The VA is required to grant service connection to a veteran who served in Southwest Asia from August 2, 1990 onward and has an undiagnosed illness. So what exactly is an “undiagnosed illness” according to the VA?
VA regulations provide that the following symptoms are symptoms of an undiagnosed illness: “fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs and symptoms, neurophysical signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders.” The symptoms of an undiagnosed illness must have been in existence for at least 6 months. The 6 month period starts at the earliest date the veteran’s symptoms showed. Also, the veteran’s symptoms must have revealed themselves during the veteran’s Gulf War service, or the symptoms must have become at least 10% disabling during a certain period of time called the presumptive period. Currently, the presumptive period for Gulf War veterans goes to December 31, 2016.
How does a veteran go about proving that they suffer from symptoms of an undiagnosed illness? Evidence of the symptoms listed above can come from an examining physician, but it does not have to. Veterans can also use buddy statements to provide evidence that they are suffering from an undiagnosed illness as long as the symptoms that are described in the buddy statement are symptoms that are identifiable by an ordinary person (someone who is not a doctor). For example, let’s say that a veteran returned from Iraq and was suffering from knee pain. If his family or friends observed him having this pain, they could provide a written statement. The statement provided by the veteran’s family or friends can describe things like: when his knee pain began, how long it lasted, and how severe the veteran’s pain was. Other non-medical evidence that can be used by a veteran suffering from an undiagnosed illness includes: showing time lost from work, evidence that they sought medical treatment for their symptoms, and evidence that shows changes in the veteran’s appearance, physical abilities, and mental or emotional attitude.
The symptoms that a veteran is suffering from must not be the result of any known clinical diagnosis. However, just because a veteran has symptoms that are also symptoms of a known diagnosis does not mean the veteran doesn’t have an undiagnosed illness. For example, consider a veteran who is having heart problems. The heart problems he is having are associated with coronary artery disease. However, when the veteran goes to the doctor they tell him he does not have coronary artery disease. This veteran’s symptoms are the result of an undiagnosed illness. So, if a Gulf War veteran’s doctor is unable to link the veteran’s disabling symptoms to a medical diagnosis, the veteran may be able to qualify for service connection under the VA’s undiagnosed illness provision.
If a Gulf War veteran meets the requirements of the undiagnosed illness provisions, they receive presumptive service connection. But then how does the VA rate a condition that is undiagnosed? The VA must rate a service-connected undiagnosed illness “by analogy.” This means that the VA will rate the undiagnosed illness under a diagnostic code in which the functions affected, the location affected, or the symptoms are similar to the undiagnosed illness.
According to the VA, once a veteran receives a diagnosis they can no longer seek benefits under the undiagnosed illness provision. Gulf War veterans may run into the problem of doctors trying force their symptoms into a diagnosis that isn’t accurate. Unfortunately, the medical opinion concerning the diagnosis or non-diagnosis of a Gulf War veteran’s condition is crucial when that veteran is seeking compensation benefits under the undiagnosed illness provisions. Gulf War veterans may still qualify for presumptive service connection under another special provision for chronic multisymptom illnesses.
If a Gulf War veteran is given a diagnosis and they do not qualify for presumptive service connection under the multisymptom illness provision, they have two options. First, the veteran could try to rebut their diagnosis. This is done by getting another medical opinion that states the veteran’s symptoms cannot actually be linked to a particular diagnosis, or that states the symptoms are linked to a condition that qualifies for presumptive service connection under other VA provisions. Second, the veteran may still be able to receive VA disability benefits for his diagnosed condition under the traditional theories of service connection that are available to all veterans.
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