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VA Rating Assistant

DC 6311 · 38 CFR 4.88b

Melioidosis C&P Exam Prep

To evaluate the current severity, activity status, and functional impact of service-connected or potentially service-connected melioidosis (Burkholderia pseudomallei infection), including any residual complications such as chronic pulmonary disease, septicemia sequelae, or organ involvement, for purposes of disability rating under 38 CFR 4.88b DC 6311.

Format:
Interview + Physical
Typical duration:
30-45 minutes
DBQ form:
Infectious_Diseases_Other_than_HIV_Related_Illness_Chronic_Fatigue_Syndrome_and_Tuberculosis (Infectious_Diseases_Other_than_HIV_Related_Illness_Chronic_Fatigue_Syndrome_and_Tuberculosis)
Examiner:
Infectious Disease Specialist or Internal Medicine

What the examiner evaluates

  • Confirmation of melioidosis diagnosis and date of original diagnosis
  • Whether the condition is currently active or inactive
  • Date of cessation of treatment for active disease, if inactive
  • History of exposure during military service (endemic regions: Southeast Asia, Northern Australia, South Asia, Pacific Islands, Caribbean, parts of Africa and South America)
  • Current symptoms including pulmonary involvement (cough, hemoptysis, chest pain, dyspnea), fever, night sweats, weight loss
  • Septicemic manifestations including prostration, bacteremia episodes
  • Localized infection findings (skin ulcers, lymphadenitis, abscesses in liver, spleen, prostate, bone, joints)
  • Neurological complications (neurological melioidosis with brainstem encephalitis)
  • Chronic suppurative infection indicators
  • Functional impact on daily activities and employment
  • Treatment history including IV ceftazidime or meropenem (intensive phase) and oral TMP-SMX or doxycycline (eradication phase)
  • Recurrence or relapse history
  • Any residual organ damage from acute or chronic infection
  • Diagnostic confirmation methods: culture, serology (indirect hemagglutination assay or ELISA), PCR, histopathology

Examination will typically be conducted in person at a VA medical center or contractor examination site. Virtual/telehealth exams are possible depending on VA scheduling. Bring all outside medical records, lab results, culture reports, and treatment records. If you were deployed to endemic regions (Vietnam, Thailand, Philippines, Guam, Pacific Islands, Southwest Asia, Iraq, Afghanistan), note the specific deployment locations and dates as geographic exposure is critical for nexus establishment.

Measurements and tests

Pulmonary Function Testing (if pulmonary melioidosis present)

What it measures: Lung function including FEV1, FVC, FEV1/FVC ratio to quantify any obstructive or restrictive deficits from chronic pulmonary involvement

What to expect: You may be asked to blow forcefully into a spirometer multiple times. The test measures how much air you can exhale and how fast. Results are compared to predicted normal values based on your age, height, and sex.

Critical thresholds

  • FEV1 < 40% predicted Supports higher disability rating for pulmonary residuals
  • FEV1 40-59% predicted Supports moderate pulmonary disability rating
  • FEV1 60-79% predicted Supports mild-to-moderate pulmonary disability rating

Tips

  • Do not use bronchodilators before the test unless medically necessary and cleared with examiner
  • Perform the test when you are feeling your worst or most symptomatic to reflect true functional capacity
  • Inform the technician of any chest pain, dyspnea at rest, or recent hemoptysis
  • Report any exercise-induced worsening of breathing symptoms

Pain considerations: Forceful exhalation may trigger coughing spells or chest discomfort; inform the technician immediately if this occurs and ensure it is documented.

Laboratory/Serologic Testing Review

What it measures: Evidence of active or prior Burkholderia pseudomallei infection through culture confirmation, indirect hemagglutination assay (IHA), ELISA antibody titers, PCR results, and complete blood count indicating systemic infection

What to expect: The examiner will review existing lab records rather than ordering new tests during the C&P exam itself. They will assess whether diagnostic confirmation was achieved and through what method. Bring all prior lab results.

Critical thresholds

  • Positive culture from blood, urine, sputum, wound, or other site Definitive diagnostic confirmation; strongest evidence for service connection
  • IHA titer - 1:40 in non-endemic area or - 1:160 in endemic area Supports diagnosis; weaker standalone evidence but useful corroboration
  • Positive PCR from clinical specimen Supports diagnosis particularly in resource-limited settings

Tips

  • Compile all culture reports with dates, specimen source, and sensitivity results
  • Include all serology results even if from private providers or military treatment facilities
  • Request copies of any microbiology reports from your military or VA treatment record
  • If diagnosed overseas or at a military installation, request those records through the National Personnel Records Center or MTF

Pain considerations: Not applicable for records review; however, note any painful procedures (e.g., abscess drainage, bone biopsy) that were required for diagnosis as these indicate disease severity.

Physical Examination - Systemic Assessment

What it measures: Presence of ongoing or residual signs of infection including fever, hepatomegaly, splenomegaly, lymphadenopathy, skin lesions, joint swelling, neurological deficits, and evidence of organ involvement

What to expect: The examiner will conduct a physical examination assessing vital signs, inspection of skin for ulcers or scars from prior abscesses, palpation of liver and spleen, lymph node assessment, neurological screening, and evaluation of any affected organ systems. Duration is approximately 10-15 minutes of the exam.

Critical thresholds

  • Active fever or signs of bacteremia at time of exam Indicates active disease warranting 100% rating evaluation
  • Hepatomegaly or splenomegaly on examination Indicates visceral involvement affecting severity rating
  • Neurological deficits (cranial nerve palsy, limb weakness, ataxia) Indicates neurological melioidosis with potential for separate or combined ratings

Tips

  • Point out all scars from surgical drainage of abscesses as they document prior disease extent
  • Mention any ongoing sites of pain, swelling, or drainage even if appearing healed
  • Report any temperature fluctuations, night sweats, or chills in the weeks preceding the exam
  • Describe any cognitive or neurological changes if neurological melioidosis was part of your history

Pain considerations: Inform the examiner of any tenderness during palpation of the abdomen, joints, or lymph nodes. Pain on examination is clinically significant and should be documented.

Rating criteria by percentage

100%

Active infection with systemic manifestations requiring ongoing treatment, or condition evaluated as active disease with severe constitutional symptoms including high fevers, septicemia, prostration, or multi-organ involvement. Under 38 CFR 4.88b, infectious diseases with active, systemic, or severe manifestations are rated at 100% while active.

Key symptoms

  • Active bacteremia or septicemia
  • Prostration and inability to perform self-care
  • High fevers unresponsive to or requiring ongoing IV antibiotic therapy
  • Multi-organ involvement (liver, spleen, lung, brain, bone simultaneously)
  • Requirement for hospitalization or intensive antibiotic therapy
  • Neurological melioidosis with encephalitis or brainstem involvement
  • Severe weight loss and debilitation
  • Hemoptysis with significant pulmonary infiltrates

From 38 CFR: Active melioidosis with systemic septicemic spread requiring intensive phase IV antibiotherapy (ceftazidime or meropenem) for 10-14 days or longer; patient unable to perform activities of daily living due to prostration, fever, and multi-organ dysfunction.

60%

Inactive melioidosis with chronic residual complications causing significant impairment. This rating level applies when the acute infection has been treated but chronic organ damage remains, such as chronic pulmonary melioidosis with cavitation or bronchiectasis, chronic hepatic or splenic involvement, or recurrent localized abscesses requiring ongoing management. Rated based on the predominant residual disability under the appropriate diagnostic code for that organ system.

Key symptoms

  • Chronic cavitary pulmonary disease with productive cough and dyspnea on moderate exertion
  • Recurrent abscesses in liver, spleen, prostate, or bones despite completed eradication therapy
  • Chronic osteomyelitis as a residual
  • Persistent lymphadenopathy with functional limitation
  • Ongoing fatigue severely limiting activities
  • Weight loss not fully recovered post-treatment
  • Bronchiectasis as pulmonary residual

From 38 CFR: Inactive melioidosis with chronic pulmonary residuals including cavitation, bronchiectasis, and moderate obstructive or restrictive pulmonary function testing results; veteran unable to perform strenuous work and experiences significant dyspnea with moderate physical activity.

30%

Inactive melioidosis with moderate residual complications causing mild-to-moderate functional impairment. The acute infection has resolved but residual damage to one or more organ systems persists, causing symptoms that interfere with work or daily activities intermittently. Chronic fatigue, mild pulmonary restriction, or well-controlled chronic localized infection may apply.

Key symptoms

  • Mild to moderate chronic fatigue limiting sustained activity
  • Mild pulmonary residuals with dyspnea on heavy exertion only
  • Well-controlled chronic localized infection with periodic flare-ups
  • Intermittent fevers or constitutional symptoms during reactivation
  • Mild hepatic enlargement without severe functional compromise
  • Recurrent skin lesions or lymphadenitis requiring periodic treatment
  • Cognitive difficulties if mild neurological sequelae present

From 38 CFR: Inactive melioidosis with mild residual pulmonary involvement and intermittent constitutional symptoms during periods of stress or intercurrent illness; veteran able to perform most daily activities but limited in sustained heavy physical work.

10%

Inactive melioidosis with minimal residual complications causing only slight functional impairment. The infection is fully treated and inactive, with only minor lingering symptoms such as occasional fatigue, minimal pulmonary symptoms, or small residual scarring without significant functional loss. Condition is well-controlled and does not substantially interfere with occupational or daily functioning.

Key symptoms

  • Occasional mild fatigue not limiting daily activities
  • Minimal residual scarring from prior abscesses or surgical drainage
  • Mild intermittent cough without significant sputum production
  • Slight exercise intolerance without meeting threshold for moderate pulmonary limitation
  • Occasional night sweats without fever or active infection markers
  • No recurrence requiring additional antibiotic treatment

From 38 CFR: Inactive melioidosis, fully treated, with minor residual symptoms including occasional fatigue and mild cough; veteran able to perform all occupational duties and daily activities without significant restriction.

Describing your symptoms accurately

Fatigue and Constitutional Symptoms

How to describe it: Describe the frequency, severity, and functional impact of fatigue accurately. Specify whether fatigue is present daily or episodically, whether it is present at rest or only with exertion, how it compares to your pre-illness baseline, and what activities you can no longer perform or must limit because of it. Use specific examples such as inability to complete a full workday, needing to rest mid-afternoon, or inability to sustain physical activity beyond a certain duration.

Example: On my worst days, I wake up already exhausted despite sleeping 8 to 10 hours. By mid-morning I am unable to concentrate or remain physically active. I need to lie down for 2 to 3 hours in the afternoon. I cannot complete household chores without taking breaks every 10 to 15 minutes, and by evening I am too fatigued to engage socially or cook a meal. This occurs approximately 3 to 4 days per week.

Examiner listens for: Specific frequency and duration of fatigue episodes, quantifiable functional limitations, comparison to pre-service or pre-illness baseline, impact on employment and self-care, whether fatigue is associated with low-grade fever or other constitutional symptoms suggesting subclinical activity.

Avoid: Saying only 'I get tired sometimes' without explaining how often, how severely, or how it limits your function. Avoid minimizing symptoms to appear stoic; the examiner needs to understand your actual daily experience to accurately rate your disability.

Pulmonary Symptoms

How to describe it: Accurately describe any cough, sputum production, hemoptysis, dyspnea, wheezing, or chest pain. Quantify dyspnea using specific activity thresholds: Can you climb one flight of stairs without stopping? Can you walk one block on flat ground? Do you experience shortness of breath at rest? Describe the character of any cough (dry vs. productive), frequency, and whether sputum is clear, yellow, green, or bloody. Note whether symptoms have worsened over time.

Example: On my worst days, I have a persistent productive cough throughout the day that produces a tablespoon or more of thick yellowish-green sputum per episode. I become significantly short of breath walking from my car to a store entrance, approximately 50 yards on flat ground. I experience chest tightness that worsens with any physical effort and have had two episodes this month of coughing up blood-tinged sputum. At night, my coughing wakes me three to four times.

Examiner listens for: Objective correlation with imaging findings such as cavitation or bronchiectasis, whether symptoms have persisted or progressed since initial treatment, frequency of acute exacerbations, any hospitalizations or emergency visits for respiratory symptoms, and impact on occupational functioning.

Avoid: Saying 'I have a cough' without describing its frequency, productivity, or functional impact. Avoid stating symptoms are 'manageable' if they actually require daily medication, limit activity, or cause significant disruption to sleep or work.

Recurrence and Relapse History

How to describe it: Melioidosis has a well-documented risk of relapse, particularly if eradication therapy was not completed or the veteran is immunocompromised. Accurately describe any episodes after initial treatment that involved return of fever, new abscesses, bacteremia, or worsening symptoms. Provide dates, treatment required, hospitalization, and outcomes. Even subclinical reactivations with elevated inflammatory markers or imaging changes are clinically relevant.

Example: Approximately 14 months after completing my initial treatment course, I developed a fever of 102 degrees, right-sided flank pain, and extreme fatigue. I was hospitalized for 8 days for what my doctors confirmed was relapsed melioidosis with a new prostatic abscess. I required IV antibiotics again and subsequently restarted a prolonged oral eradication course. Since that relapse I have had two additional episodes of culture-confirmed bacteremia requiring outpatient IV therapy.

Examiner listens for: Number of relapses, time intervals between relapses, whether relapses represent true relapse from the original strain versus reinfection, treatment required for each episode, whether the veteran remains on suppressive therapy, and whether an underlying immunocompromising condition contributes.

Avoid: Failing to mention relapses or treating them as separate unrelated illnesses. Relapses are a characteristic feature of melioidosis and strengthen the severity and chronicity of the diagnosis. Do not omit them even if they occurred years after the initial infection.

Multi-Organ Involvement and Complications

How to describe it: Accurately describe any organ systems affected during the initial illness or subsequent relapses. Melioidosis can affect the lungs, liver, spleen, prostate, bones, joints, skin, and central nervous system. For each affected organ, describe symptoms, diagnostic findings, treatment required, and current residual symptoms. Be specific: abdominal pain and its location, joint pain and which joints, skin lesions and their locations and character, neurological symptoms such as weakness, numbness, difficulty speaking or swallowing.

Example: During my acute illness, I developed abscesses in my liver confirmed on CT scan, as well as septic arthritis of my right knee requiring surgical drainage. My right knee still swells with prolonged standing or walking more than 15 minutes, and I have chronic right knee pain rated at 6 out of 10 that limits my ability to perform physical work or stand for extended periods. I also experience persistent upper right abdominal discomfort that worsens after fatty meals, which my gastroenterologist attributes to residual hepatic scarring.

Examiner listens for: Documentation of multi-organ involvement during acute illness through imaging, culture, or surgical records; current residual symptoms in each affected organ system; whether separate ratings for residual complications of specific organs are warranted; functional limitations from each residual complication.

Avoid: Mentioning only the primary pulmonary or systemic presentation while omitting organ-specific complications. Each organ system residual may warrant a separate disability rating or contribute to a combined evaluation. Do not minimize joint pain, abdominal symptoms, or neurological symptoms by attributing them to other causes without investigation.

Impact on Occupational and Daily Functioning

How to describe it: Describe specifically how melioidosis and its residuals have affected your ability to work, maintain employment, perform household duties, engage in social activities, and care for yourself and dependents. Use concrete examples with frequencies and durations. Note any job changes, reductions in hours, inability to sustain certain physical demands, missed work days, and any accommodations required. If unemployed, describe why and whether melioidosis or its residuals are a contributing factor.

Example: Before my illness I worked full-time as a construction supervisor and managed crews on physically demanding job sites. Since my diagnosis and the resulting chronic pulmonary complications and fatigue, I have been unable to return to construction work. I currently work part-time in a sedentary office role but still miss approximately 3 to 4 days per month due to fatigue, respiratory exacerbations, or fever episodes. I can no longer perform home repairs, yard work, or recreational activities I previously enjoyed such as hiking. My wife has taken over most household physical tasks.

Examiner listens for: Whether the condition causes unemployability or significant occupational limitation that may support Total Disability based on Individual Unemployability (TDIU); specific work tasks the veteran cannot perform; whether the disability is the primary cause of occupational limitation; frequency of sick days or hospitalizations related to the condition.

Avoid: Stating 'it affects my daily life' without providing specific examples. Avoid saying you are 'doing fine' or 'managing' if in reality you have made significant lifestyle or occupational adaptations to accommodate your symptoms. The examiner needs to understand the actual burden of the condition on your functioning.

Common mistakes to avoid

Describing only the acute phase of illness without addressing current residual symptoms

Why: The C&P examination rates your current level of disability, not the severity of your initial illness. Focusing only on how sick you were at diagnosis without describing ongoing residuals leads the examiner to rate an inactive condition with minimal current disability.

Do this instead: Prepare a current symptom inventory covering each body system affected by melioidosis. Describe what symptoms you experience today, their frequency and severity, and how they limit your current functioning. Bring a written symptom diary if helpful.

Impact: All rating levels - particularly the difference between 10% and 30-60% for inactive conditions with varying residual impact

Failing to disclose all episodes of relapse or recurrence

Why: Melioidosis is notorious for relapse, sometimes years after apparent cure. Omitting relapse history understates the chronic, recurrent nature of the condition and may lead to an inactive rating when the condition has in fact been repeatedly active.

Do this instead: Compile a chronological list of all melioidosis-related illness episodes, hospitalizations, antibiotic courses, culture-positive recurrences, and imaging-confirmed new lesions. Present this timeline to the examiner at the start of the appointment.

Impact: Active (100%) vs. inactive ratings - relapses may qualify the condition as currently active or support a higher residual rating

Not connecting melioidosis to service-connected deployment in endemic regions

Why: Melioidosis is geographically restricted to endemic zones. If the veteran deployed to Southeast Asia, Northern Australia, South Asia, Pacific Islands, or other endemic regions during service, that geographic nexus is essential for service connection. Failing to clearly articulate the deployment location and timeline weakens the nexus argument.

Do this instead: Bring your DD-214, deployment orders, and any unit history documentation confirming service in endemic regions. Explicitly state to the examiner: 'I was deployed to [location] from [date] to [date], which is a known endemic area for melioidosis, and I was first diagnosed with melioidosis in [year].'

Impact: Service connection itself - this mistake can result in denial rather than a lower rating

Minimizing symptoms due to military culture of stoicism

Why: Veterans commonly underreport symptoms during medical evaluations due to training to minimize medical complaints. Examiners can only rate what is documented in the DBQ. Understating symptoms results in ratings that do not accurately reflect the true disability level.

Do this instead: Report your symptoms on your worst days, not your best days. Per M21-1 guidance, the examiner should capture the full range of your symptoms including worst-case presentations. Practice describing your worst symptom days before the exam and use those descriptions during the appointment.

Impact: All rating levels - the difference between 10% and 60% often comes down to how accurately the examiner documents symptom severity and frequency

Failing to mention all affected organ systems

Why: Melioidosis is a multi-system infection. If the veteran experienced liver abscesses, splenic involvement, osteomyelitis, septic arthritis, prostatic abscess, or neurological complications but only discusses pulmonary symptoms, the examiner will not document residuals of other organ systems. Each organ system residual may warrant its own rating or contribute to a combined evaluation.

Do this instead: Before the exam, create a written list of every organ system affected during your acute illness and during any relapses. Include current symptoms for each. Present this to the examiner and ask that each be addressed and documented in the DBQ.

Impact: 30% to 100% - multi-organ involvement substantially increases the combined disability rating through VA math

Not bringing diagnostic records confirming Burkholderia pseudomallei

Why: Melioidosis is a rare diagnosis in the US and many examiners may have limited familiarity with it. Without documentary evidence (culture reports, serology, PCR, or histopathology), the examiner may express diagnostic uncertainty that weakens the DBQ's evidentiary value.

Do this instead: Assemble all confirmatory diagnostic records: microbiology culture reports identifying B. pseudomallei, antibiotic sensitivity results, serology reports, imaging showing characteristic features (cavitary lung lesions, splenic or hepatic abscesses), and treatment records. Organize these chronologically and bring copies to the exam.

Impact: Service connection and all rating levels - diagnostic uncertainty undermines the foundation of the claim

Prep checklist

  • critical

    Obtain all military treatment records documenting melioidosis diagnosis and treatment

    Request records through the National Personnel Records Center (NPRC), Joint Legacy Viewer if you have VA access, or directly from the military treatment facility where you were diagnosed. Include hospitalization records, culture reports, imaging reports, and treatment summaries. Allow 30-90 days for NPRC requests and submit as early as possible.

    before exam

  • critical

    Compile all private and VA medical records related to melioidosis and its complications

    Gather records from all treating providers including infectious disease specialists, pulmonologists, gastroenterologists, neurologists, and any surgeons who performed abscess drainage or other procedures. Include all laboratory reports, imaging studies (CT scans, MRIs, chest X-rays), and operative reports. Organize chronologically from initial diagnosis to present.

    before exam

  • critical

    Document deployment history to melioidosis-endemic regions

    Locate your DD-214 and any deployment orders showing service in Southeast Asia (Vietnam, Thailand, Philippines, Malaysia, Singapore, Myanmar, Cambodia, Laos), Northern Australia, South Asia (India, Sri Lanka, Bangladesh), Pacific Islands (Guam, Micronesia), or other endemic areas. Unit histories and buddy statements can supplement official records if deployment records are incomplete.

    before exam

  • critical

    Create a written chronological timeline of the illness

    Write a clear timeline including: date and location of first symptoms, date of diagnosis and confirming test, initial treatment course with dates and medications, any relapses with dates and treatment required, current status (active vs. inactive), and current ongoing symptoms and treatments. Bring this to the exam and offer it to the examiner.

    before exam

  • critical

    Prepare a current symptom inventory by organ system

    Document current symptoms for each affected system: respiratory (cough, hemoptysis, dyspnea), constitutional (fatigue, fever, night sweats, weight), gastrointestinal or hepatic (abdominal pain, nausea, jaundice), musculoskeletal (joint pain, bone pain), neurological (weakness, numbness, cognitive changes, swallowing difficulty), and skin or lymphatic (ongoing lesions, lymphadenopathy). Rate each symptom by frequency (daily, weekly, monthly) and severity (1-10 scale) and note functional limitations.

    before exam

  • recommended

    Obtain a nexus letter from your treating infectious disease physician if possible

    Ask your treating infectious disease specialist to write a letter opining that your melioidosis is at least as likely as not related to your military service in an endemic region. A well-supported nexus letter from a qualified physician significantly strengthens service connection claims, particularly for a rare disease like melioidosis.

    before exam

  • recommended

    Research the current status of your claim and any pending development letters

    Log into VA.gov or contact your VSO to confirm what is being evaluated at the C&P exam: initial service connection, increase in rating, or continuing evaluation. Understanding the specific question the examiner needs to answer helps you prepare the most relevant information.

    before exam

  • recommended

    Contact a VSO or accredited VA claims agent for pre-exam preparation assistance

    Organizations such as DAV, VFW, American Legion, or AMVETS can provide free claims assistance. A VSO can review your file, identify missing evidence, and advise you on what the examiner will focus on based on your specific claim type.

    before exam

  • optional

    Research your right to record the C&P examination

    Check your state's recording consent laws. In one-party consent states you may record without notifying the examiner. In two-party consent states you must notify the examiner. VA policy generally supports veterans' right to record exams. Confirm with your VSO or NVLSP before the exam. Recording provides an accurate record if the DBQ does not reflect what was discussed.

    before exam

  • critical

    Arrive with all organized medical records and written symptom notes

    Bring two complete copies of your organized medical records: one for the examiner to keep and one for your reference. Also bring your written symptom inventory and illness timeline. Do not rely on the examiner to have reviewed your file - assume they have not and be prepared to present your evidence clearly.

    day of

  • critical

    Do not minimize your symptoms on the day of the exam

    The C&P exam should capture your true level of disability including your worst-day presentations. If you are having a relatively better day at the time of the exam, proactively state: 'Today is not my worst day. My worst days involve...' and describe your typical worst presentations. Per M21-1, the examiner should document the full range of your disability.

    day of

  • critical

    Clearly state your deployment history and geographic nexus at the beginning of the exam

    At the start of the examination, proactively tell the examiner: 'I am claiming melioidosis which I contracted while deployed to [location], a known endemic region for Burkholderia pseudomallei. I was diagnosed on [date] and have documentation of that diagnosis.' Do not assume the examiner has read your file.

    day of

  • critical

    Describe each organ system involvement and current residual symptoms

    Work through your prepared organ-system inventory with the examiner. For each affected system, describe the involvement during acute illness, any ongoing or residual symptoms, and functional limitations. Ensure the examiner acknowledges each system in the DBQ documentation.

    day of

  • critical

    Describe the impact on your occupational and daily functioning with specifics

    Use concrete, quantified examples of functional limitation. Avoid vague statements. State specific tasks you cannot perform, the frequency of limitation, and what accommodations or modifications you have made. Describe the worst week you have had in the past month in terms of symptom burden.

    day of

  • recommended

    Ask the examiner to confirm the diagnosis checkbox for melioidosis is being marked

    The DBQ field PUBLICDBQINFECTINFECTIOUSDISEASES_51_MELIOIDOSIS is the specific checkbox for your condition. Politely confirm with the examiner that melioidosis is being documented as the primary condition. This ensures your claim is rated under the correct diagnostic code (6311).

    day of

  • critical

    Answer questions completely and accurately - do not guess or fabricate

    If you do not know an exact date or detail, say 'approximately' or 'I believe it was around' rather than guessing a specific incorrect date. Accuracy and credibility are essential. If you do not know the answer to a clinical question, say so rather than speculating.

    during exam

  • critical

    Correct any misstatements or misunderstandings during the exam

    If the examiner states something that is inaccurate - for example, characterizing your condition as inactive when you believe it is still active - politely but clearly correct the record during the exam. State: 'I want to clarify that I have continued to have [symptoms/relapses] as recently as [date].'

    during exam

  • recommended

    If asked to perform a physical task that causes symptoms, note those symptoms aloud

    If the examiner asks you to breathe deeply, perform any exertion, or palpates an area that causes pain or triggers symptoms, immediately describe what you are experiencing: 'That palpation is causing significant pain rated at 7 out of 10' or 'Deep breathing triggers a coughing episode.' Ensure these responses are part of the examination record.

    during exam

  • critical

    Write a detailed account of the exam immediately after it concludes

    Within one hour of leaving the exam, write down everything that was discussed, every question asked, and every symptom you described. Note whether the examiner appeared to document your responses. Note anything that was not covered that you believe should have been. This record will be essential if you need to challenge the DBQ or request a new examination.

    after exam

  • critical

    Request a copy of the completed DBQ through your VSO or via a FOIA request

    After the exam, submit a written request to obtain a copy of the completed DBQ. You can request this through your VSO, through eBenefits, or via a Freedom of Information Act (FOIA) request. Review the DBQ carefully to ensure it accurately reflects your reported symptoms and functional limitations.

    after exam

  • recommended

    Review the DBQ for accuracy and file a rebuttal if the exam was inadequate

    If the completed DBQ contains inaccuracies, omits significant symptoms you reported, or reaches conclusions unsupported by the evidence, work with your VSO to submit a written rebuttal or request for a new examination (CUE or inadequate examination argument). An inadequate exam is grounds for a new examination under Barr v. Nicholson.

    after exam

  • recommended

    Monitor your VA.gov claim status and respond promptly to any development letters

    After the C&P exam, monitor VA.gov for claim status updates. Respond to any requests for additional evidence or clarification within the specified timeframe (typically 30 days). Failure to respond to development letters can result in a decision based on the existing record without your additional evidence.

    after exam

Your rights during a C&P exam

  • You have the right to a thorough and accurate C&P examination. Under Barr v. Nicholson, if the VA's examination is inadequate, you are entitled to a new examination. An examination is inadequate if it fails to consider all relevant evidence, does not address all conditions at issue, or relies on unsupported conclusions.
  • You have the right to submit your own independent medical opinion (IMO) or nexus letter from a private physician to support your claim. Private IMOs carry significant weight, particularly for rare diseases like melioidosis where VA examiners may have limited clinical experience.
  • You have the right to bring a representative to your C&P examination. This can be a VSO representative, accredited claims agent, or VA-accredited attorney. The representative may be present for support but typically may not answer questions on your behalf.
  • You have the right to request that your C&P examination be recorded in most states, subject to state recording consent laws. Recording can protect you if the examiner's DBQ does not accurately reflect what was discussed during the exam. Check your state's one-party or two-party consent requirements before recording.
  • You have the right to review all medical evidence in your claims file (C-file). You can request a complete copy of your C-file through VA.gov or by submitting VA Form 20-10206. Reviewing your C-file allows you to identify missing records, incorrect information, and the basis for any prior rating decisions.
  • You have the right to appeal any VA rating decision you disagree with. Under the Appeals Modernization Act (AMA), you may choose the Supplemental Claim Lane (new and relevant evidence), the Higher-Level Review Lane (senior reviewer, same evidence), or the Board of Veterans' Appeals (BVA) with or without a hearing. All appeals must be filed within one year of the rating decision to preserve your effective date.
  • You have the right to receive the benefit of the doubt under 38 U.S.C. - 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to a claim, the benefit of the doubt shall be given to the claimant. This is a lower standard than 'preponderance of the evidence' used in civil courts.
  • You have the right to claim any secondary conditions caused or aggravated by your service-connected melioidosis. Residual complications affecting the lungs, liver, spleen, joints, bones, nervous system, or skin that resulted from melioidosis may be ratable as secondary service-connected conditions, potentially under their own diagnostic codes in addition to or instead of DC 6311.
  • You have the right to request a personal hearing before a VA Decision Review Officer (DRO) or the Board of Veterans' Appeals (BVA) if you disagree with a rating decision. A hearing allows you to present testimony, submit additional evidence, and clarify your claims before an adjudicator.
  • You have the right to free claims assistance from an accredited VSO. Organizations including the DAV, VFW, American Legion, AMVETS, PVA, and many state veterans affairs departments provide free representation and claims assistance throughout the claims and appeals process.

Related conditions

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This guide covers what to expect for any veteran with this condition. If you have already uploaded your medical records, sign in to generate a packet that maps your specific symptoms to the DBQ fields your examiner will fill out.

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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.