The Problem
Gulf War veterans face an uphill battle when trying to get presumptive service connection under the regulation 38 CFR § 3.317. In fact, a study released by the Department of Veterans Affairs in 2014 showed that 80% of Gulf War related claims get denied by the VA. One situation in particular that presents a frustrating experience comes into play with Gulf War veterans suffering from a “medically unexplained chronic multi-symptom illness.”
The frustration and confusion is largely due to the fact that getting a diagnosis for qualifying chronic conditions can be very difficult. For example, one doctor might classify a veteran’s symptoms as “undiagnosed” while another doctor gives that same veteran a specific diagnosis such as chronic fatigue syndrome. Why does this matter? Let’s look at a situation where a Gulf War veteran is suffering from symptoms such as fatigue, loss of memory, unexplained muscle pain, sore throat, and headaches of a new type or severity. That veteran goes to his doctor and explains the symptoms he is suffering from. The doctor may run a series of tests and try to rule out certain diseases. This could result in a diagnosis of Chronic Fatigue Syndrome (CFS), but it could also result in the doctor saying that the symptoms cannot be attributed to any identifiable disease (i.e. the symptoms are undiagnosed). To understand the impact of these results let’s look at each one separately.
- Diagnosis of CFS: The veteran meets the diagnostic criteria for CFS. The veteran is entitled to presumptive service connection, and should be able to present a successful claim with the right medical evidence.
- Undiagnosed symptoms: If a doctor rules that the veteran’s symptoms are not attributed to any known clinical diagnosis (undiagnosed) then the veteran should qualify for presumptive service connection for an undiagnosed illness.
The veteran filing a claim for CFS, and who has an actual diagnosis of CFS will have a much easier time getting presumptive service connection. This is typically true even if the veteran has a doctor that has classified his symptoms as “undiagnosed.” One would think that the veteran with “undiagnosed” symptoms should qualify for presumptive service connection under 38 U.S.C.S. § 1117(a)(2)(A) covering undiagnosed illnesses. Instead, the VA has been denying presumptive service connection for medically unexplained chronic illnesses such as CFS due to the fact that the veteran does not have a diagnosis of CFS (the same idea applies to claims for IBS and fibromyalgia). If the veteran doesn’t have a specific diagnosis for CFS, the VA will often say that the veteran’s symptoms were due to another disease because the symptoms did not meet the requirements for CFS.
In summary, the VA seems to place a lot of emphasis on the diagnosis of a condition such as CFS, and seems to forget about the complete regulation on presumptive service connection for Gulf War veterans. So, it is important for Gulf War veterans to be aware of the diagnostic process for conditions such as CFS. It is also important to be aware of the rules regarding undiagnosed illnesses should they be unable to get a diagnosis for their symptoms.
Diagnosis of CFS
To understand why claims for conditions such as CFS are so difficult it is important to understand how the condition is diagnosed in the first place. Because there is no blood test, brain scan, or other lab test to diagnose CFS, a doctor usually diagnoses CFS by ruling out other possible causes of the symptoms.
Diagnosing CFS can be complicated by a number of factors such as:
- There are no lab tests for CFS
- Fatigue and other symptoms of CFS are common to many illnesses
- For some CFS patients, it may not be obvious to doctors that they are even ill
- The illness has a pattern of remission and relapse
- Symptoms vary from person to person in type, number, and severity
Because diagnosing CFS is so difficult and presents unique challenges, it is important to be thorough when explaining your symptoms to a doctor and prepare for an appointment with a doctor. Some questions that a doctor might ask include:
- What are your symptoms and when did they begin?
- How much do you symptoms limit your ability to function?
- What treatments have you tried so far for this condition? How have they worked?
Additionally, asking the right questions well help ensure that you get the information you need. Here are some questions to ask your doctor when CFS is at issue:
- What are the possible causes of my symptoms or condition?
- If tests don’t pinpoint the cause of my symptoms, what additional tests might I need?
- On what basis would you make a diagnosis of chronic fatigue syndrome?
Being thorough with your doctor is crucial. If the doctor can’t make a diagnosis of CFS, don’t forget to ask him to address whether your symptoms are attributable to any other condition. If not, get that information documented to support a claim for an undiagnosed illness.
What Does This Mean for Gulf War Claims?
When making a claim for CFS or another explained multi-symptom illness such as IBS or fibromyalgia, be on alert for a denial due to no diagnosis. If a doctor says that your symptoms are not attributable to any known conditions, you are entitled to presumptive service connection for an undiagnosed illness. Just because you don’t have a diagnosis of CFS or other explained multi-symptom illness does not mean you are not entitled to presumptive service connection for your condition.
