Understanding Medically Unexplained Chronic Multisymptom Illnesses (MUCMI)

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A Medically Unexplained Chronic Multisymptom Illness (MUCMI) is a diagnosed condition without a conclusive pathophysiology or etiology that is characterized by clusters of symptoms. Etiology is the cause of the illness.  Pathophysiology is the disruption to the body’s regular functioning caused by the illness. Veterans who meet certain criteria can receive VA compensation for their condition.

What Are MUCMIs?

MUCMIs are sometimes included in the category “Gulf War Syndrome” or “Gulf War Illness” because their cluster of symptoms may not result from a diagnosable condition and they largely affect veterans of the Persian Gulf War. MUCMI symptoms vary widely and can include, but are not limited to:

• Fatigue
• Headaches
• Joint pain
• Indigestion
• Insomnia
• Dizziness
• Respiratory disorders
• Memory problems

As noted, symptoms vary widely so veterans will likely experience different things, including symptoms not listed above.

MUCMIs and Presumptive Service Connection

MUCMIs are covered under VA’s statute and regulation, at 38 U.S.C. § 1117 and 38 C.F.R. § 3.317 respectively, authorizing presumptive service connection for Persian Gulf War veterans. The presumption allows veterans who meet certain requirements to obtain service connection for a MUCMI without proving that it was caused by their service. Under this regulation, VA presumes that the veteran’s PGW service caused their MUCMI.

Are You Eligible for Presumptive Service Connection?

Under 38 U.S.C. 1117, Gulf War veterans can receive presumptive service connection for a qualifying chronic disability if they had active military service in the Southwest Asia theater of operations between August 1, 1990 and December 31, 2026. Veterans must experience signs and symptoms for at least six months for it to be considered chronic. Countries considered to be in the Southwest Asia theater of operations include:

• Iraq
• Kuwait
• Saudi Arabia
• The neutral zone between Iraq and Saudi Arabia
• Bahrain
• Qatar
• The United Arab Emirates (U.A.E.)
• Oman
• Gulf of Aden
• Gulf of Oman
• Waters of the Persian Gulf, the Arabian Sea, and the Red Sea
• The airspace above these locations

The regulation thus includes veterans who served in Operation Iraqi Freedom and Operation New Dawn.

What Causes a MUCMI?

By nature, MUCMIs are medically unexplained; doctors do not know what causes them or why veterans get them. Veterans who served in the Southwest Asia theater of operations may have been exposed to an assortment of environmental and chemical hazards that can cause serious health issues. VA lists, among others, the following as possible exposures:

• Oil well fires
• Depleted Uranium
• Sand, dust, and particulates

The various exposures can cause unusual conditions or symptoms in servicemembers who served in the Persian Gulf, and many veterans experience multiple symptoms.

Oil Well Fires

Iraqi military forces set fire to hundreds of oil wells in Kuwait in 1991. The fires sent dense clouds of pollutants into the atmosphere, and some remained low to the ground, engulfing U.S. military forces. Heath effects from exposure to the oil well fires include skin irritation, cough, shortness of breath, runny nose, irritation of the eyes, nose and throat, and sinus and asthma conditions. Long term health effects are still poorly understood.

Depleted Uranium

Depleted Uranium was used in U.S. military tank armor and some bullets during the Gulf War. Veterans may have been exposed to depleted uranium if small pieces of the metal became embedded in their muscle or soft tissue. Depleted Uranium can also be inhaled or ingested if the particles are airborne. Exposure results to depleted uranium are also poorly understood.

Particulate Matter (Sand, dust, and particulates)

Particulate matter is a mixture of small particles and liquid droplets in the air. Servicemembers who served in the Persian Gulf were often exposed to both large and small particulate matter. Sand is an example of large particulate matter, and can become trapped in the nose and throat. Small particulate matter, such as soils, dust, and chemicals, can be inhaled into the lungs and airways and cause serious health problems.