities
- Describe shortness of breath, leg swelling, or difficulty lying flat that may indicate cardiac involvement
- Note if cardiac symptoms worsened during or after a period of documented vitamin deficiency
Pain considerations: Cardiac symptoms such as chest tightness, palpitations, and severe fatigue significantly impact daily function - describe how these limit your activities on your worst days.
Dermatological and Mucosal Examination
Presence of symmetrical dermatitis, moist dermatitis, and stomatitis (mouth inflammation) associated with niacin and other vitamin deficiencies
What to expect:
The examiner will visually inspect exposed skin for symmetrical rash patterns, particularly on sun-exposed areas (neck, hands, forearms). They will examine the mouth and tongue for stomatitis, glossitis, or mucosal changes.
Key thresholds:
- Symmetrical dermatitis present — Supports pellagra/avitaminosis diagnosis; elevates DBQ severity tier
- Moist dermatitis with mental changes and inability to retain food — Highest-tier pellagra severity finding on DBQ
Tips:
- Take dated photographs of skin rashes, lesions, or dermatitis flares before the exam to show the examiner
- Describe how the rash behaves - is it worse in sunlight, does it crack or weep, does it cause pain or itching
- Note any mouth sores, tongue swelling, or difficulty eating due to stomatitis
- Mention if dermatitis has been previously treated and whether it has fully resolved or left residuals
Pain considerations: Active dermatitis can be extremely painful and debilitating. Describe the burning, cracking, and open lesions on your worst days, and how they interfere with wearing clothing, sleeping, or working.
Mental Status and Cognitive Assessment
Presence of mental symptoms, confusion, memory problems, or Wernicke-Korsakoff syndrome signs attributable to vitamin deficiency (especially B1 and B12)
What to expect:
The examiner may ask questions about memory, orientation, concentration, and mood. They will evaluate for signs of Wernicke encephalopathy (confusion, ataxia, eye movement abnormalities) or Korsakoff syndrome (memory impairment, confabulation).
Key thresholds:
- Mental symptoms present (e.g., confusion, cognitive impairment, mood changes) — Elevates DBQ severity; Wernicke-Korsakoff is highest-tier finding
- Marked mental changes with inability to retain food — Highest severity tier on DBQ for pellagra/avitaminosis
Tips:
- Bring a family member or caregiver who can describe cognitive changes they have observed
- Keep a written log of specific cognitive or mental symptoms to share with the examiner
- Describe how mental symptoms interfere with work, managing finances, driving, or social interactions
- Do not minimize confusion, memory lapses, or personality changes - accurately describe their frequency and severity
Pain considerations: Mental symptoms from vitamin deficiency, including severe anxiety, confusion, and emotional dysregulation, are profoundly disabling. Describe how these affect your ability to function on your worst days.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 60% | Congestive heart failure, anasarca (generalized edema), or Wernicke-Korsakoff syndrome, OR marked mental changes with moist dermatitis and inability to retain food. Severe systemic involvement with major organ compromise or incapacitating neurological/psychiatric manifestations. |
CFR: Under 38 CFR 4.88b DC 6313, the highest rating tier reflects life-threatening or severely disabling manifestations of vitamin deficiency, including major cardiac compromise, generalized edema, or severe neuropsychiatric syndrome. These conditions represent the most debilitating presentations of avitaminosis. |
| 30% | Peripheral neuropathy with foot drop or atrophy of thigh or leg muscles, OR cardiomegaly, OR symmetrical dermatitis with mental symptoms. Significant functional impairment affecting mobility, cardiovascular function, or mental health. |
CFR: Under 38 CFR 4.88b DC 6313, foot drop, muscle atrophy, or cardiomegaly represent severe end-organ manifestations of vitamin deficiency that substantially limit physical function. These findings trigger higher rating consideration. |
| 20% | Peripheral neuropathy with absent knee or ankle jerks AND loss of vibration or position sense, OR presence of weakness, fatigue, anorexia, dizziness, or headache symptoms beyond nonspecific findings. Symptoms moderately impact daily functioning. |
CFR: Under 38 CFR 4.88b DC 6313, peripheral neuropathy findings such as absent reflexes with sensory loss represent a more significant neurological impact requiring a higher evaluation than simple symptomatic complaints. |
| 10% | Confirmed diagnosis of avitaminosis with nonspecific symptoms such as decreased appetite, weight loss, and malaise, OR stomatitis, achlorhydria, or diarrhea present. Condition is mild and controlled with supplementation but produces residual functional impact. |
CFR: Under 38 CFR 4.88b DC 6313, the 10% rating reflects a confirmed avitaminosis diagnosis with mild systemic symptoms that limit but do not incapacitate normal function. Symptoms may be partially controlled with supplementation but persist to a compensable degree. |
60% Congestive heart failure, anasarca (generalized edema), or W ...
Congestive heart failure, anasarca (generalized edema), or Wernicke-Korsakoff syndrome, OR marked mental changes with moist dermatitis and inability to retain food. Severe systemic involvement with major organ compromise or incapacitating neurological/psychiatric manifestations.
Key Symptoms
- Congestive heart failure attributable to vitamin deficiency (wet beriberi)
- Anasarca (severe generalized edema)
- Wernicke encephalopathy or Korsakoff syndrome
- Marked mental changes (severe confusion, dementia-like presentation)
- Moist, weeping dermatitis
- Inability to retain food (severe vomiting or malabsorption)
- Severe neurological compromise
- Inability to perform basic self-care activities
CFR: Under 38 CFR 4.88b DC 6313, the highest rating tier reflects life-threatening or severely disabling manifestations of vitamin deficiency, including major cardiac compromise, generalized edema, or severe neuropsychiatric syndrome. These conditions represent the most debilitating presentations of avitaminosis.
30% Peripheral neuropathy with foot drop or atrophy of thigh or ...
Peripheral neuropathy with foot drop or atrophy of thigh or leg muscles, OR cardiomegaly, OR symmetrical dermatitis with mental symptoms. Significant functional impairment affecting mobility, cardiovascular function, or mental health.
Key Symptoms
- Foot drop (inability to lift front of foot)
- Atrophy of thigh or leg muscles
- Cardiomegaly (enlarged heart on imaging)
- Symmetrical dermatitis on sun-exposed areas
- Mental symptoms (confusion, cognitive impairment, mood disturbance)
- Significant weakness affecting ambulation
- Impaired cardiac function
CFR: Under 38 CFR 4.88b DC 6313, foot drop, muscle atrophy, or cardiomegaly represent severe end-organ manifestations of vitamin deficiency that substantially limit physical function. These findings trigger higher rating consideration.
20% Peripheral neuropathy with absent knee or ankle jerks AND lo ...
Peripheral neuropathy with absent knee or ankle jerks AND loss of vibration or position sense, OR presence of weakness, fatigue, anorexia, dizziness, or headache symptoms beyond nonspecific findings. Symptoms moderately impact daily functioning.
Key Symptoms
- Absent knee or ankle deep tendon reflexes
- Loss of vibration sense in extremities
- Loss of position sense
- Weakness and persistent fatigue
- Anorexia
- Dizziness and balance disturbance
- Headache attributable to vitamin deficiency
- Moderate impaired bodily vigor
CFR: Under 38 CFR 4.88b DC 6313, peripheral neuropathy findings such as absent reflexes with sensory loss represent a more significant neurological impact requiring a higher evaluation than simple symptomatic complaints.
10% Confirmed diagnosis of avitaminosis with nonspecific symptom ...
Confirmed diagnosis of avitaminosis with nonspecific symptoms such as decreased appetite, weight loss, and malaise, OR stomatitis, achlorhydria, or diarrhea present. Condition is mild and controlled with supplementation but produces residual functional impact.
Key Symptoms
- Decreased appetite
- Unexplained weight loss
- General malaise and fatigue
- Stomatitis (mouth sores or tongue inflammation)
- Achlorhydria (reduced stomach acid)
- Diarrhea related to vitamin deficiency
- Mild impaired bodily vigor
CFR: Under 38 CFR 4.88b DC 6313, the 10% rating reflects a confirmed avitaminosis diagnosis with mild systemic symptoms that limit but do not incapacitate normal function. Symptoms may be partially controlled with supplementation but persist to a compensable degree.
How to Describe Your Symptoms
Fatigue and Impaired Bodily Vigor
How to describe:
Describe the specific nature of your fatigue - is it physical exhaustion, mental fogginess, or both? Quantify how it limits daily tasks. State how many hours per day you can function before fatigue becomes incapacitating, and how long recovery takes.
Worst-day example:
“On my worst days, I wake up exhausted despite sleeping 9 hours and cannot complete basic tasks like showering or preparing a meal without needing to rest. I feel as if my body has no energy reserves. This happens multiple times per week and can last the entire day.”
What the examiner listens for:
Specific functional limitations tied to fatigue, frequency of severe episodes, impact on work attendance or productivity, and whether fatigue correlates with vitamin deficiency flares.
Understatements to avoid:
Do not say 'I get a little tired.' Instead, describe the degree to which fatigue prevents you from completing routine daily activities and how it has changed your ability to work or care for yourself.
Peripheral Neuropathy Symptoms
How to describe:
Describe the location, character, and intensity of neuropathy symptoms. Use specific descriptors: burning, stabbing, electric shock, numbness, or pins-and-needles. Note whether symptoms are constant or intermittent, and whether they are worse at night, with activity, or in cold temperatures.
Worst-day example:
“On my worst days, the burning in both my feet is a 9 out of 10 and extends up to my shins. I cannot wear shoes comfortably and walking even 50 feet causes significant pain. I wake up multiple times at night due to the burning sensation and have tripped and fallen twice this month because I cannot feel the ground properly.”
What the examiner listens for:
Bilateral vs. unilateral distribution, specific sensory quality, functional mobility limitations, fall history, and whether neuropathy symptoms have progressed over time.
Understatements to avoid:
Do not say 'my feet tingle sometimes.' Describe the intensity, frequency, bilateral nature, and specific functional limitations including falls, inability to stand, and sleep disruption.
Gastrointestinal Symptoms (Diarrhea, Stomatitis, Appetite Loss)
How to describe:
Describe frequency and severity of GI symptoms. For diarrhea, note the number of episodes per day on bad days, any urgency or incontinence, and how it restricts your ability to leave home. For stomatitis, describe pain severity, difficulty eating or speaking, and duration of flares.
Worst-day example:
“During my worst weeks, I have watery diarrhea 6-8 times per day with no warning. I am afraid to leave the house. The mouth sores make eating solid food impossible and I survive on liquids for days at a time, which causes significant weight loss and weakness.”
What the examiner listens for:
Frequency and severity of GI episodes, ability to maintain nutrition and hydration, weight loss documentation, and whether GI symptoms are continuous or episodic with identifiable triggers.
Understatements to avoid:
Do not describe GI symptoms as occasional or mild if they routinely prevent you from eating, leaving home, or maintaining weight. Describe the actual frequency and the specific functional restrictions they impose.
Mental and Cognitive Symptoms
How to describe:
Describe specific cognitive deficits: difficulty concentrating, memory lapses, confusion, difficulty finding words, emotional dysregulation, or personality changes. Provide concrete examples of tasks you can no longer perform or errors you now make that were not a problem before.
Worst-day example:
“On my worst days, I cannot remember conversations that happened an hour ago, I get confused about where I am in familiar environments, and I become irritable and emotionally volatile without provocation. My family has noticed I repeat myself constantly. I have made significant financial errors because I cannot track information the way I used to.”
What the examiner listens for:
Specific cognitive domains affected, functional impact on work and self-management, observations from family members, and whether symptoms align with known presentations of B-vitamin deficiency-related neuropsychiatric syndromes.
Understatements to avoid:
Do not minimize cognitive symptoms as 'just being forgetful.' Describe specific incidents, their frequency, and the functional consequences at work, in relationships, and in daily independence.
Dermatitis and Skin Manifestations
How to describe:
Describe the location, appearance, and behavior of skin manifestations. Note whether the dermatitis is symmetrical, sun-exposed, weeping or dry, painful or itchy, and how it responds to treatment. Describe flare frequency and duration.
Worst-day example:
“During flares, the rash on both my forearms and the back of my neck becomes bright red, swollen, and begins to crack and weep. The pain is a 7 out of 10 and I cannot wear long sleeves due to fabric rubbing on the raw skin. Flares last 2-3 weeks and occur every 1-2 months even with supplementation.”
What the examiner listens for:
Bilateral and symmetrical distribution consistent with pellagra-spectrum deficiency, severity and weeping quality, impact on sleep and activities of daily living, and frequency of flares.
Understatements to avoid:
Do not describe the rash as just a skin problem. Explain the pain severity, the functional restrictions it imposes, and the psychological impact of visible skin disease.
Cardiac and Systemic Symptoms
How to describe:
Describe any shortness of breath, heart palpitations, leg swelling, or inability to lie flat. Quantify activity tolerance (e.g., 'I cannot walk to my mailbox without stopping to rest'). Describe how cardiac symptoms have developed or worsened in connection with your vitamin deficiency.
Worst-day example:
“On my worst days, I become severely short of breath walking from the bedroom to the bathroom. My legs and ankles are swollen to the point where I cannot wear shoes. I must sleep propped up on three pillows. These symptoms began when my thiamine levels were critically low and have not fully resolved.”
What the examiner listens for:
Documented cardiac findings on imaging, functional activity tolerance, edema severity, and a clear timeline connecting cardiac symptoms to periods of documented vitamin deficiency.
Understatements to avoid:
Do not minimize cardiac symptoms as 'occasional breathlessness.' Describe specific activity thresholds that trigger symptoms, the severity of edema, and how these findings have been documented medically.
Common Mistakes to Avoid
Reporting only current symptoms after treatment, not the full history of severity
If your vitamin deficiency has been partially treated with supplements, your symptoms at the moment of the exam may be milder than your peak severity. The VA rates your current level of disability, but residual impairment and the documented history of severe episodes also matter.
Instead: Bring documentation of your worst periods, including lab values showing critical deficiency, hospitalizations, and prior symptom descriptions from treating providers. Describe residual symptoms that persist despite supplementation.
Impact: All levels - particularly 30% and 60%
Failing to connect vitamin deficiency to specific organ complications
The DBQ has separate checkboxes for cardiac findings (cardiomegaly, CHF), neurological findings (peripheral neuropathy tiers), and psychiatric findings (Wernicke-Korsakoff). If you do not specifically discuss these complications, the examiner may not check the higher-severity boxes.
Instead: Explicitly mention every complication to the examiner. Say 'I have been told I have peripheral neuropathy from my vitamin deficiency' or 'My cardiologist noted cardiomegaly that my doctor linked to my thiamine deficiency.' Bring supporting records.
Impact: 20%, 30%, and 60%
Understating mental and cognitive symptoms
Veterans often minimize confusion, memory problems, and mood changes out of embarrassment or because they have adapted to the deficits. However, these symptoms are explicitly rated in the DBQ and can elevate the rating to the highest tier if severe.
Instead: Describe cognitive and mental symptoms in detail with specific examples. Bring a statement from a family member or caregiver who can describe changes they have observed. Reference any neuropsychological testing or psychiatric evaluations.
Impact: 30% and 60%
Not bringing lab results showing documented vitamin deficiency
The DBQ requires a confirmed diagnosis, and the examiner needs objective lab evidence to support the specific deficiency type and its severity. Without labs, the diagnosis may be characterized as unconfirmed.
Instead: Print all lab results showing below-reference vitamin levels. Organize them chronologically and highlight the deficient values. Bring the most recent labs and any historic labs showing your worst deficiency period.
Impact: All levels - foundational to the confirmed diagnosis checkbox
Describing only the best days instead of the worst days
Per M21-1 guidance, the VA rating is meant to reflect the average impairment in earning capacity. Describing only good days results in an underestimate of functional impairment.
Instead: When asked how you are feeling or how often symptoms occur, describe the full range including your worst days. Use phrases like 'On my worst days, which happen [frequency], I experience [specific symptoms and limitations].'
Impact: All levels
Failing to describe the impact on occupational and daily functioning
The DBQ includes a specific field asking about the impact of nutritional deficiency on occupational and daily functioning. If the examiner does not ask this question directly, veterans may not volunteer this critical information.
Instead: Proactively describe how your condition has affected your ability to work, maintain attendance, perform job duties, cook, shop, exercise, socialize, and care for yourself or dependents. Be specific about lost employment, reduced hours, or job accommodations.
Impact: All levels - directly populates the functional impact field on the DBQ
Not mentioning all related nutritional deficiency diagnoses
The DBQ covers multiple nutritional deficiency conditions (avitaminosis, beriberi, pellagra, and other conditions). If you have more than one deficiency, each should be addressed, as they may have different ICD codes and severity profiles.
Instead: List every nutritional deficiency you have been diagnosed with. Bring documentation for each. Ask the examiner to document all confirmed deficiencies on the DBQ, not just the primary one.
Impact: All levels - ensures all diagnoses are captured for rating purposes
Prep Checklist
Before Your Exam
Day Of
During the Exam
After the Exam
Your Rights During a C&P Exam
- You have the right to record your C&P examination in most states. Inform the examiner before the exam begins that you intend to record it. Recording provides a verbatim record in case the written report is inaccurate or incomplete.
- You have the right to review the completed C&P examination report (DBQ) after it is submitted. Request a copy from your VA Regional Office in writing.
- You have the right to submit a rebuttal if the C&P exam report contains factual errors, omits symptoms you reported, or mischaracterizes your condition. Submit your rebuttal with supporting medical evidence promptly.
- You have the right to request a new C&P examination if the original examination is found to be inadequate, incomplete, or conducted without proper review of your evidence. An inadequate exam includes one where the examiner did not review submitted records or did not address all claimed disabilities.
- You have the right to bring a representative, VSO, or accredited claims agent to your C&P exam. You may also bring a caregiver or family member for support, though they may be asked to wait outside during portions of the physical exam.
- You have the right to have the examiner review all evidence you bring to the exam. Hand-deliver your documentation and ask the examiner to confirm in the report that the evidence was reviewed.
- You have the right to a competent examination by a qualified examiner. If you believe the examiner lacked the expertise to evaluate your nutritional deficiency (e.g., a general examiner with no nutritional medicine training), you may challenge the adequacy of the exam.
- You have the right to claim all secondary conditions that result from your service-connected vitamin deficiency, including peripheral neuropathy, cardiac conditions, and psychiatric conditions, as secondary service-connected disabilities.
- You have the right to a fully favorable rating decision based on the benefit of the doubt standard under 38 CFR 3.102. When the evidence is in approximate balance, the VA must resolve reasonable doubt in your favor.
- You have the right to appeal any rating decision you disagree with through the Appeals Modernization Act (AMA) pathways: Supplemental Claim Lane, Higher-Level Review, or direct appeal to the Board of Veterans' Appeals.
Related Conditions
- Beriberi (Vitamin B1/Thiamine Deficiency) Specific subtype of avitaminosis rated under the same DBQ. Beriberi presents with wet (cardiac) or dry (neurological) manifestations and may warrant a separate diagnostic code and rating alongside general avitaminosis.
- Pellagra (Vitamin B3/Niacin Deficiency) Specific subtype of avitaminosis characterized by the classic triad of dermatitis, diarrhea, and dementia (the 3 Ds). Rated on the same DBQ with specific symptom checkboxes for pellagra spectrum findings.
- Peripheral Neuropathy A common and potentially separately ratable complication of vitamin deficiency (especially B1, B12, and B6). Can be claimed as secondary to service connected avitaminosis and rated under the neurological disability rating schedule.
- Wernicke-Korsakoff Syndrome A severe neuropsychiatric complication of thiamine (B1) deficiency, explicitly listed in the highest severity tier of the avitaminosis DBQ. May also be rated as a secondary neurological or psychiatric condition.
- Congestive Heart Failure A potentially life threatening cardiac complication of severe thiamine deficiency (wet beriberi). Can be claimed as secondary to service connected avitaminosis and rated under the cardiovascular disability rating schedule.
- Malnutrition (Nutritional Deficiency, Unspecified) Broader nutritional deficiency condition that may co occur with or underlie specific vitamin deficiencies. Rated on the same Nutritional Deficiencies DBQ and may be documented alongside avitaminosis.
- Irritable Bowel Syndrome / Gastrointestinal Conditions GI conditions that impair vitamin absorption (malabsorption syndromes) can cause or worsen vitamin deficiencies. Conversely, vitamin deficiency can cause GI symptoms such as achlorhydria and diarrhea. May be relevant to establishing nexus or secondary service connection.
- Depression and Anxiety Mental health conditions can develop secondary to the chronic pain, fatigue, and functional limitations of vitamin deficiency. Additionally, B vitamin deficiencies directly affect neurological and psychiatric function and can cause or exacerbate depressive and anxiety symptoms.
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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.