b. Provisions of the GW Veterans’ Act of 1998 The “Persian Gulf War Veterans’ Act of 1998,” PL 105-277, authorized VA to compensate GW Veterans for diagnosed or undiagnosed disabilities that are determined by VA regulation to warrant a presumption of service connection (SC) based on a positive association 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 PL added . c. Provisions of the Veterans Education and Benefits Expansion Act of 2001 The “Veterans Education and Benefits Expansion Act of 2001,” PL 107-103, expanded the definition of “qualifying chronic disability” under to include, effective March 1, 2002, not only a disability resulting from an undiagnosed illness but also a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs and symptoms, and any diagnosed illness that is determined by VA regulation to warrant presumption of SC. Reference: For more information on MUCMIs, see M21-1, Part IV, Subpart ii, 2.D.1.i. d. Provisions of 38 CFR 3.317 implements by defining certain key terms and providing for presumptive SC for undiagnosed illness or MUCMIs, and a list of infectious diseases. e. Definition: Qualifying Veteran Under 38 CFR 3.317 A qualifying Veteran, under , is a Veteran who served on active military, naval, or air service in the Southwest Asia theater of operations during the GW period. Per , the GW period extends from August 2, 1990, through a date yet to be determined by law or Presidential proclamation. Reference: For a definition of the Southwest Asia theater of operations, see , and M21-1, Part IV, Subpart ii, 2.D.1.f.
f. Definition: Southwest Asia Theater of Operations The Southwest Asia theater of operations includes the following locations and the airspace above them Iraq 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. Qualifying Chronic Disability Under 38 CFR 3.317 Qualifying chronic disability, under , means a chronic disability resulting from any of the following or any combination of the following an undiagnosed illness, or an MUCMI. References: For more information on determining chronicity, see M21-1, Part IV, Subpart ii, 2.D.1.o, and rating action to be taken based on specific disability patterns, see M21-1, Part IV, Subpart ii, 2.D.2.h. h. Definition: Undiagnosed Illness An undiagnosed illness is a type of chronic qualifying disability where qualifying signs and/or symptoms cannot be attributed to any known clinical diagnosis by history, physical examination and laboratory tests. References: For more information on signs and symptoms of undiagnosed illness, see M21-1, Part IV, Subpart ii, 2.D.1.n, and the examiner’s determination of disability pattern, see M21-1, Part IV, Subpart ii, 2.D.2.g. i. Definition: MUCMI An MUCMI is a type of chronic qualifying disability in which there is a diagnosed illness that has both an inconclusive pathophysiology, and an inconclusive etiology
References: For more information on requesting examinations in GW claims, see M21-1, Part III, Subpart iv, 3.A, and the need for an adequate characterization of the disability, see M21-1, Part IV, Subpart ii, 2.D.2.g d. Role of Third Party Lay Evidence in Establishing Signs or Symptoms Lay statements from third party lay witnesses that are competent and credible may help establish the presence of objective indications of a chronic disability. Such statements may cover what the Veteran complained of when complaints began how long complaints lasted, and nature/severity of witnessed signs or symptoms. Reference: For more information on when evidence is competent and credible, see M21-1, Part III, Subpart iv, 5. e. Role of Indicators in Establishing Signs and Symptoms Non-medical indicators may help establish signs and symptoms of a qualifying disability. Non-medical indicators may include time lost from work evidence that the Veteran sought medical treatment for his/her symptoms, and relevant observations, such as changes in the Veteran’s appearance physical abilities, and/or mental or emotional status. f. Considering VHA Persian Gulf Health Registry Examinations In all cases when the Veteran has been examined as part of the Veterans Heath Administration (VHA) Persian Gulf Health Registry, ensure those results have been obtained and considered when rating the GW-related issues. Reference: For more information on developing for the Gulf War Registry examination, see M21-1 Part IV, Subpart ii, 1.E.1.b. g. VA Examiner’s Determination of Disability Pattern for Claims Based on Southwest Ensure, before making a decision, that the examination report contains the examiner’s determination of disability pattern. If it does not send the examination report and claims folder back to the examiner with a copy of the “notice to examiner” shown in M21-1, Part IV, Subpart ii,
Asia Service 1.E.2.g, and included in the Examination Request Builder - ordering a GW Disability Benefits Questionnaire, and ask the examiner to characterize the specific claimed issue(s), as requested in the notice. Important: The Federal Circuit, in , 766 F.3d 1393 (Fed. Cir. 2014) held that a medical professional does not have to have eliminated all possible diagnoses before the Veteran can be compensated for a disability due to an undiagnosed illness. h. Rating Action Taken Based on Disability Pattern Determination The table below shows the rating action taken based on the VA examiner’s determination of disability pattern. If the examiner determined the Veteran’s disability pattern to be … Then … an undiagnosed illness, or a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology award SC under if the Veteran is otherwise eligible. a diagnosable chronic illness with a partially explained etiology, such as diabetes or multiple sclerosis, or a disease with a clear and specific etiology SC cannot be awarded under , and may be awarded only if the medical evidence is sufficient to establish SC on a direct or other presumptive basis. an undiagnosed illness, and the examiner opines that the undiagnosed illness is not related to GW service but does not provide a statement that the condition was caused by a specific supervening condition or event, or was due to willful misconduct or alcohol or drugs award SC under . Note: See regarding what constitutes affirmative evidence that would prevent payment of qualifying GW condition. an undiagnosed illness, and the examiner opines that the undiagnosed illness is not related to GW service but instead is related to a supervening condition or an event that occurred after service. The examiner supports the opinion with a clear medical rationale SC cannot be awarded under .
b. Language for the Decision Section of the Rating Decision For every disability for which SC was considered, state the following in the Decision section of the rating decision: Service connection for [disability] is denied, or Service connection for [disability] is awarded with an evaluation of [percent] percent effective [date]. Note: The earliest effective date for entitlement to SC under the provisions of is November 2, 1994. c. Referencing Relevant Dates in the Rating Decision In the rating decision, explicitly refer to any date that is pertinent to the decision. This particularly includes the 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. Reference: For more information on documenting a decision see M21-1, Part III, Subpart iv, 6.C. d. Termination or Reduction of Benefits Previously Awarded Under 38 CFR 3.317 Situations may arise that will require termination or reduction of payments previously awarded under . Follow the normal procedures for reduction of benefits or severance of SC outlined in M21-1, Part I, 2. Notes: Termination or reduction of benefits paid under does not preclude continuation of payments if entitlement can be established for SC based on incurrence or aggravation under the provisions of and , respectively, or based on presumption under the provisions of . was amended by the addition of , which specifically requires that severance of SC or reduction of benefits under or 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 indicates that the Veteran’s condition, which had previously been characterized as an undiagnosed illness that was compensated under , is now a clinically diagnosed condition with a clear etiology.