Undiagnosed Illness

Gulf War Illness (GWI) is only a term and cannot be used when filing for a claim under 38 CFR §3.317.  If someone files a claim by saying, “I am filing for Gulf War Illness due to my service,” the Regional Office will send a letter asking what symptoms are being considered.  This is where many doctors, the WRIISC, and some veterans pushing for change get it wrong.  The law does not have any term of GWI in it, nor is there an IC10 code for it. However, if you do suffer from undiagnosed muscle pain, the ICD-10 code M62. 9 for Disorder of muscle, unspecified is a medical classification to use.  If a doctor does diagnose you with GWI in your records, is what he/ she is saying really wrong?  No one can really tell without the doctor spelling out all of the symptoms that you have and the testing that was done to rule out the other different types of diagnosed illness that might have caused the symptoms. Without a very detailed reasoning, it will be ready for the long road to winning a claim or getting any needed medical help.

GWI is just a term that refers to the listed symptoms first documented among the veterans as they came home from Operation Desert Storm in 1991.  More than one in four of these veterans are estimated to experience a wide range of unexplained symptoms or a medically unexplained chronic multi-symptom illness (CMI) – such as fatigue, pain, and problems with digestion – for which there is no visible cause or explanation.  Many have had these conditions since their deployment or soon after their return home.  Still others became ill later in their lives.

  It took years of strong advocacy by the NGWRC and other VSO’s before much of the medical community, including the VA, accepted GWI as a medical disorder.  Today, the exact cause remains unknown, and treatment is still far off.  Scientific research proves that whatever the cause, the disability is real, and it is likely related to military service in the Southwest Asia area of operations.  Treatment methods and compensation ratings for this condition are still evolving.

When is a symptom not an undiagnosed illness?

You may have many symptoms of pain in your joints, muscles, chest or you have other problems. If it is from the symptoms of a diagnosed illness, it cannot be claimed as an “undiagnosed illness” from the gulf war. You cannot file for sleep apnea, arthritis, Diabetes Type I or Type II, Multiple Sclerosis, coronary artery disease and GERD under this law.  They are not presumptive illnesses as they have a known cause to the diagnosis.  Some of these are addressed in the rulemaking found in the federal register and some in the 38 CFR 3.317. 

The C&P examiner will be looking at everything you are diagnosed with to see if any of it can cause the same symptoms.  This is in keeping with the law passed by Congress; if the symptom can be assigned to a known cause, then it cannot be an undiagnosed illness.  This is concluded by means of testing.  Decisions are not always satisfying, however.  Sometimes the examiner will “overreach” in writing the medical opinion or give a medical opinion that has no medical rationale or facts to uphold it.  Other times, the opinion will show the examiner does not understand the field they are talking about.  These are the times you need to point out the inadequate exams.

  We have seen problems where veterans did have many symptoms in their records that they filed for, and the Gulf War General Medical examination will show “no” to most of them anyway.  In those cases, the examiner may not have read the veteran’s statements or the research the VSO sent in with the claim.  Each one of these can make the exam inadequate.

Preparing a claim for an undiagnosed illness

  Any claim under 38 CFR § 3.317 can be very hard, but a claim for undiagnosed illness can be one of the hardest.  Some veteran service organization representatives (VSO reps), agents, and lawyers have a hard time preparing these claims and working an appeal if it becomes necessary.  That is why you, the veteran, will need to get a lot of paperwork done to help your POA with your claim –even more than in most claims.  The veteran is the one who knows the times he/she went to the doctor’s office for the symptoms, and he/she is the only one who can write about the symptoms and how they are affecting his/her life.  If you went to non-VA doctors, you must get the records, fill out a VA Form 21-4142a, and list all the doctors that have treated your symptoms since the service.   Use the information in this chapter to help prepare a claim for undiagnosed illness or for specific symptoms which have not been associated with any diagnosis.

If you have a diagnosed illness with the same symptoms and it is not a medically unexplained chronic multi-symptom illness as outlined in the regulation, then you should file under a different section of VA regulations.  You may or may not have a 38CFR§ 3.317 (a) claim for presumptive service connection. 

Key elements that should be established in your claim

  To receive compensation for an undiagnosed illness due to your service in the Gulf War, you will need to include/prove some of the following to the VA:

1. US military service in the Southwest Asia Theater between 2 Aug, 1990 and the current date*.

2. You have an undiagnosed illness of some type.  (You cannot just claim “Gulf War Illness.”)

3. You have “Objective Medical Evidence” as per § 3.317(3)
   1. Records from work showing time lost due to the symptoms you have.
   2. A detailed statement from you on the symptoms.  This need to be on VA-Form 21-4138.
   3. A detailed statement from others that have firsthand knowledge of you and your conditions(s) and service. This needs to be on VA-Form 21-4138.

4. All medical records for the symptoms that the doctors could not diagnose.

Use your DD214. Have your VSO or the VA certify it before THEY fax it to the VA Regional Office (VARO).  Also, send in a 21-4138 stating what unit you were in.  You may say: B Btry, 4th BN 5th FA, 1st ID, Ft. Riley Kansas, but it may be better if you did it like this: 2nd Battalion of the 505th Parachute Infantry (UIC WABVA0).  If you are submitting a claim for PTSD, it may be best to reference the UIC on the orders sending you to and from the unit and theater of operations.  Sometimes claimants are told they were not in the Gulf War, and this attention to detail will help stop that.  Remember you are working to win at the VBA and/or BVA.

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