Medically Unexplained Chronic Multisymptom Illness (CMI)
Scientists and Medical Researchers now use the term medically unexplained Chronic Multisymptom Illness (CMI) instead of Gulf War Illness (GWI). They mean the same thing. CMI is a more inclusive term which applies to all people affected by the disorder. Exposures present in the Southwest Asia Theater (SWAT) of Operations greatly increased the risk of CMI among Gulf War Veterans. The National Academy of Sciences (NAS) Institute of Medicine (IOM) uses the following definition in its 2013 report: Gulf War and Health: Treatment for Chronic Multisymptom Illness.
“We defined CMI as the presence of a spectrum of chronic symptoms experienced for six months or longer in at least two of six categories—fatigue, mood and cognition, musculo-skeletal, gastrointestinal, respiratory, and neurologic—that may overlap with, but are not fully captured by, known syndromes (such as irritable bowel syndrome, chronic fatigue syndrome, and fibromyalgia) or other diagnoses.”
When you have an illness that is a CMI that is of an inconclusive etiology, have your VSO use this case law in the appeal.
Stewart v. Wilkie, 30 Vet.App.383 (2018) United States Court of Appeals for Veterans Claims
— The Court held that under the first sentence of 38 C.F.R. § 3.317(a)(2)(ii), a medically unexplained chronic multisymptom illness (MUCMI) is established if the diagnosed illness has either an inconclusive etiology or pathophysiology.
— Demonstration of both an inconclusive etiology and pathophysiology is no longer required to establish a MUCMI.
Qualifying chronic disability, under 38CFR§3.317(a)(2)(i), means a chronic disability resulting from any of the following or any combination of the following:
(A) An undiagnosed illness.
(B) A medically unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms, such as
- Chronic fatigue syndrome (CFS)
- Functional gastrointestinal disorders (FGID)(excluding structural gastrointestinal diseases). (Note: in 2001 congress passed the Veterans Improvement Act that added functional disorder of IBS as the presumptive illness and in 2011 the VA secretary expanded 38 CFR § 3.317 to include all other functional gastrointestinal disorders.
Fibromyalgia (FM) is a syndrome predominately characterized by widespread muscular pains and fatigue. The causes of FM are unknown. There are difficulties in diagnosing FM. Its clinical picture can overlap other illnesses, and there are no definitive diagnostic tests. Patient education, pharmacologic agents, and other nonpharmacologic therapies are used to treat FM. Exercise has been found to improve outcomes for people with FM. The medical community’s understanding of this disease is evolving. For more in-depth and up-to-date information, visit the websites of the Mayo Clinic or the Centers for Disease Control.
Functional gastrointestinal disorders, like irritable bowel syndrome (IBS), are disorders characterized by dyspepsia, cramping, abdominal pain, bloating, constipation, and diarrhea in the absence of demonstrable pathology on conventional testing. IBS is when you have more than just one of the symptoms that causes a great deal of discomfort and distress. FGID does not harm the intestines and does not lead to a serious disease, such as cancer. Some people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, FGID can be disabling. They may be unable to work, attend social events, or even travel short distances.
You might develop some secondary issues due to FGID that can be service connected and rated. The constipation and diarrhea are known to cause fecal incontinence and can also cause hemorrhoids. See the Educational Guide on secondary claim for more information.
For more information on FGID see this link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850201/#:~:text=Functional%20gastrointestinal%20disorders%20(FGID)%20are,demonstrable%20pathology%20on%20conventional%20testing.
Chronic fatigue syndrome (CFS) is a condition that makes you feel so tired that you can’t do all of your normal, daily activities. This like the other CMI’s is an illness diagnosed by exclusion. The doctor has to exclude other causes to the symptoms that you have. That is why it is very hard to get a diagnosis by the VA for CFS.
There are other symptoms too but being very tired for at least 6 months is the main one. Myalgic encephalomyelitis (ME) is another name for CFS. Sometimes you will see the acronym ME/CFS used to refer to CFS. The illness is characterized by prolonged, debilitating fatigue and a characteristic group of accompanying symptoms, particularly problems with memory and concentration, unrefreshing sleep, muscle and joint pain, headache, and recurrent sore throat. It is marked by a dramatic difference in pre- and post-illness activity level and stamina.
For more information on CFS read what the CDC has. https://www.cdc.gov/me-cfs/about/index.html
You must have a proper diagnosis.
The Educational Guide on doing claims will help give you more information on filing a claim for benefits with the Department of Veterans Affairs. The guide covers each of the CMI’s and the regulations when filing your claim. These claims have been denied at a very high rate in the past due to errors and to veterans not being diagnosed for the listed CMI.
Even though you may have the symptoms of a presumptive illness, like IBS, you still need to have a diagnosis before filing a claim for that illness. The first requirement in filing a claim is a current diagnosis of the illness. The second requirement is fulfilled by the presumptive, as long as you meet the requirements under the laws and regulation.
The Pact Act that was signed into law on August 10, 2022, did add more areas of operation to 38 U.S.C 1117/1118 thus allowing more veterans to be covered by these presumptive illnesses. It also added 30 U.S.C 1119 and 1120.
It is still sad that the Department of the Veterans Affairs, since March 2002, denied over 50% of these CMI claims in errors by stating the illness did not start when the veteran was on active duty or that it is not in the veteran service medical records. Please work with an VA accredited claims representative if this happened to you as this is a Clear and Unmistakable Error (CUE) claim and I have fixed many of them for veterans.
Always use a VA accredited claims agent, Veterans Service Officer (VSO) or lawyer for your VA benefits. You can trust these professionals because they’re trained and certified in the VA claims and appeals processes. They can help you with VA-related needs. Look up the person wanting to help you at the VA’s website. Do not trust your information to just anyone who say they can help you. By law the VA accredited claims agent, Veterans Service Officer (VSO) or lawyer are the only one to help you file your claim or work your appeal.
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