Body condition score (BCS) at calving is a time of interest when evaluating risk of future transition disease outcomes. An observational study was conducted comparing calving BCS to β-hydroxybutyrate (BHB) concentrations. The DeLaval Automated BCS Camera (DeLaval, Tumba, Sweden) was installed at a Southern Illinois farm to access BCS at calving of Holstein cows, all lactations. The automated scores were reported in 0.01 increments on a 1 to 5 scale. Blood samples were taken once per cow within 0 to 7 DIM. Concentrations of whole blood BHB were determined using BHBCheck (PortaCheck, Moorestown, NJ). Distributions of BCS were described using the FREQ procedure SAS (version 9.3 SAS Institute, Inc., Cary, NC). Classification of BCS <3.0 and >4.0 accounted for 2.54% and 0.28% of the recorded scores, respectively. The percentage of scores 3.25 ≤ BCS <3.75 was high in the herd (77.12%). Data from 354 cows were evaluated for effects of BCS at calving (BCS ± SD; 3.48, 1.23 ± 0.53) and BHB concentrations (BHB ± SD; 0.78, 0.48 ± 1.32), using the GLM procedure of. No statistically significant relationship was found between calving BCS and BHB concentrations (P = 0.10). Concentrations of BHB were described as either a positive (BHB ≥1.2 mmol/L) or negative (BHA < 1.2 mmol/L) hyperketonemia. The GLM procedure was used to evaluate the relationship between calving BCS and hyperketonemia case outcome and no statistically significant relationship was found (P = 0.47). The results of this study do not agree with previous studies reporting BCS at calving can be related to hyperketonemia. Although the BCS at calving did not have an effect in this study, managing BCS throughout lactation and the dry period may help to reduce other metabolic disease incidences in high-risk cows.