Like PTSD, Gulf War Syndrome is marching up the ranks in prevalence today, and has earned its own regulation in the VA federal and United States codes. Because it is multi-symptomatic, Gulf War Syndrome can be discussed in many different ways. In a previous post, we gave a general overview of Gulf War Syndrome and how to obtain service-connection by presumption. Here we will discuss a specific on-going issue: obtaining service-connection for COPD as related to the oil well fires of 1991.
With President Obama’s announcement on August 31, 2010, the US combat mission in Iraq (Operation Iraqi Freedom) had officially ended, and with that, the second phase of the Gulf War. The first Gulf War, led by U.S. and coalition troops in January 1991, followed the August 1990 Iraqi invasion of Kuwait. The war was over on February 28, 1991, and an official cease-fire was signed in April 1991. Fourteen years later, Operation Iraqi Freedom (2003-2010) and Operation New Dawn (2010-2011) created a new group of Gulf War Veterans.
From a legal and medical standpoint, the Gulf War presented a unique set of challenges. Veterans who served in these eras have experienced health issues commonly known as Gulf War Syndrome—with symptoms such as fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems. What makes Gulf War Syndrome unique is the inability of medical professionals to diagnose these symptoms. As a result, the VA established 38 CFR §3.317, which more clearly defines parameters of “undiagnosed illnesses” and the guidelines for receiving compensation for those illnesses. One of the respiratory illnesses that we are seeing more of is Chronic Obstructive Pulmonary Disorder (COPD).
COPD is an obstructive lung disease characterized by chronically poor airflow. It typically worsens over time. In contrast to asthma, medication does not significantly improve the airflow. While the primary cause of COPD is considered to be tobacco smoke, COPD can also be caused by occupational exposures and pollution from indoor fires (in some countries). Some of the characteristics of COPD include:
- Shortness of breath, especially during physical activities
- Chest tightness
- Having to clear throat first thing in the morning, due to excess mucus in lungs
- A chronic cough that produces sputum that may be clear, white, yellow or greenish
- Blueness of the lips or fingernail beds (cyanosis)
- Frequent respiratory infections
- Lack of energy
- Unintended weight loss (in later stages)
- Exacerbations—severe episodes during which symptoms become worse and persist for days or longer
Servicemen who spent time in Kuwait in 1991 will remember the huge billows of smoke and the smog that hung over the ground as over 600 oil wells burned for seven months. Hundreds of US soldiers worked around those fires, breathing in the fumes with little or no protection. Years later, the breathing problems they developed in Kuwait have only gotten worse.While the Veterans Administration has declared that there is no evidence of long-term health problems from exposure to oil well fires at this time, the health problems of veterans who served in Kuwait tell another story. Since COPD is not on the list of presumptive diseases associated with Gulf War Syndrome, it is more difficult of veterans to get service-connection for conditions outside this list. However, in the news release dated September 28, 2010, the VA stated that, “for non-presumptive conditions, a Veteran is required to provide medical evidence to establish an actual connection between military service in Southwest Asia or Afghanistan and a specific disease”. Moreover, under 38 USC §1117(g)(8) and 38 CFR §3.317 (b)(8), “signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multisymptom illness include: […] signs or symptoms involving the upper or lower respiratory system”. The caveat to these regulations is that it is more difficult to prove service-connection “if there is affirmative evidence that the disability is the result of the veteran’s own willful misconduct or abuse of alcohol or drugs”. Or, in this case, willful misconduct or abuse might include the use of tobacco/cigarettes.
In order to be successful in establishing service-connection for conditions such as COPD, it is beneficial to get an outside medical opinion on the matter. The VA is required to consider the evidence of medical opinions outside of the VA. If the opinion of the independent medical practitioner is positive, the VA will be looking for the phrase “at least as likely as not”. If this phrase is not included in the report, or something to the equivalent, the VA will not make a favorable decision on the claim based upon that report.