Gulf War Syndrome & Gulf War Presumptives Explained
Michelle DeTore: Welcome to another edition of CCK Live. My name is Michelle DeTore, and I’m joined today by Matt Fusco and Brandon Paiva. And today, we’re going to be discussing Gulf War syndrome and Gulf War Presumptive Conditions. We’ve also put some blog links in the comment sections for you, as for the material to reference all these issues.
So, what is the Persian Gulf War, and what is a Persian Gulf War Veteran? So, the Persian Gulf War refers to service in Southwest Asia, beginning in 1990 and going through December 2021. So, this is one of the longest periods for a presumptive period that you’ve seen. VA considers it, which I think is interesting, it’s not just the countries in Southwest Asia, it’s also the waters of the Persian Gulf, including the Red Sea and the Arabian Sea, and the airspace above these locations.
So, it gives you a little bit more wiggle room when you’re talking about locations and something that you don’t necessarily always think about when you’re thinking about countries of service.
So, veterans who served in Operation Desert Storm, Operation New Dawn, Operation Iraqi Freedom, and in some instances Operation Enduring Freedom, usually meet the requirements to be considered a Persian Gulf War Veteran.
So, Matt, do you want to tell us a little bit about the gulf war exposure and why we have presumptive conditions?
Matt Fusco: Sure. Thanks, Michelle. So, during the Persian Gulf War, veterans were exposed to a variety of hazardous toxins and harmful environmental conditions. Importantly, not all of the exposures are known or understood at this time. But we do know some specific examples in that a lot of veterans were exposed to smoke from oil well fires, the release of nerve agents or nerve gas, insecticides and pesticides, various vaccinations, and high levels of particulate matters as well.
All of these known and unknown exposures have resulted in veterans developing a variety of health conditions. And it’s worth mentioning that the terms Gulf War illness and Gulf War syndrome are used interchangeably and there’s technically no medical diagnosis of something like Gulf War syndrome or Gulf War illness. These terms are instead used to characterize the wide range of symptoms and conditions that veterans of the Gulf War have experienced.
Michelle: Yeah. Typically, we don’t see veterans service-connected for Gulf War syndrome or Gulf War illness. They’ll usually link it to the condition or as close as they can get to the actual condition.
Brandon Paiva: Yes. So, we’ll talk a little bit about the Gulf War presumption and kind of, what VA uses as far as their regulation when they’re adjudicating these claims. So, in order to address the many unexplained illnesses that Gulf War veterans were experiencing post-service, VA went ahead and created a presumption for Gulf War veterans under 38 CFR § 3.317. This presumption is mainly intended to make it easier for veterans to obtain service connection for conditions they develop as due to their service in the Gulf War.
Now, this presumption, 38 CFR § 3.317, applies to Veterans who served in the previously mentioned locations between August 2, 1990 and, newly, December 31, 2021, and those veterans who experienced certain signs or symptoms.
Specifically, those symptoms must be present during active duty or prior to December 31 of 2021, which that date still has some potential to change. The symptoms must be chronic, meaning it has to last more than six months. And lastly, those symptoms need to manifest to a degree of at least 10 percent disabling. So, they need to manifest to what VA determines is a compensable degree.
The presumption includes what we call MUCMI’s, which we’re going to dive into in a little bit, undiagnosed illnesses, and certain infectious diseases. So, as I stated, I used the term MUCMI. So, MUCMI is actually an acronym, it’s M-U-C-M-I, and that stands for medically unexplained chronic multi-symptom illness. I know that that’s a mouthful, which is why you will oftentimes hear us refer to it as MUCMI or MUCMI’s.
So, a medically unexplained chronic multi-symptom illness, or MUCMI, as you’ll hear us refer to, is a diagnosed condition without a conclusive pathophysiology. Meaning, the mechanisms by which the disease operates or the etiology, the unknown cause, that is characterized by a cluster of symptoms. So, essentially, there is no known cause for these conditions, they sort of just manifest.
Now examples of these, which I think may help to provide is chronic fatigue syndrome, which is often referred to as CFS, fibromyalgia, and also functional gastrointestinal disorders. Essentially, if there is really no known or if it’s an unexplained illness that you suffer from, you know, I said, like the common examples are chronic fatigue syndrome, fibromyalgia, and gastrointestinal disorders, and you’ve served in the Gulf War between those time periods, between 1990 and 2021, chances are you may qualify for some compensation. As long as those conditions manifest like I said, to a compensable degree of 10 percent or more.
Michelle: Yeah, I think with MUCMIs, I think something that VA often overlooks and people as well as sometimes don’t necessarily know is that it’s a case-by-case basis.
So, VA doesn’t need to find that a medical condition, in general, is a MUCMI. They just need to find that your medical condition that you have.
So, let’s say you have rheumatoid arthritis and, you know, that condition as a whole to me like, do something, but maybe yours isn’t. So, that’s just something important to think about in claims and then just also to know when filing those types of claims as well.
So, Brandon had talked about the fact that there are also undiagnosed illness. So, this is usually when a veteran has a range of symptoms and conditions that appear to be unrelated or don’t conform to a diagnosis.
So, with this one, I think it’s important to point out that there’s usually objective evidence that a veteran has a symptom and the doctor can’t find or figure out a cause or diagnosis. So, what’s important here is that there usually needs to be treatment showing that you have this symptom or this condition that the doctors are having trouble linking to a medical condition. So, treatment is important for these.
Some examples are abnormal weight loss, cardiovascular diseases, fatigue, headaches, menstrual disorders, muscle and joint pain, neurological and psychological problems, respiratory disorders, sleep disturbances, skin conditions, and obviously these are just examples. There can be other conditions as well.
Also, we were talking about infectious diseases. So, with MUCMI and undiagnosed illness, there’s not really an exhaustive list. But with infectious diseases, there are certain diseases that VA has deemed are presumptive. And this also is, unique because, with infectious diseases, they also include veterans who served in Afghanistan. There is a list of them, I will not butcher the list of the diseases for you, but there are a list of about 10 diseases that are also going to be located in the blog post below. But that’s also good to know, and it’s also really good to know that this will include veterans that served in Afghanistan as it does not include them for undiagnosed illness and the medically unexplained chronic multi-symptom illness.
Now, Matt, we’re talking about veterans that served in Operation Iraqi Freedom, Operation Enduring Freedom, Veterans that served in Iraq. Now, there are Gulf War claims and then there are burn pit claims. Since these two locations impact both, do you mind talking about how they’re different?
Matt: Well, some of the time periods and locations of service certainly overlap between both Gulf War and Burn Pit claims. It’s important to differentiate that the two categories of claims are separate. The main difference between claims for Gulf War illness or Gulf War syndrome versus claims for burn pit conditions is that burn pit claims are limited to veterans with service in specifically Iraq, Afghanistan, and Djibouti after September 11, 2001. The time period covered by burn pit claims covers veterans who served during Operation Iraqi Freedom and Operation Enduring Freedom.
When it comes to specific disabilities that have a presumed relationship to burn pits, VA only presumes that specifically allergic rhinitis, sinusitis, and asthma are related to a veteran’s burn pit exposure during service.
Importantly, in order to obtain service connection for a disability stemming from burn pit exposure, veterans must be able to show that a medical nexus exists between the two things. Meaning a link between their current diagnosed disability in their exposure to burn pits during service. So, that’s kind of the main difference between Gulf War claims and burn pit claims.
Michelle: So, now we’ve given you some background as to what Gulf War claims are or what constitutes Gulf War service. Brandon, would you mind walking us through a little bit about how VA adjudicates Gulf War claims?
Brandon: Absolutely, and that’s a great question. So, in June of 2018, the U.S. Government Accountability Office, or G.A.O, released a report which found that VA denies more than 80 percent of veterans disability claims related to the Gulf War. That same report also found that the Gulf War syndrome claims have longer wait times, and that there is a poor understanding of Gulf War syndrome among VA staff. This report contained a ton of information that we’ve sort of included here for you as well. If you’re interested, I’m sure you can do an online Google search, I’m sure it’s available for you there, as well.
The same report also found that the approval rate for Gulf War illness claims is three times lower than all other medical issues, despite the presumption of 3.317. Additionally, VA does not require C&P examiners to undergo training on Gulf War illnesses, which as you can probably imagine, frequently leads to incorrect assessments up to and including ultimate denials of your claim.
So, one thing we kind of want to close this with, as far as like a tip whenever you are submitting evidence or submitting a claim. If you fall into the category of Gulf War illnesses, one thing that we would advise is, veterans should consider submitting lay evidence to support their claim. Lay evidence can be submitted by friends, family members, basically anybody who has seen the progression of your disability or your condition, and had, can maybe even speak to the development of your condition as well. This can even include fellow service members who witness the condition that you suffered from as well.
So, because VA doesn’t necessarily have the greatest guidance when it comes to dealing with these issues, you should go out and try to supplement the record or supplement your claim, at least with trying to obtain lay statements. That could be something that could really substantiate your case, really substantiate the claim, and really help to show and prove that you have this condition that developed due to your time in service, up to and including like I said, the Gulf War illness.
Michelle: Thank you, Brandon. I think it is important that Brandon pointed out the fact that it seems VA has a lot of difficulties adjudicating these cases. And a lot of times it is from… VA relies heavily on VA examinations and unfortunately, sometimes VA examinations are not adequate. So, one thing to point out is that if you are going for VA examinations, we do highly recommend that you obtain a copy, review it, and respond accordingly. And if, you know, sometimes there is a point in time where you… it is time to seek representation on the issues. So, you know, don’t hesitate to reach out to service organizations, attorneys, for assistance with your claims. Now, Brandon, Matt, any helpful tips or anything you’d like to add?
Brandon: I think one thing I want to add in closing, is if you fall into the category of having the Gulf War illness, or if you believe you have a Gulf War illness and are interested in filing a claim. File the claim sooner rather than later. So, that kind of, piggybacking off of some of our previous CCK Lives and some information posted on our blog, VA’s going to adjudicate the claim basically as soon as they get it and the effective date is going to be the date the VA receives that claim.
So, if you believe that you fall into this category, and are interested in filing a claim, go ahead and file that claim. Whether it’s a 526EZ or supplemental claim form, file that sooner rather than later. Because in the event that you get granted for that disability, it’s going to go back to the date of claim. So, the sooner you can submit it, the sooner VA can start to get to work on it for you.
Matt: Just to echo some of Brandon’s points, when submitting your claim, if a nexus is one of the things that you’re hoping to establish, we would always recommend reaching out to any treatment providers that you may have in your network who might be willing to write an opinion for you to be able to facilitate your claim in creating that link between your disability and service. So, just to add, that that might be something to consider getting from a treatment provider or other medical professionals that you may have or that you may know when you’re filing these claims.
Michelle: That is all we have for this edition of CCK Live. Thank you for joining us. For more information on this topic, you can find it within our blog, which again, we’re going to post in the comments.
And don’t forget to like and subscribe to our channel so that you can see more information on this topic and other topics regarding Veterans Affairs. Thank you for joining us today.
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