### Section D. Service Connection for Certain Disabilities Associated With Gulf War (GW) Service

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  13           General Information on Certain Disabilities    2-D-2
               Associated With GW Service                     

  14           Rating Claims for Service Connection for       2-D-6
               Certain Disabilities Associated With GW        
               Service                                        

  15           General Information About Rating Decisions     2-D-10
               Addressing Certain Disabilities Associated     
               With GW Service                                

  16           Granting Service Connection for Certain        2-D-13
               Disabilities Associated With GW Service        

  17           Denying Service Connection for Certain         2-D-19
               Disabilities Associated With GW Service        
  ------------ ---------------------------------------------- ------------

#### 13. General Information on Certain Disabilities Associated With GW Service

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains background information on certain |
| troduction | > disabilities associated with Gulf War (GW) service,   |
|            | > including the                                         |
|            |                                                         |
|            | -   provisions of                                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   the GW Veterans' Benefits Act                       |
|            |                                                         |
|            | -   the GW Veterans' Act of 1998                        |
|            |                                                         |
|            | -   the Veterans Education and Benefits Expansion Act   |
|            |     of 2001, and                                        |
|            |                                                         |
|            | -   38 CFR 3.317                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   definition of                                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   a ***GW veteran***, and                             |
|            |                                                         |
|            | -   the ***Southwest Asia theater of operations***      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   definition of a ***qualifying chronic disability*** |
|            |                                                         |
|            | -   presumptive period for manifestation of disability  |
|            |     under 38 CFR 3.317                                  |
|            |                                                         |
|            | -   qualifying disabilities, and                        |
|            |                                                         |
|            | -   provisions of the requirement for chronicity.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > September 5, 2008                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > On November 2, 1994, Congress enacted the "*Persian   |
| ### a. Pro | > Gulf War Veterans' Benefits Act*," Title I of the     |
| visions of | > "*Veterans' Benefits Improvements Act of 1994*,"      |
|  the GW Ve | > *Public Law (PL) 103-446*.                            |
| terans' Be | >                                                       |
| nefits Act | > The statute added a new section, [38 U.S.C.           |
|            | > 1117](http://straylight.law.cornell.edu/              |
|            | uscode/html/uscode38/usc_sec_38_00001117----000-.html), |
|            | > authorizing the Department of Veterans Affairs (VA)   |
|            | > to compensate any Gulf War (GW) veteran suffering     |
|            | > from a chronic disability resulting from an           |
|            | > undiagnosed illness or combination of undiagnosed     |
|            | > illnesses which manifested either                     |
|            |                                                         |
|            | -   during active duty in the Southwest Asia theater of |
|            |     operations during the GW, or                        |
|            |                                                         |
|            | -   to a degree of 10 percent or more within a          |
|            |     presumptive period following service in the         |
|            |     Southwest Asia theater of operations during the GW. |
+------------+---------------------------------------------------------+

Continued on next page

13\. General Information on Certain Disabilities Associated With GW
Service, Continued

+------------+---------------------------------------------------------+
| #          | > The "*Persian Gulf War Veterans' Act of 1998*," *PL   |
| #### b. Pr | > 105-277*, authorized VA to compensate GW veterans for |
| ovisions o | > diagnosed or undiagnosed disabilities that are        |
| f the GW V | > determined by VA regulation to warrant a presumption  |
| eterans' A | > of service connection based on a positive association |
| ct of 1998 | > with exposure to one of the following as a result of  |
|            | > GW service:                                           |
|            |                                                         |
|            | -   a toxic agent                                       |
|            |                                                         |
|            | -   an environmental or wartime hazard, or              |
|            |                                                         |
|            | -   a preventive medication or vaccine.                 |
|            |                                                         |
|            | > ***Note***: This statute added [38 U.S.C.             |
|            | > 1118](http://straylight.law.cornell.edu/              |
|            | uscode/html/uscode38/usc_sec_38_00001118----000-.html). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c. P | > The "*Veterans Education and Benefits Expansion Act   |
| rovisions  | > of 2001*," *PL 107-103*, expanded the definition of   |
| of the Vet | > "qualifying chronic disability" under [38 U.S.C.      |
| erans Educ | > 1117](http://straylight.law.cornell.edu               |
| ation and  | /uscode/html/uscode38/usc_sec_38_00001117----000-.html) |
| Benefits E | > to include, effective March 1, 2002, not only a       |
| xpansion A | > disability resulting from an undiagnosed illness but  |
| ct of 2001 | > also                                                  |
|            |                                                         |
|            | -   a medically unexplained chronic multi-symptom       |
|            |     illness that is defined by a cluster of signs and   |
|            |     symptoms, and                                       |
|            |                                                         |
|            | -   any diagnosed illness that is determined by VA      |
|            |     regulation to warrant presumption of service        |
|            |     connection.                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > [38 CFR                                               |
|  d. Provis | > 3.317](http://w                                       |
| ions of 38 | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC), |
|  CFR 3.317 | > which implements [38 U.S.C.                           |
|            | > 1117](http://straylight.law.cornell.edu/              |
|            | uscode/html/uscode38/usc_sec_38_00001117----000-.html), |
|            | > defines GW service and "qualifying chronic            |
|            | > disability," and provides                             |
|            |                                                         |
|            | -   a broad, but non-exclusive, list of signs and       |
|            |     symptoms which may be representative of undiagnosed |
|            |     or chronic, multi-symptom illnesses for which       |
|            |     compensation may be paid, and                       |
|            |                                                         |
|            | -   the presumptive period for service connection.      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > A ***GW veteran***, under [38 CFR                     |
| #### e. De | > 3.317](http://w                                       |
| finition:  | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC), |
| GW Veteran | > is a veteran who served on active military, naval, or |
|            | > air service in the Southwest Asia theater of          |
|            | > operations during the GW.                             |
|            | >                                                       |
|            | > Per [38 U.S.C.                                        |
|            | > 101(33)](http://straylight.law.cornell.edu/           |
|            | uscode/html/uscode38/usc_sec_38_00000101----000-.html), |
|            | > the GW extends from August 2, 1990, through a date    |
|            | > yet to be determined by law or Presidential           |
|            | > proclamation.                                         |
+------------+---------------------------------------------------------+

Continued on next page

13\. General Information on Certain Disabilities Associated With GW
Service, Continued

+------------+---------------------------------------------------------+
| ##### f    | > The ***Southwest Asia theater of operations***        |
| . Definiti | > includes the following locations and the airspace     |
| on: Southw | > above them:                                           |
| est Asia T |                                                         |
| heater of  | -   Iraq                                                |
| Operations |                                                         |
|            | -   Kuwait                                              |
|            |                                                         |
|            | -   Saudi Arabia                                        |
|            |                                                         |
|            | -   the neutral zone between Iraq and Saudi Arabia      |
|            |                                                         |
|            | -   United Arab Emirates                                |
|            |                                                         |
|            | -   Bahrain                                             |
|            |                                                         |
|            | -   Qatar                                               |
|            |                                                         |
|            | -   Oman                                                |
|            |                                                         |
|            | -   the Gulf of Aden                                    |
|            |                                                         |
|            | -   the Gulf of Oman                                    |
|            |                                                         |
|            | -   the Persian Gulf                                    |
|            |                                                         |
|            | -   the Arabian Sea, and                                |
|            |                                                         |
|            | -   the Red Sea.                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g. D | > ***Qualifying chronic disability,*** under [38 CFR    |
| efinition: | > 3.317](http://w                                       |
|  Qualifyin | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC), |
| g Chronic  | > means a chronic disability resulting from any of the  |
| Disability | > following or any combination of the following:        |
|            |                                                         |
|            | -   an undiagnosed illness                              |
|            |                                                         |
|            | -   a medically unexplained chronic multi-symptom       |
|            |     illness, such as chronic fatigue syndrome,          |
|            |     fibromyalgia, and irritable bowel syndrome, that is |
|            |     defined by a cluster of signs or symptoms, and/or   |
|            |                                                         |
|            | -   any diagnosed illness that is determined by VA      |
|            |     regulation to warrant a presumption of service      |
|            |     connection.                                         |
|            |                                                         |
|            | > ***Reference***: For more information on the          |
|            | > requirement that disabilities be chronic in nature,   |
|            | > see [M21-1MR, Part IV, Subpart ii,                    |
|            | > 2.D.13.j](http://vbaw.vba.va.gov/bl/21/M21-           |
|            | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.13.j). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### h.   | > The presumptive period for manifestation of           |
|  Presumpti | > qualifying chronic disability under [38 CFR           |
| ve Period  | > 3.317](http://                                        |
| for Manife | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
| station of |                                                         |
|  Disabilit | -   begins on the date following last performance of    |
| y Under 38 |     active military, naval, or air service in the       |
|  CFR 3.317 |     Southwest Asia theater of operations during the GW, |
|            |     and                                                 |
|            |                                                         |
|            | -   extends through December 31, 2011.                  |
+------------+---------------------------------------------------------+

Continued on next page

13\. General Information on Certain Disabilities Associated With GW
Service, Continued

+------------+---------------------------------------------------------+
| ##         | > [38 CFR                                               |
| ### i. Qua | > 3.317](http://                                        |
| lifying Di | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
| sabilities | > specifies the following 13 categories of signs or     |
|            | > symptoms that may represent a qualifying chronic      |
|            | > disability:                                           |
|            |                                                         |
|            | -   abnormal weight loss                                |
|            |                                                         |
|            | -   cardiovascular signs or symptoms                    |
|            |                                                         |
|            | -   fatigue                                             |
|            |                                                         |
|            | -   gastrointestinal signs or symptoms                  |
|            |                                                         |
|            | -   headache                                            |
|            |                                                         |
|            | -   joint pain                                          |
|            |                                                         |
|            | -   menstrual disorders                                 |
|            |                                                         |
|            | -   muscle pain                                         |
|            |                                                         |
|            | -   neurologic signs or symptoms                        |
|            |                                                         |
|            | -   neuropsychological signs or symptoms                |
|            |                                                         |
|            | -   signs or symptoms involving the skin                |
|            |                                                         |
|            | -   signs or symptoms involving the upper and lower     |
|            |     respiratory system, and                             |
|            |                                                         |
|            | -   sleep disturbances.                                 |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   The list of 13 illness categories is not exclusive. |
|            |                                                         |
|            | -   Signs or symptoms not represented by one of the     |
|            |     listed categories may also qualify for              |
|            |     consideration under [38 CFR                         |
|            |     3.317](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
|            |                                                         |
|            | -   A disability that is affirmatively shown to have    |
|            |     resulted from a cause other than GW service may not |
|            |     be compensated under [38 CFR                        |
|            |     3.317](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > To qualify, the claimed disability must be chronic,   |
| ### j. Det | > that is, it *must* have persisted for a period of six |
| ermining C | > months.                                               |
| hronicity  | >                                                       |
|            | > Measure the six-month period of chronicity from the   |
|            | > earliest date on which all pertinent evidence         |
|            | > establishes that the signs or symptoms of the         |
|            | > disability first became manifest.                     |
|            | >                                                       |
|            | > ***Note***: If a disability is subject to             |
|            | > intermittent episodes of improvement and worsening    |
|            | > within a six-month period, consider the disability to |
|            | > be chronic.                                           |
+------------+---------------------------------------------------------+

#### 14. Rating Claims for Service Connection for Certain Disabilities Associated With GW Service

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about rating claims   |
| troduction | > for service connection for certain disabilities       |
|            | > associated with GW service, including information on  |
|            |                                                         |
|            | -   rating a symptoms as a single or multiple issue     |
|            |                                                         |
|            | -   information required to decide the issue of service |
|            |     connection for an undiagnosed illness               |
|            |                                                         |
|            | -   the relevancy of                                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   medical evidence                                    |
|            |                                                         |
|            | -   the veteran's testimony, and                        |
|            |                                                         |
|            | -   lay evidence                                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   lay evidence consisting of non-medical indicators   |
|            |                                                         |
|            | -   the veracity of lay evidence                        |
|            |                                                         |
|            | -   determining inclusion in the Veterans Heath         |
|            |     Administration (VHA) Persian Gulf Health Registry,  |
|            |     and                                                 |
|            |                                                         |
|            | -   considering the need for a future examination.      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > The decision to rate multiple symptoms or signs       |
| # a. Ratin | > together as a single issue or separately as multiple  |
| g Symptoms | > issues depends on the outcome most favorable to the   |
|  as a Sing | > veteran.                                              |
| le or Mult | >                                                       |
| iple Issue | > Although rating multiple manifestations under a       |
|            | > single body system will in most cases provide the     |
|            | > maximum benefit, be alert to symptoms affecting       |
|            | > fundamentally different body systems that may clearly |
|            | > warrant separate consideration.                       |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   If service connection for several symptoms or signs |
|            |     is denied for the same reason, consider such        |
|            |     symptoms and signs as a single issue.               |
|            |                                                         |
|            | -   Assign one hyphenated diagnostic code (DC) in the   |
|            |     coded conclusion to each issue that is separately   |
|            |     considered, whether service connection is awarded   |
|            |     or denied.                                          |
+------------+---------------------------------------------------------+

Continued on next page

14\. Rating Claims for Service Connection for Certain Disabilities
Associated With GW Service, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > The following information is required in order to     |
|  Informati | > determine whether service connection for an           |
| on Require | > undiagnosed illness is in order:                      |
| d to Decid |                                                         |
| e the Issu | -   when the illness arose                              |
| e of Servi |                                                         |
| ce Connect | -   whether the illness was severe enough to warrant    |
| ion for an |     the assignment of a compensable evaluation at any   |
|  Undiagnos |     time during the presumptive period, unless          |
| ed Illness |     manifested while in the Southwest Asia theater, and |
|            |                                                         |
|            | -   whether the illness chronically persisted for at    |
|            |     least six months.                                   |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > When the object of service connection is              |
|  Relevancy | > identification of a *diagnosed* illness, medical      |
|  of Medica | > evidence is of paramount importance because a         |
| l Evidence | > physician specializes in identifying disabilities     |
|            | > through diagnoses.                                    |
|            | >                                                       |
|            | > The concept of "objective indications" expressed in   |
|            | > [38 CFR                                               |
|            | > 3.317](http://                                        |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
|            | > makes clear that the evidence required for            |
|            | > *undiagnosed* illnesses, or illnesses which are       |
|            | > outside the scope of medical understanding, is not so |
|            | > dependent on formal medical evidence.                 |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > When combined with an examining physician's inability |
|  d. Releva | > to make a diagnosis, the veteran's testimony that     |
| ncy of the | > he/she is experiencing the symptoms described may be  |
|  Veteran's | > sufficient to establish the existence of the illness. |
|  Testimony |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Lay statements from knowledgeable individuals may be  |
| # e. Relev | > accepted as evidence of objective indications of      |
| ancy of La | > chronic disability. Lay evidence is credible if       |
| y Evidence |                                                         |
|            | -   its source was in a position to know the alleged    |
|            |     facts, and                                          |
|            |                                                         |
|            | -   it is not contradicted by evidence of record that   |
|            |     is more credible.                                   |
|            |                                                         |
|            | > A lay person's statement regarding the veteran's      |
|            | > complaints, when they began, how long they lasted,    |
|            | > and the severity of the observed symptoms/illness,    |
|            | > may be sufficient to satisfy the requirements for     |
|            | > objective indications of chronic disability.          |
+------------+---------------------------------------------------------+

Continued on next page

14\. Rating Claims for Service Connection for Certain Disabilities
Associated With GW Service, Continued

+------------+---------------------------------------------------------+
| ##### f.   | > Lay evidence may consist of non-medical indicators,   |
|  Lay Evide | > such as                                               |
| nce Consis |                                                         |
| ting of No | -   time lost from work                                 |
| n-Medical  |                                                         |
| Indicators | -   evidence that the veteran sought medical treatment  |
|            |     for his/her symptoms, and                           |
|            |                                                         |
|            | -   relevant observations, such as changes in the       |
|            |     veteran's                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   appearance                                          |
|            |                                                         |
|            | -   physical abilities, and/or                          |
|            |                                                         |
|            | -   mental or emotional status.                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Do not                                                |
| ## g. Vera |                                                         |
| city of La | -   dismiss any evidence as self-serving, as it is      |
| y Evidence |     reasonable to expect claimants to provide evidence  |
|            |     they believe best supports their claim, and/or      |
|            |                                                         |
|            | -   attempt to corroborate the evidence unless there is |
|            |     affirmative reason to doubt the credibility of the  |
|            |     evidence.                                           |
|            |                                                         |
|            | > ***Example***: If lay evidence indicates the veteran  |
|            | > lost a certain amount of time from employment, accept |
|            | > that statement without further development if the     |
|            | > statement is otherwise credible.                      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### h. D | > In all cases, ask the veteran if he/she was           |
| etermining |                                                         |
|  Inclusion | -   included in the Veterans Heath Administration (VHA) |
|  in the VH |     Persian Gulf Health Registry, and                   |
| A Persian  |                                                         |
| Gulf Healt | -   examined as part of the Registry, and, if so, where |
| h Registry |     he/she was examined.                                |
|            |                                                         |
|            | > If he/she has been examined, secure examination       |
|            | > results from the appropriate VA medical center        |
|            | > (VAMC).                                               |
+------------+---------------------------------------------------------+

Continued on next page

14\. Rating Claims for Service Connection for Certain Disabilities
Associated With GW Service, Continued

+------------+---------------------------------------------------------+
| ####       | > Because the course of an undiagnosed illness cannot   |
| # i. Consi | > be predicted, monitor it by establishing the          |
| dering the | > necessary controls for a future examination within 24 |
|  Need for  | > months of the last examination of record.             |
| a Future E | >                                                       |
| xamination | > At the expiration of the control period, review the   |
|            | > evidence of record to determine whether reexamination |
|            | > is necessary.                                         |
+------------+---------------------------------------------------------+

#### 15. General Information About Rating Decisions Addressing Certain Disabilities Associated With GW Service

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information about rating  |
| troduction | > decisions for certain disabilities associated with GW |
|            | > service, including information on                     |
|            |                                                         |
|            | -   properly stating the issue                          |
|            |                                                         |
|            | -   language for the *Decision* section of the rating   |
|            |     decision                                            |
|            |                                                         |
|            | -   referencing relevant dates in the rating decision   |
|            |                                                         |
|            | -   termination or reduction of benefits, and           |
|            |                                                         |
|            | -   results from VA-sponsored research projects.        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > State the issue in the rating decision as "*Service   |
|  a. Proper | > connection for* **\[specify signs or symptoms\]** *as |
| ly Stating | > due to a qualifying chronic disability*."             |
|  the Issue |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### b    | > For every disability for which service connection was |
| . Language | > considered, state the following in the *Decision*     |
|  for the * | > section of the rating decision: "*Service connection  |
| Decision*  | > for* **\[disability\]** *is denied*," or "*Service    |
| Section of | > connection for* **\[disability\]** *is awarded with   |
|  the Ratin | > an evaluation of* **\[percent\]** *percent effective* |
| g Decision | > **\[date\]**."                                        |
|            | >                                                       |
|            | > ***Note***: The earliest effective date for           |
|            | > entitlement to service connection under the           |
|            | > provisions of [38 CFR                                 |
|            | > 3.317](http://                                        |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
|            | > is November 2, 1994.                                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > In the *Reasons for Decision* section of the rating   |
| ### c. Ref | > decision, explicitly refer to any date that is        |
| erencing t | > pertinent to the decision.                            |
| he Relevan | >                                                       |
| t Dates in | > This particularly includes the                        |
|  the Ratin |                                                         |
| g Decision | -   dates during which the veteran served in the        |
|            |     Southwest Asia theater of operations, and           |
|            |                                                         |
|            | -   earliest date that a qualifying chronic disability  |
|            |     may have become manifest.                           |
+------------+---------------------------------------------------------+

Continued on next page

15\. General Information About Rating Decisions Addressing Certain
Disabilities Associated With GW Service, Continued

+------------+---------------------------------------------------------+
| #####      | > Situations may arise that will require termination or |
|  d. Termin | > reduction of payments previously awarded under [38    |
| ation or R | > CFR                                                   |
| eduction o | > 3.317](http://w                                       |
| f Benefits | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
|            | >                                                       |
|            | > Follow the normal procedures for reduction of         |
|            | > benefits or severance of service connection outlined  |
|            | > in [M21-1MR, Part I,                                  |
|            | > 2](                                                   |
|            | http://vbaw.vba.va.gov/bl/21/M21-1MR/m21-1mr_main.htm). |
|            | >                                                       |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Termination or reduction of benefits paid under [38 |
|            |     CFR                                                 |
|            |     3.317](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
|            |     does not preclude continuation of payments if       |
|            |     entitlement is established under other regulations  |
|            |     governing the establishment of service connection   |
|            |     based on incurrence or aggravation during service,  |
|            |     or on a presumptive basis.                          |
|            |                                                         |
|            | -   38 CFR 3.500 was amended by the addition of [38 CFR |
|            |     3.500(y)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_500.DOC), |
|            |     which specifically requires that severance of       |
|            |     service connection or reduction of benefits under   |
|            |     [38 CFR                                             |
|            |     3.105(d)](http://                                   |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_105.DOC) |
|            |     or [38 CFR 3.105                                    |
|            |     (e)](http://                                        |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_105.DOC) |
|            |     be effective the first of the month, 60 days after  |
|            |     final notice of the adverse action has been issued  |
|            |     to the veteran.                                     |
|            |                                                         |
|            | > ***Example***: A physician diagnoses a previously     |
|            | > undiagnosed illness for which compensation was paid   |
|            | > under [38 CFR                                         |
|            | > 3.317](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
+------------+---------------------------------------------------------+

Continued on next page

15\. General Information About Rating Decisions Addressing Certain
Disabilities Associated With GW Service, Continued

+------------+---------------------------------------------------------+
| ##         | > Effective December 27, 2001, if a GW veteran          |
| ### e. Res | > participates in a VA-sponsored medical research       |
| ults From  | > project, service connection established for a         |
| VA-Sponsor | > disability under [38 U.S.C.                           |
| ed Researc | > 1117](http://straylight.law.cornell.edu               |
| h Projects | /uscode/html/uscode38/usc_sec_38_00001117----000-.html) |
|            | > or [38 U.S.C.                                         |
|            | > 1118](http://straylight.law.cornell.edu               |
|            | /uscode/html/uscode38/usc_sec_38_00001118----000-.html) |
|            | > is protected, regardless of the project's findings.   |
|            | >                                                       |
|            | > ***Exception***: Service connection is not protected  |
|            | > if the original award was based on fraud, or military |
|            | > records clearly show that the veteran did not have    |
|            | > the requisite service or character of discharge.      |
|            | >                                                       |
|            | > ***Note***: A list of VA-sponsored medical research   |
|            | > projects for which service connection is protected is |
|            | > published in the Federal Register.                    |
+------------+---------------------------------------------------------+

#### 16. Granting Service Connection for Certain Disabilities Associated With GW Service

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information about granting        |
| troduction | > service connection for certain disabilities           |
|            | > associated with GW service, including information on  |
|            |                                                         |
|            | -   establishing service connection for a qualifying    |
|            |     chronic disability that manifested during the GW    |
|            |                                                         |
|            | -   establishing service connection for a compensable   |
|            |     qualifying chronic disability that arose during the |
|            |     presumptive period                                  |
|            |                                                         |
|            | -   evaluating the level of impairment by analogy       |
|            |                                                         |
|            | -   using hyphenated diagnostic codes (DCs)             |
|            |                                                         |
|            | -   assigning appropriate DCs, and                      |
|            |                                                         |
|            | -   examples of analogous evaluations.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > Establish service connection if the qualifying        |
| # a. Estab | > chronic disability, per [M21-1MR, Part IV, Subpart    |
| lishing Se | > ii,                                                   |
| rvice Conn | > 2.D.13.i](http://vbaw.vba.va.gov/bl/21/M21-           |
| ection for | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.13.i), |
|  Qualifyin | > became manifest, whether to a compensable degree or   |
| g Chronic  | > not, while the claimant was on active service in the  |
| Disability | > Southwest Asia theater of operations during the GW.   |
|  That Mani | >                                                       |
| fested Dur | > Include the following sentence in the *Reasons for    |
| ing the GW | > Decision*: "*Service connection is established for*   |
|            | > **\[disability\]** *as due to an undiagnosed illness  |
|            | > which began in the Southwest Asia theater of          |
|            | > operations during the Gulf War*."                     |
+------------+---------------------------------------------------------+

Continued on next page

16\. Granting Service Connection for Certain Disabilities Associated
With GW Service, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > Establish service connection if the qualifying        |
| Establishi | > chronic disability arose to a compensable degree      |
| ng Service | > after the veteran last served in the Southwest Asia   |
|  Connectio | > theater of operations during the GW, regardless of    |
| n for a Co | > the veteran's active duty status at the time.         |
| mpensable  | >                                                       |
| Qualifying | > If service connection is established during the       |
|  Chronic D | > presumptive period, include the following statement   |
| isability  | > in the *Reasons for Decision*: "*Service connection   |
| That Arose | > may be presumed for disabilities resulting from       |
|  During th | > undiagnosed illnesses or diagnosed illnesses which    |
| e Presumpt | > arose to a compensable degree after service in the    |
| ive Period | > Southwest Asia theater of operations during the Gulf  |
|            | > War. Service connection for* **\[disability\]** *has  |
|            | > been awarded on the basis of this presumption*."      |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c. E | > Evaluate the level of impairment of chronic           |
| valuating  | > undiagnosed disabilities by drawing an analogy to an  |
| Level of I | > existing DC in the rating schedule per [38 CFR        |
| mpairment  | > 4.27](http://                                         |
| by Analogy | www.warms.vba.va.gov/regs/38CFR/BOOKC/PART4/S4_27.DOC). |
|            | >                                                       |
|            | > Precede a discussion of the evaluation criteria in    |
|            | > the *Reasons for Decision* section of the rating      |
|            | > decision with the following statement: "*Since the    |
|            | > disability at issue does not have its own evaluation  |
|            | > criteria assigned in VA regulations, a closely        |
|            | > related disease or injury was used for this           |
|            | > purpose*."                                            |
+------------+---------------------------------------------------------+

Continued on next page

16\. Granting Service Connection for Certain Disabilities Associated
With GW Service, Continued

+------------+---------------------------------------------------------+
| ##### d.   | > Use hyphenated DCs for all undiagnosed conditions.    |
| Using Hyph | >                                                       |
| enated DCs | > The table below describes each of the codes that      |
|            | > comprise a complete hyphenated DC                     |
|            | >                                                       |
|            | > ***Reference***: For more information on analogous    |
|            | > DCs, see                                              |
|            |                                                         |
|            | -   [M21-1MR, Part IV, Subpart ii,                      |
|            |     2.D.16.f](http://vbaw.vba.va.gov/bl/21/M21-         |
|            | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.16.f), |
|            |     and                                                 |
|            |                                                         |
|            | -   [M21-1MR, Part IV, Subpart ii,                      |
|            |     2.D.16.g](http://vbaw.vba.va.gov/bl/21/M21-         |
|            | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.16.g). |
+------------+---------------------------------------------------------+

+-----------------+-----------------+--------------+-------------------+
| Code            | Description     | Example      | Reference         |
+-----------------+-----------------+--------------+-------------------+
| First DC        | Should always   | 8863, for    | For more          |
|                 | be one of the   | diseases     | information on    |
|                 | DCs established | analogous to | DCs, see          |
|                 | for GW          | systemic     |                   |
|                 | undiagnosed     | diseases     | -   [M21-1MR,     |
|                 | illness         |              |     Part IV,      |
|                 |                 |              |     Subpart ii,   |
|                 |                 |              |     2.D.16.e](htt |
|                 |                 |              | p://vbaw.vba.va.g |
|                 |                 |              | ov/bl/21/M21-1MR/ |
|                 |                 |              | pt04/sp02/ch02/pt |
|                 |                 |              | 04_sp02_ch02_secD |
|                 |                 |              | #IV.ii.2.D.16.e), |
|                 |                 |              |     and           |
|                 |                 |              |                   |
|                 |                 |              | -   [M21-1MR,     |
|                 |                 |              |     Part IV,      |
|                 |                 |              |     Subpart ii,   |
|                 |                 |              |     2.D.16.f](htt |
|                 |                 |              | p://vbaw.vba.va.g |
|                 |                 |              | ov/bl/21/M21-1MR/ |
|                 |                 |              | pt04/sp02/ch02/pt |
|                 |                 |              | 04_sp02_ch02_secD |
|                 |                 |              | #IV.ii.2.D.16.f). |
+-----------------+-----------------+--------------+-------------------+
| Second DC       | Use the DC that | 6354, for    | For more          |
|                 | most closely    | systemic     | information on    |
|                 | fits the        | disease      | analogous codes,  |
|                 | evaluating      |              | see [M21-1MR,     |
|                 | criteria        |              | Part IV, Subpart  |
|                 |                 |              | ii,               |
|                 |                 |              | 2.D.16.g](htt     |
|                 |                 |              | p://vbaw.vba.va.g |
|                 |                 |              | ov/bl/21/M21-1MR/ |
|                 |                 |              | pt04/sp02/ch02/pt |
|                 |                 |              | 04_sp02_ch02_secD |
|                 |                 |              | #IV.ii.2.D.16.g). |
+-----------------+-----------------+--------------+-------------------+

+------------+---------------------------------------------------------+
| ###        | > In order to properly identify and track disabilities  |
| ## e. Crea | > for which service connection is granted or denied     |
| ting Appro | > based on the *Persian Gulf War Veterans' Act*, a DC   |
| priate DCs | > series beginning with "88" has been established.      |
|            | >                                                       |
|            | > The 88 code is the first element of an analogous      |
|            | > code. The second two digits of the 88 code are        |
|            | > assigned according to the body system of the          |
|            | > analogous code that it precedes.                      |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   DCs, see [M21-1MR, Part IV, Subpart ii,             |
|            |     2.D.16.f](http://vbaw.vba.va.gov/bl/21/M21-         |
|            | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.16.f), |
|            |     and                                                 |
|            |                                                         |
|            | -   analogous codes, see [M21-1MR, Part IV, Subpart ii, |
|            |     2.D.16.g](http://vbaw.vba.va.gov/bl/21/M21-         |
|            | 1MR/pt04/sp02/ch02/pt04_sp02_ch02_secD#IV.ii.2.D.16.g). |
+------------+---------------------------------------------------------+

Continued on next page

16\. Granting Service Connection for Certain Disabilities Associated
With GW Service, Continued

+------------+---------------------------------------------------------+
| ##### f. L | > The table below lists the first element in a          |
| ist of App | > hyphenated analogous code and the type of undiagnosed |
| ropriate D | > condition to which each code refers.                  |
| Cs for GW- |                                                         |
| Related Di |                                                         |
| sabilities |                                                         |
+------------+---------------------------------------------------------+

  -------------------------- --------------------- -----------------------
  If the condition is        And the analogous     Then the first DC is
  analogous to ...           code begins with ...  ...

  musculoskeletal diseases   50                    8850

  amputations                51                    8851

  joints, skull, and ribs    52                    8852

  muscle injuries            53                    8853

  diseases of the eye        60                    8860

  hearing loss               61                    8861

  ear and other sense organs 62                    8862

  systemic diseases          63                    8863

  nose and throat            65                    8865

  trachea and bronchi        66                    8866

  tuberculosis               67                    8867

  lungs and pleura           68                    8868

  heart diseases             70                    8870

  arteries and veins         71                    8871

  upper digestive system     72                    8872

  lower digestive system     73                    8873

  genitourinary system       75                    8875

  gynecological system       76                    8876

  hemic and lymphatic system 77                    8877

  skin                       78                    8878

  endocrine system           79                    8879

  central nervous system     80                    8880

  miscellaneous neurological 81                    8881

  cranial nerve paralysis    82                    8882

  cranial nerve neuritis     83                    8883

  cranial nerve neuralgia    84                    8884

  peripheral nerve paralysis 85                    8885

  peripheral nerve neuritis  86                    8886

  peripheral nerve neuralgia 87                    8887
  -------------------------- --------------------- -----------------------

Continued on next page

16\. Granting Service Connection for Certain Disabilities Associated
With GW Service, Continued

  -----------------------------------------------------------------------
  f\. List of Appropriate DCs for GW-Related Disabilities (continued)

  -----------------------------------------------------------------------

  -------------------------- --------------------- -----------------------
  If the condition is        And the analogous     Then the first DC is
  analogous to ...           code begins with ...  ...

  epilepsies                 89                    8889

  psychotic disorders        92                    8892

  organic mental             93                    8893

  psychoneurotic             94                    8894

  psychophysiologic          95                    8895

  dental and oral            99                    8899
  -------------------------- --------------------- -----------------------

+------------+---------------------------------------------------------+
| #####      | > The table below contains examples of analogous codes  |
| g. Example | > that may be used when evaluating undiagnosed          |
| s of Analo | > illnesses manifest by the 13 signs or symptoms found  |
| gous Codes | > in [38 CFR                                            |
|            | > 3.317](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
|            | > The second code should be a DC with rating criteria   |
|            | > by which manifestations of the illness can most       |
|            | > accurately be evaluated.                              |
|            | >                                                       |
|            | > ***Note***: This list does not contain all possible   |
|            | > analogous codes.                                      |
|            | >                                                       |
|            | > ***Reference***: For more information on the 13 signs |
|            | > or symptoms of an undiagnosed illness, see [38 CFR    |
|            | > 3.317](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
+------------+---------------------------------------------------------+

+----------------------------------+-----------------------------------+
| If the symptom is ...            | Then the hyphenated DC is ...     |
+----------------------------------+-----------------------------------+
| abnormal weight loss             | 8873-7328, (resection of          |
|                                  | intestine).                       |
+----------------------------------+-----------------------------------+
| cardiovascular signs or symptoms | 8870-7013, (tachycardia).         |
+----------------------------------+-----------------------------------+
| cardiovascular signs or symptoms | 8870-7005, (arteriosclerotic      |
|                                  | heart disease (ASHD)).            |
+----------------------------------+-----------------------------------+
| fatigue                          | 8863-6354, (chronic fatigue       |
|                                  | syndrome).                        |
+----------------------------------+-----------------------------------+
| fatigue                          | 8877-7700, (anemia).              |
+----------------------------------+-----------------------------------+
| gastrointestinal signs or        | -   8873-7305, (ulcer), or        |
| symptoms                         |                                   |
|                                  | -   8873-7319, (irritable bowel   |
|                                  |     syndrome).                    |
+----------------------------------+-----------------------------------+
| headache                         | 8881-8100, (migraine headaches).  |
+----------------------------------+-----------------------------------+
| joint pain                       | 8850-5002, (rheumatoid            |
|                                  | arthritis).                       |
+----------------------------------+-----------------------------------+
| menstrual disorders              | 8876-7622, (uterus displacement). |
+----------------------------------+-----------------------------------+
| muscle pain                      | 8850-5021, (myositis).            |
+----------------------------------+-----------------------------------+
| > neurologic signs or symptoms   | 8885-85\_\_, (peripheral          |
|                                  | neuropathy).                      |
+----------------------------------+-----------------------------------+

Continued on next page

16\. Granting Service Connection for Certain Disabilities Associated
With GW Service, Continued

  -----------------------------------------------------------------------
  g\. Examples of Analogous Codes (continued)

  -----------------------------------------------------------------------

+----------------------------------+-----------------------------------+
| If the symptom is ...            | Then the hyphenated DC is ...     |
+----------------------------------+-----------------------------------+
| > neuropsychological signs or    | 8893-9300, (organic mental        |
| > symptoms                       | disorder).                        |
+----------------------------------+-----------------------------------+
| > signs or symptoms involving    | -   8865-65\_\_, (respiratory     |
| > the respiratory system (upper  |     system)                       |
| > or lower)                      |                                   |
|                                  | -   8866-66\_\_, (respiratory     |
|                                  |     system), or                   |
|                                  |                                   |
|                                  | -   8868-68\_\_, (respiratory     |
|                                  |     system).                      |
+----------------------------------+-----------------------------------+
| > signs or symptoms involving    | 8878-7806, (eczema).              |
| > the skin                       |                                   |
+----------------------------------+-----------------------------------+
| > sleep disturbances             | 8894-9400, (generalized anxiety). |
+----------------------------------+-----------------------------------+

#### 17. Denying Service Connection for Certain Disabilities Associated With GW Service

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on denying service    |
| troduction | > connection for certain disabilities associated with   |
|            | > GW service, including information on                  |
|            |                                                         |
|            | -   discussing the denial in the rating decision        |
|            |                                                         |
|            | -   addressing                                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   diagnosed illnesses                                 |
|            |                                                         |
|            | -   an illness that is not chronic                      |
|            |                                                         |
|            | -   an illness attributable to some other etiology      |
|            |                                                         |
|            | -   a condition that is not shown by the evidence of    |
|            |     record, and                                         |
|            |                                                         |
|            | -   a qualifying chronic disability that is less than   |
|            |     10-percent disabling.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > September 5, 2008                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Begin a discussion of the denial of service           |
| ## a. Disc | > connection in the *Reasons for Decision* section of   |
| ussing the | > the rating decision with a description of the general |
|  Denial in | > requirements for service connection under [38 CFR     |
|  the Ratin | > 3.317](http://w                                       |
| g Decision | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC), |
|            | > including the following statement:                    |
|            | >                                                       |
|            | > "*Service connection may be established for           |
|            | > disability resulting from undiagnosed illness or a    |
|            | > medically unexplained chronic multi-symptom illness   |
|            | > that is defined by a cluster of symptoms, or a        |
|            | > diagnosed illness that is determined by VA regulation |
|            | > to warrant a presumption of service connection which  |
|            | > manifested itself either during active service in the |
|            | > Southwest Asia theater of operations during the Gulf  |
|            | > War, or to a degree of ten percent or more after the  |
|            | > date on which the veteran last performed service in   |
|            | > the Southwest Asia theater of operations during the   |
|            | > Gulf War*."                                           |
+------------+---------------------------------------------------------+

Continued on next page

17\. Denying Service Connection for Certain Disabilities Associated With
GW Service, Continued

+------------+---------------------------------------------------------+
| ##### b. A | > Service connection may not be granted under [38 CFR   |
| ddressing  | > 3.317](http://                                        |
| Diagnosed  | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
| Illnesses  | > for an illness having a known clinical diagnosis      |
|            | > unless it meets the criteria for a qualifying chronic |
|            | > disability shown in [M21-1MR, Part IV, Subpart ii,    |
|            | > 2.D.13.g](http://vbaw.vba.va.gov/bl/21/M21-1MR/       |
|            | pt04/sp02/ch02/pt04_sp02_ch02_secD.xml#IV.ii.2.D.13.g). |
|            | > However, service connection under other provisions of |
|            | > the law must be considered.                           |
|            | >                                                       |
|            | > If service connection for a claimed undiagnosed       |
|            | > illness is denied on this basis, include the          |
|            | > following language in the *Reasons for Decision*      |
|            | > section of the rating decision: "*Service connection  |
|            | > for* **\[claimed disability\]** *is denied because    |
|            | > this disability is determined to result from a known  |
|            | > clinical diagnosis of* **\[diagnosed disability\]***, |
|            | > which neither occurred in, nor was caused or          |
|            | > aggravated by, service*."                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c. A | > The fact that a claimed disability is not found on    |
| ddressing  | > the veteran's last VA examination does not            |
| an Illness | > necessarily preclude his/her entitlement to           |
|  That Is N | > compensation under [38 CFR                            |
| ot Chronic | > 3.317](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC). |
|            | >                                                       |
|            | > The requirement for chronicity is fulfilled if the    |
|            | > disability has persisted for at least six months.     |
|            | > Disabilities subject to episodic improvement and      |
|            | > worsening within a six-month period are considered    |
|            | > chronic.                                              |
|            | >                                                       |
|            | > If the disability does not meet the six-month         |
|            | > requirement, include the following statement under    |
|            | > the *Reasons for Decision* section of the rating      |
|            | > decision: "*The disability must have persisted for a  |
|            | > period of at least six months. Service connection     |
|            | > for* **\[disability\]** *is denied since this         |
|            | > disability was first manifested on* **\[date\]** *and |
|            | > lasted less than six months.*"                        |
+------------+---------------------------------------------------------+

Continued on next page

17\. Denying Service Connection for Certain Disabilities Associated With
GW Service, Continued

+------------+---------------------------------------------------------+
| ####       | > Service connection under [38 CFR                      |
| # d. Addre | > 3.317](http://                                        |
| ssing an I | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC) |
| llness Tha | > may not be established if there is affirmative        |
| t Is Attri | > evidence that an undiagnosed illness was not incurred |
| butable to | > during active service or was caused by some           |
|  Some Othe | > intercurrent circumstance.                            |
| r Etiology | >                                                       |
|            | > ***Important***: Affirmative evidence that the        |
|            | > illness is caused by willful misconduct or alcohol or |
|            | > drug abuse will also preclude entitlement.            |
|            | >                                                       |
|            | > Include the following statement under the *Reasons    |
|            | > for Decision* section of the rating decision if       |
|            | > service connection is denied on this basis: "*Service |
|            | > connection under this provision is precluded if there |
|            | > is affirmative evidence that the disability was       |
|            | > unrelated to service in the Gulf War. Service         |
|            | > connection for* **\[disability\]** *is denied because |
|            | > evidence established that this disability resulted    |
|            | > from* **\[unrelated event, accident, injury,          |
|            | > etc.\]**."                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > If the evidence of record fails to show that a        |
| # e. Addre | > condition exists or has existed in the past, include  |
| ssing a Co | > the following statement in the *Reasons for Decision* |
| ndition Th | > section of the rating decision: "*There is no         |
| at Is Not  | > evidence that the condition ever existed*."           |
| Shown to E |                                                         |
| xist by th |                                                         |
| e Evidence |                                                         |
|  of Record |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f. A | > If the veteran fails to qualify for service           |
| ddressing  | > connection because the severity of the qualifying     |
| a Qualifyi | > chronic disability is noncompensable, include the     |
| ng Chronic | > following statement in the *Reasons for Decision*     |
|  Disabilit | > section of the rating decision: "*Service connection  |
| y That Is  | > for* **\[disability\]** *is denied since this         |
| Less Than  | > disability neither arose during service in the        |
| 10-Percent | > Southwest Asia theater of operations,* *nor was it    |
|  Disabling | > manifested to a compensable degree after the last     |
|            | > date of service in the Persian Gulf theater during    |
|            | > the Gulf War*."                                       |
|            | >                                                       |
|            | > ***Reference***: For more information on              |
|            | > qualifications for service connection, see [M21-1MR,  |
|            | > Part IV, Subpart ii,                                  |
|            | > 2.D.13.a](http://vbaw.vba.va.gov/bl/21/M21-1MR/       |
|            | pt04/sp02/ch02/pt04_sp02_ch02_secD.xml#IV.ii.2.D.13.a). |
+------------+---------------------------------------------------------+