Veterans of the Persian Gulf War are eligible for presumptive service connection. In the last post we gave an introduction to how these presumptions came about and explained the first few requirements for establishing that presumption. In this post, we will continue exploring what a veteran has to prove in order to receive compensation benefits for their disability.
There are three requirements for a veteran to establish entitlement to presumptive service connection. The veteran must:
- Be a Persian Gulf War veteran
- Suffer from a “qualifying chronic disability”, which is either:
- An undiagnosed illness,
- A medically unexplained chronic multisymptom illness, OR
- Any other illness deemed by law
- The particular qualifying chronic disability must have manifested:
- During active military service in the Southwest Asia area of operations OR
- To a degree of 10% at any time since the veteran’s return from active duty in Southwest Asia.
In the last post we talked about what it means to be a Persian Gulf War veteran, and we began explaining what it means to suffer from a qualifying chronic disability. A qualifying chronic disability is either 1) an undiagnosed illness 2) a medically unexplained chronic multisymptom illness, or 3) any other illness deemed by law. In the last post we talked about what is an undiagnosed illness. Now let’s look at what a medically unexplained chronic multisymptom illness is.
A medically unexplained chronic multisymptom illness is defined by a cluster of signs or symptoms. The definition is “a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.” The most common examples are chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome or other functional gastrointestinal disorders. Other functional gastrointestinal disorders are functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain, and function dysphagia. But these are not the only ones. Functional gastrointestinal disorder is described as “a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis.” Any condition that fits these characteristics may be considered a functional gastrointestinal disorder subject to service connection. And anything else that may fit the definition of a medically unexplained chronic multisymptom illness can qualify as one. So if a veteran qualifies as a Persian Gulf War veteran and develops chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, some other functional gastrointestinal disorder, or any other medically unexplained chronic illness, the veteran should be entitled to compensation benefits, as long as he meets the final requirement.
But there is one more way to have a qualifying chronic disability. The third type of illness is a diagnosed illness that the Secretary determines warrants a presumption of service connection. This is determined by looking at those illnesses that have a positive association with exposure to a biological, chemical, or other toxic agent, environmental or wartime hazard or preventative medicine or vaccine known or presumed to be associated with service during the Persian Gulf War. There are currently nine infectious diseases subject to presumptive service connection, and they are: brucellosis; campylobacter jejuni; coxiella burnetti (Q fever); malaria; mycobacterium tuberculosis; nontyphoid salmonella; shigella; visceral leishmaniasis; and West Nile virus. There are also certain long-term health effects associated with each of the nine infectious diseases. For a more detailed explanation, click here.
The final requirement to establish presumptive service connection is that the condition should have first become manifest during the veteran’s active service in the Southwest Asia theater of operations, or to a degree of 10% or more during the presumptive period. The presumptive period is from the time the veteran returned from active duty in Southwest Asia, up until December 31, 2016 which is what Congress has set as the end of the presumptive period for now. Note that the presumptive period begins when the veteran leaves Southwest Asia, not when the veteran is separated from service. Certain infectious diseases have different presumptive periods depending on the disease.
To determine whether an undiagnosed illness has been at least 10% disabling, the rating schedule criteria for that illness is used. But because there are undiagnosed or chronic multisymptom illnesses that are not included in the rating schedule, the illness is evaluated using the rating schedule criteria for a similar disease or injury that has similar effects on the body as the undiagnosed illness. Chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome each have their own diagnostic codes in the rating schedule. But the rest have to be evaluated under the rating schedule criteria of another illness or condition. If the veteran can show that their illness was showing symptoms at a rate of 10% at any time since they left service in Southwest Asia, they have met the final requirement.
Once you have established each of these elements, you are entitled to compensation benefits through presumptive service connection. For more information, click here.
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