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C&P Exam Prep: Pellagra (Niacin / B3 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 of Pellagra (Vitamin B3/Niacin deficiency) and its associated symptoms, determine service connection if not already established, and assign a disability rating under Diagnostic Code 6301 based on the presence and severity of the classic 'Four Ds': Dermatitis, Diarrhea, Dementia (mental changes), and Death (in severe cases). The examiner will assess how your condition impacts daily functioning, employment, and quality of life.
What the examiner evaluates:
- Presence and severity of symmetrical dermatitis, especially on sun-exposed skin areas
- Gastrointestinal symptoms including diarrhea, stomatitis, achlorhydria, and nausea
- Mental and neurological changes including confusion, memory loss, depression, psychosis, or dementia
- Impaired bodily vigor and systemic weakness or fatigue
- Peripheral neuropathy including absent knee or ankle jerks and loss of sensation
- Cardiovascular involvement including cardiomegaly or congestive heart failure
- Presence of anasarca or severe systemic manifestations
- Wernicke-Korsakoff syndrome or other neurological sequelae
- Confirmed diagnosis status versus residual findings after treatment
- Functional impact on occupational and daily activities
- Current medications used to treat the nutritional deficiency
- History of onset, course, and any periods of improvement or exacerbation
The examination will include both an interview about your symptoms and history, and a physical examination assessing skin, neurological reflexes, gastrointestinal findings, and cardiovascular status. The examiner will review your service treatment records, VA medical records, and any private medical evidence you have submitted. Be prepared to describe your worst typical day, not just how you feel on the day of the exam. You may request that the exam be recorded in most jurisdictions.
Typical duration: 30-45 minutes
Dermatological Assessment - Symmetrical Dermatitis
Presence, distribution, and severity of the classic pellagrous dermatitis, typically appearing symmetrically on sun-exposed areas such as the neck (Casal necklace), hands, forearms, and face. May present as hyperpigmentation, scaling, cracking, weeping, or ulceration.
What to expect:
The examiner will visually inspect skin on sun-exposed areas. They may ask about sensitivity to sunlight, burning, itching, and whether skin lesions weep, bleed, or become infected. They will note whether dermatitis is active or represents a residual/post-treatment finding.
Key thresholds:
- Symmetrical dermatitis present and active — Key marker for moderate-to-severe rating; supports ratings of 30% or higher depending on associated symptoms
- Moist dermatitis with inability to retain food — Supports 60% rating level when combined with marked mental changes
- Residual dermatitis post-treatment with no active symptoms — May support lower rating or non-compensable finding; document any ongoing skin residuals carefully
Tips:
- Wear clothing that allows easy inspection of arms, neck, and legs
- Do not apply heavy makeup or cover skin lesions the day of the exam
- Photograph active skin lesions before the exam to show typical or worst-day appearance
- Describe any sensitivity to sunlight and how it limits your outdoor activities
- Note whether skin worsens seasonally (spring/summer sun exposure often triggers flares)
Pain considerations: Describe any burning, painful cracking, or raw/weeping skin areas. Note if skin pain disturbs sleep or prevents wearing certain clothing.
Neurological Reflex Examination
Peripheral neuropathy associated with chronic niacin deficiency, including assessment of deep tendon reflexes (knee and ankle jerks), sensory function, proprioception, and signs of foot drop or muscle atrophy of the thigh or leg.
What to expect:
The examiner will use a reflex hammer to test knee and ankle jerks. They may test sensation using pinprick, light touch, or vibration. They will observe your gait and assess for muscle wasting. They may also evaluate for foot drop by asking you to walk on your heels.
Key thresholds:
- Absent knee or ankle jerks with loss of sensation — Supports peripheral neuropathy finding; contributes to moderate-to-severe rating tier
- Foot drop or atrophy of thigh or leg muscles — Supports higher severity rating; significant functional impairment indicator
Tips:
- Report any numbness, tingling, burning, or weakness in your feet or legs honestly and in detail
- Mention if you have fallen or stumbled due to leg weakness or loss of sensation
- Describe how neuropathy affects your ability to walk, stand, or use stairs
- Note if symptoms are worse at night or after prolonged standing
Pain considerations: Neuropathic pain can be severe. Describe burning, electric shock sensations, or hypersensitivity to touch (allodynia) in affected limbs. Note the frequency and intensity on your worst days.
Mental Status Examination
Cognitive and psychiatric manifestations of pellagra including confusion, memory impairment, depression, anxiety, irritability, psychosis, dementia, or Wernicke-Korsakoff syndrome attributable to chronic niacin deficiency.
What to expect:
The examiner may ask orientation questions, assess short-term memory, and inquire about mood, behavior, and cognitive function. They will ask your family member or companion (if present) about observed changes in your behavior or cognition. This may be brief or more detailed depending on severity of symptoms.
Key thresholds:
- Marked mental changes present (confusion, memory loss, depression, irritability) — Key component of 60% rating when combined with moist dermatitis and inability to retain food
- Congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome — Supports highest severity rating tier (100%)
Tips:
- Bring a family member or caregiver who can describe observed cognitive or behavioral changes
- Report all mental symptoms honestly - confusion, memory gaps, mood swings, depression
- Describe how mental changes have affected your ability to work, manage finances, or maintain relationships
- Note any psychiatric diagnoses that have developed or worsened since onset of pellagra
Pain considerations: Mental symptoms in pellagra can cause significant emotional suffering. Describe depressive episodes, anxiety, emotional instability, and how these symptoms affect your worst days.
Gastrointestinal and Nutritional Assessment
GI manifestations of pellagra including diarrhea, stomatitis (mouth inflammation), achlorhydria (absence of stomach acid), nausea, vomiting, weight loss, decreased appetite, and inability to retain food.
What to expect:
The examiner will ask about bowel habits, frequency and character of diarrhea, oral sores, difficulty swallowing, and weight changes. They may examine the mouth and tongue for glossitis or stomatitis. They will assess for signs of malnutrition.
Key thresholds:
- Inability to retain food due to GI symptoms — Critical criterion for 60% rating when combined with marked mental changes and moist dermatitis
- Diarrhea, stomatitis, or achlorhydria present — Supports moderate rating; important documented finding
Tips:
- Keep a diary of bowel frequency and consistency in the week before your exam
- Note any weight loss - bring records of your highest and lowest weights
- Describe painful mouth sores, difficulty eating, or food avoidance due to oral pain
- Report nausea or vomiting frequency on your worst days
- Mention any foods you cannot tolerate and why
Pain considerations: Describe the pain and urgency of diarrhea, abdominal cramping, and how GI symptoms interrupt sleep, work, and social activities on your worst days.
Cardiovascular Assessment
Cardiac complications of severe pellagra including cardiomegaly (enlarged heart) and congestive heart failure, which represent the most severe end of the disease spectrum.
What to expect:
The examiner may auscultate the heart and lungs, check for edema (fluid retention in legs), and review any cardiac imaging or echocardiogram results in your records. They will assess for signs of anasarca (generalized edema).
Key thresholds:
- Cardiomegaly present — Severe finding supporting higher rating tiers
- Congestive heart failure or anasarca — Supports 100% rating level
Tips:
- Bring any cardiac test results including ECG, echocardiogram, or chest X-ray reports
- Report any shortness of breath, leg swelling, or exercise intolerance
- Note if you sleep with multiple pillows due to breathing difficulty (orthopnea)
Pain considerations: Describe chest discomfort, breathlessness with minimal exertion, and how cardiac symptoms limit your daily activities on your worst days.
Rating Criteria Breakdown
| Rating % | Criteria | Key Symptoms |
|---|---|---|
| 100% | Congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome. This represents the most severe and life-threatening presentation of pellagra with critical cardiovascular, systemic fluid retention, or severe irreversible neurological compromise. The veteran requires significant assistance with activities of daily living. |
CFR: Under DC 6301, the 100% rating is reserved for the most critical presentations: congestive heart failure, anasarca (total body edema), or Wernicke-Korsakoff syndrome - all of which represent life-threatening or severely disabling consequences of chronic niacin deficiency. |
| 60% | Marked mental changes, moist dermatitis, and inability to retain food. This triad represents severe pellagra with significant neuropsychiatric involvement, active weeping or moist skin lesions, and GI compromise severe enough to prevent adequate nutrition. Peripheral neuropathy with foot drop or atrophy of the thigh or leg may also be present. |
CFR: The 60% criterion under DC 6301 requires the convergence of marked mental changes, moist dermatitis, and inability to retain food - representing severe systemic disease with multi-system involvement. |
| 30% | Confirmed diagnosis of pellagra with impaired bodily vigor. Symptoms include symmetrical dermatitis, mild mental symptoms (irritability, mild depression, forgetfulness), peripheral neuropathy with absent knee or ankle jerks and loss of sensation, stomatitis, achlorhydria, or diarrhea. Functioning is reduced but the veteran retains capacity for some daily activities. |
CFR: Impaired bodily vigor combined with confirmed pellagra diagnosis and at least one of dermatitis, mental symptoms, peripheral neuropathy, or GI manifestations supports this rating tier under DC 6301. |
| 10% | Non-specific symptoms only - such as decreased appetite, weight loss, fatigue, weakness, dizziness, or other mild systemic manifestations without confirmed diagnosis of active pellagra or residual findings following treatment that are minimal in nature. |
CFR: Non-specific symptoms such as weakness, fatigue, anorexia, dizziness, and heaviness in the extremities at this level reflect the mildest compensable presentation under DC 6301. |
100% Congestive heart failure, anasarca, or Wernicke-Korsakoff sy ...
Congestive heart failure, anasarca, or Wernicke-Korsakoff syndrome. This represents the most severe and life-threatening presentation of pellagra with critical cardiovascular, systemic fluid retention, or severe irreversible neurological compromise. The veteran requires significant assistance with activities of daily living.
Key Symptoms
- Congestive heart failure with dyspnea, orthopnea, and reduced ejection fraction
- Anasarca: generalized severe edema throughout the body
- Wernicke-Korsakoff syndrome: severe amnesia, confabulation, ophthalmoplegia, ataxia
- Complete functional dependence
- Inability to perform self-care activities
- Severe malnutrition with multi-organ involvement
CFR: Under DC 6301, the 100% rating is reserved for the most critical presentations: congestive heart failure, anasarca (total body edema), or Wernicke-Korsakoff syndrome - all of which represent life-threatening or severely disabling consequences of chronic niacin deficiency.
60% Marked mental changes, moist dermatitis, and inability to re ...
Marked mental changes, moist dermatitis, and inability to retain food. This triad represents severe pellagra with significant neuropsychiatric involvement, active weeping or moist skin lesions, and GI compromise severe enough to prevent adequate nutrition. Peripheral neuropathy with foot drop or atrophy of the thigh or leg may also be present.
Key Symptoms
- Marked mental changes: confusion, psychosis, significant memory loss, dementia
- Moist dermatitis: weeping, raw, or ulcerating skin lesions
- Inability to retain food: severe nausea, vomiting, or diarrhea preventing adequate nutrition
- Peripheral neuropathy with foot drop
- Atrophy of thigh or leg muscles
- Cardiomegaly
- Significant weight loss and malnutrition
CFR: The 60% criterion under DC 6301 requires the convergence of marked mental changes, moist dermatitis, and inability to retain food - representing severe systemic disease with multi-system involvement.
30% Confirmed diagnosis of pellagra with impaired bodily vigor. ...
Confirmed diagnosis of pellagra with impaired bodily vigor. Symptoms include symmetrical dermatitis, mild mental symptoms (irritability, mild depression, forgetfulness), peripheral neuropathy with absent knee or ankle jerks and loss of sensation, stomatitis, achlorhydria, or diarrhea. Functioning is reduced but the veteran retains capacity for some daily activities.
Key Symptoms
- Symmetrical dermatitis (hyperpigmented, scaling, or mildly inflamed)
- Impaired bodily vigor - general loss of stamina and strength
- Mild mental symptoms: irritability, forgetfulness, depression
- Stomatitis (painful mouth sores)
- Achlorhydria
- Diarrhea
- Peripheral neuropathy with absent deep tendon reflexes
- Loss of sensation in extremities
CFR: Impaired bodily vigor combined with confirmed pellagra diagnosis and at least one of dermatitis, mental symptoms, peripheral neuropathy, or GI manifestations supports this rating tier under DC 6301.
10% Non-specific symptoms only - such as decreased appetite, wei ...
Non-specific symptoms only - such as decreased appetite, weight loss, fatigue, weakness, dizziness, or other mild systemic manifestations without confirmed diagnosis of active pellagra or residual findings following treatment that are minimal in nature.
Key Symptoms
- Mild fatigue and weakness
- Decreased appetite
- Mild weight loss
- Dizziness or lightheadedness
- General malaise
- Minimal residual skin changes post-treatment
CFR: Non-specific symptoms such as weakness, fatigue, anorexia, dizziness, and heaviness in the extremities at this level reflect the mildest compensable presentation under DC 6301.
How to Describe Your Symptoms
Dermatitis and Skin Manifestations
How to describe:
Describe the exact location of skin lesions (neck, hands, forearms, face), their appearance (red, scaling, cracking, weeping, hyperpigmented), and how they change with sun exposure. Quantify how often skin flares occur, how long they last, and what triggers them. Describe any infection, pain, or odor from weeping lesions. Explain how skin symptoms affect your ability to wear clothing, work outdoors, or engage in social activities.
Worst-day example:
“On my worst days, the skin on my neck and both forearms is raw, weeping, and extremely painful. I cannot wear a collar or long sleeves without the fabric sticking to the open areas. Even brief sun exposure causes the skin to blister and weep within an hour. The pain is a constant 7 out of 10 and the burning keeps me awake at night. I have avoided going outdoors entirely during spring and summer because of how severely my skin reacts.”
What the examiner listens for:
Symmetry of skin involvement, sun-exposure relationship, presence of moist vs. dry dermatitis, infection history, functional limitations caused by skin symptoms, and correlation with pellagra diagnosis.
Understatements to avoid:
Do not say 'my skin is just a little irritated' if you experience significant cracking, weeping, or infection. Do not minimize sun sensitivity. Do not fail to mention all affected body areas.
Mental and Cognitive Symptoms
How to describe:
Be specific about cognitive changes: describe memory failures with concrete examples, episodes of confusion or disorientation, mood instability, depression, or psychotic symptoms. Describe when these began, whether they are constant or episodic, and how they have changed over time. Explain the impact on your ability to manage finances, follow conversations, remember appointments, or maintain relationships.
Worst-day example:
“On my worst days, I cannot remember whether I have eaten or taken my medications. My family tells me I become agitated and say things that do not make sense. I have gotten lost driving in my own neighborhood twice this month. The confusion comes on suddenly and can last for hours. My wife handles all financial decisions now because I cannot reliably track numbers or follow multi-step processes.”
What the examiner listens for:
Nature and severity of cognitive changes, onset and progression, impact on instrumental activities of daily living, whether symptoms meet criteria for marked mental changes versus mild irritability, and any formal neuropsychological testing.
Understatements to avoid:
Do not say 'I'm just a little forgetful' if you have significant memory gaps or disorientation. Do not omit behavioral changes that family members have observed. Do not minimize depression or emotional instability as unrelated to your condition.
Gastrointestinal Symptoms
How to describe:
Describe the frequency and urgency of diarrhea with specific numbers (e.g., 8-10 loose stools per day on bad days). Describe nausea, vomiting, inability to eat, mouth sores that prevent chewing, and any associated weight loss with actual numbers. Explain how GI symptoms affect your ability to leave home, maintain employment, or eat a normal diet.
Worst-day example:
“On my worst days, I have 8 to 10 episodes of watery diarrhea with no warning. I am afraid to leave the house because I cannot reach a restroom in time. The sores inside my mouth and on my tongue make it impossible to eat anything but soft foods, and even water causes burning. I have lost 22 pounds over the past six months because I am afraid to eat. The nausea is constant and I vomit at least once daily during bad weeks.”
What the examiner listens for:
Documented diarrhea frequency, stomatitis severity, achlorhydria findings, weight loss with quantification, inability to retain food as a distinct clinical finding, and correlation with nutritional deficiency.
Understatements to avoid:
Do not say 'I have some loose stools' if you experience multiple episodes daily. Do not omit mouth sores or difficulty swallowing. Do not fail to mention your actual weight loss in pounds.
Peripheral Neuropathy Symptoms
How to describe:
Describe the exact sensations in your feet and legs: numbness, tingling, burning, electric shock feelings, or loss of balance. Note whether you have tripped, fallen, or needed a cane or other assistive device. Describe difficulty with stairs, uneven ground, or fine motor tasks. Explain how neuropathy affects your ability to stand, walk distances, or perform physical work.
Worst-day example:
“On my worst days, both my feet feel like they are encased in thick rubber gloves - I cannot feel the ground when I walk. I have fallen three times in the past two months because my right foot drags and catches on uneven surfaces. I cannot walk more than half a block without stopping due to weakness in my legs. At night the burning in my feet is so severe I cannot tolerate any sheet touching them and I average only 3-4 hours of sleep.”
What the examiner listens for:
Objective signs of peripheral neuropathy (absent reflexes, sensory loss), presence of foot drop or muscle atrophy, functional impact on ambulation and daily activities, and correlation with pellagra-related niacin deficiency.
Understatements to avoid:
Do not say 'my feet feel a little numb sometimes' if you have significant functional impairment. Do not fail to mention falls or use of assistive devices. Do not omit nighttime pain that disrupts sleep.
Systemic Weakness and Impaired Bodily Vigor
How to describe:
Describe your overall loss of stamina, endurance, and physical capacity compared to before your illness. Quantify what you can no longer do: distances you can walk, weight you can lift, duration of activity before exhaustion. Explain how fatigue affects your work, household responsibilities, and social life.
Worst-day example:
“On my worst days, I am exhausted after walking to the bathroom. I used to work a full eight-hour shift in a warehouse; now I cannot stand for more than ten minutes without needing to sit down. By noon I am too fatigued to do anything productive. I have had to reduce my work hours by 75% and I still cannot complete a full day without going to bed immediately afterward.”
What the examiner listens for:
Quantifiable loss of functional capacity, correlation between fatigue and nutritional deficiency, impact on employability, and how impaired bodily vigor intersects with other pellagra manifestations.
Understatements to avoid:
Do not say 'I get tired more easily' if you have profound functional limitation. Do not compare yourself only to healthy peers - compare to your own pre-illness baseline. Do not omit the occupational impact.
Common Mistakes to Avoid
Reporting only how you feel on the day of the exam
Pellagra symptoms can fluctuate. If you are having a relatively good day, the examiner may underestimate your typical or worst-day severity, resulting in a lower rating.
Instead: Explicitly tell the examiner: 'Today is a relatively good day. On my worst days, which occur [X times per month], my symptoms are as follows...' Describe your worst typical presentation, not your current presentation.
Impact: All levels - particularly the difference between 10% and 30%, or 30% and 60%
Failing to describe all four systems affected by pellagra
Pellagra's rating criteria under DC 6301 are based on the convergence of multi-system findings. If you only mention skin problems and omit GI, mental, or neurological symptoms, the examiner may not document the full picture needed for a higher rating.
Instead: Before the exam, prepare a written summary covering all four domains: skin, GI, mental/cognitive, and neurological. Hand it to the examiner or reference it during the interview.
Impact: Critical for achieving 60% versus 30%
Not quantifying GI symptoms precisely
The distinction between 'diarrhea' (30% level) and 'inability to retain food' (60% level) requires specific documentation of severity. Vague descriptions may be coded as mild.
Instead: Report exact stool frequency on bad days, document weight loss with specific numbers, and describe episodes of vomiting that prevent adequate nutrition. Use a symptom diary for the 2 weeks before your exam.
Impact: 30% versus 60%
Minimizing mental and cognitive symptoms
Veterans often downplay psychiatric and cognitive symptoms out of stigma or the belief they are unrelated to their nutritional condition. The 60% rating specifically requires 'marked mental changes,' which cannot be documented if not reported.
Instead: Report all cognitive and psychiatric symptoms honestly and specifically. Bring a family member who can corroborate observed changes. Describe how mental symptoms have impaired your work, relationships, and ability to manage daily tasks.
Impact: 30% versus 60%
Not bringing documentation of niacin deficiency lab work or treatment records
The DBQ includes a field for confirmed diagnosis. Without lab confirmation (serum niacin, urinary metabolites, or clinical diagnosis documented by a provider), the examiner may check 'unconfirmed' which can undermine your claim.
Instead: Gather all laboratory results showing low niacin levels, any treating provider letters confirming pellagra diagnosis, and records of niacin supplementation treatment. Submit these to VA before your exam.
Impact: All levels - foundational to claim validity
Not reporting cardiovascular symptoms that may indicate cardiomegaly or heart failure
The 100% rating requires congestive heart failure or anasarca. Veterans may not realize their shortness of breath, leg swelling, or exercise intolerance could be related to their pellagra and therefore fail to report it.
Instead: Report any heart or fluid retention symptoms to the examiner. Bring cardiac test results (echocardiogram, chest X-ray, ECG) to the exam. Note if any cardiologist has linked cardiac findings to your nutritional deficiency.
Impact: 60% versus 100%
Leaving the exam without confirming the examiner documented residuals after treatment
If you were treated for pellagra and improved, residual symptoms must still be documented. Some examiners may note 'resolved' without capturing ongoing dermatitis, neuropathy, or cognitive deficits that persist after treatment.
Instead: Clearly communicate which symptoms persisted or became permanent even after niacin supplementation. Ask the examiner to document your current residual findings, not just your initial diagnosis status.
Impact: All post-treatment rating levels
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 a thorough and fully adequate C&P examination. An examiner who spends insufficient time with you or fails to address all symptom areas has potentially produced an inadequate exam that can be challenged.
- You have the right to record your C&P examination in most jurisdictions with single-party consent. Check your state's recording consent laws in advance. Use a visible recorder and inform the examiner at the outset.
- You have the right to submit a written personal statement (VA Form 21-4138) correcting or supplementing the examiner's report if the completed DBQ contains inaccuracies or omissions.
- You have the right to request a copy of your completed C&P examination report through the VA's release of information process or via MyHealtheVet.
- You have the right to submit private medical evidence, including independent medical opinions (nexus letters or IMOs) from qualified healthcare providers, at any time before a final claims decision is issued.
- You have the right to bring a support person - a family member, caregiver, or VSO representative - to your C&P examination to provide moral support and, in some cases, to offer corroborating observations to the examiner.
- You have the right to be evaluated under the benefit of the doubt standard (38 U.S.C. - 5107(b)): when there is an approximate balance of positive and negative evidence regarding your claim, the benefit of the doubt shall be given to you.
- You have the right to challenge an inadequate or insufficient C&P examination by requesting a new examination through your VSO or by filing a supplemental claim with additional evidence.
- You have the right to free claims assistance from an accredited Veterans Service Organization (VSO), State Department of Veterans Affairs representative, or accredited claims agent at no cost.
- You have the right to appeal any rating decision you disagree with through the Board of Veterans' Appeals (BVA) or the Court of Appeals for Veterans Claims (CAVC) if you believe the examiner's findings or the rating decision were incorrect.
Related Conditions
- Beriberi (Vitamin B1 / Thiamine Deficiency) Co occurring nutritional deficiency rated on the same DBQ form. Both conditions share overlapping symptoms of peripheral neuropathy, cardiovascular involvement, and systemic weakness. Veterans with malnutrition, alcoholism, or malabsorption disorders are at risk for multiple concurrent B vitamin deficiencies.
- Avitaminosis (Vitamin A Deficiency) Evaluated on the same Nutritional Deficiencies DBQ. May co occur with pellagra in cases of global nutritional deprivation. Shares the pathway of general malnutrition as a causative mechanism.
- Peripheral Neuropathy A direct neurological consequence of chronic pellagra. Absent knee or ankle jerks, loss of sensation, and foot drop documented in the pellagra DBQ may also support a separate or secondary peripheral neuropathy claim if the neuropathy has become an independent disabling condition.
- Depressive Disorder / Major Depression Pellagra can cause or significantly exacerbate psychiatric conditions including major depression, anxiety disorders, and cognitive impairment. If mental symptoms have persisted or evolved independently, a separate mental health claim secondary to pellagra should be considered.
- Congestive Heart Failure Severe or chronic pellagra can contribute to cardiac involvement including cardiomegaly and congestive heart failure. If cardiac disease has been diagnosed as a consequence of nutritional deficiency, a secondary service connection claim for congestive heart failure may be warranted.
- Wernicke-Korsakoff Syndrome Listed explicitly in the 100% rating criteria for pellagra under DC 6301. May co occur with pellagra in the context of severe nutritional deficiency, particularly in veterans with alcohol use disorder or severe malnutrition. The DBQ specifically captures this condition as part of the highest severity tier.
- Gastroesophageal Reflux Disease (GERD) / Gastrointestinal Conditions Chronic diarrhea, achlorhydria, and stomatitis from pellagra may cause secondary GI complications or exacerbate pre existing GI conditions. Secondary claims for GI disorders caused or worsened by pellagra should be considered.
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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.