Diagnostic Code 8105 · 38 CFR §4.124a
Sydenham chorea is an autoimmune movement disorder that follows infection with group A streptococcus (the same bacterium that causes strep throat and rheumatic fever). It is part of the broader rheumatic fever spectrum and typically presents in children and adolescents, weeks to months after the initial strep infection, with rapid involuntary movements affecting the face, hands, and feet, plus emotional lability, hypotonia, and dysarthria. Most cases resolve completely within several months, but a subset persists or recurs in adulthood, particularly with subsequent streptococcal infections or during pregnancy. For veterans, the relevant cases are typically those where Sydenham chorea was diagnosed in childhood before service, with residuals or recurrence during active duty supporting aggravation theory of service connection, or where Sydenham chorea was first diagnosed during active duty following a documented strep infection. The condition is rated under 38 CFR §4.124a with tiers reflecting whether the disease is active, in remission, or producing persistent residuals.
| Rating | Criteria |
|---|---|
| 0% | History of Sydenham chorea with no current symptoms — complete remission, no current involuntary movements, no functional impairment. |
| 10% | Mild residuals or mild active disease — occasional involuntary movements, subtle motor or coordination deficits, emotional or behavioral residuals partially responding to treatment. |
| 30% | Moderate residuals or active disease — definite choreiform movements, definite functional limitation, emotional or behavioral component with measurable impact on daily activity, or recurring episodes after initial remission. |
| 60% | Severe disease — pronounced choreiform movements interfering with activities of daily living, substantial functional impairment, or coexisting rheumatic fever cardiac involvement producing combined impairment that is independently ratable under the cardiac codes. |
A neurology or pediatric neurology diagnosis distinguishing Sydenham chorea from other movement disorders is the anchor. Documentation of antecedent streptococcal infection — throat culture, anti-streptolysin O (ASO) titer, anti-DNase B titer — supports the diagnosis when contemporaneous. Cardiac evaluation rules out rheumatic carditis, which can coexist and warrants separate evaluation. Video documentation captures the choreiform movements. Treatment records covering antibiotics (penicillin for ongoing infection prophylaxis), immunosuppressants (corticosteroids, IVIG in severe cases), and movement-suppressing medications demonstrate the management burden. Service medical records establishing the in-service strep infection or the worsening of premorbid Sydenham chorea support service connection.
It is uncommon in adult veterans because Sydenham chorea typically presents in children and adolescents and resolves within months. The relevant veteran cases are: (1) adult veterans with a childhood history whose chorea recurred during active duty, supporting aggravation theory; (2) adult-onset cases following a documented in-service strep infection, supporting direct service connection; (3) veterans with persistent residuals from a childhood episode whose service connection runs through the original infection if it occurred during active duty. DC 8105 remains in the schedule for these specific situations.
Sydenham chorea (DC 8105) is post-infectious, autoimmune, typically reversible, and most often pediatric. Huntington chorea (DC 8106) is a progressive, autosomal dominant genetic disorder of adult onset characterized by chorea plus progressive cognitive decline plus psychiatric symptoms, ultimately fatal. The clinical pictures share the choreiform movement feature but differ in everything else — age of onset, time course, genetics, treatment, prognosis, and the supporting evidence. The rating frameworks differ accordingly.
The prophylactic regimen itself is treatment for the underlying condition rather than a separate ratable issue, but rheumatic heart disease can be a recognized residual of rheumatic fever and is independently ratable. If you have been on long-term penicillin prophylaxis, that supports the chronic nature of the underlying rheumatic disease and may justify keeping the rating at a higher tier or pursuing the cardiac secondary claim.