GULF WAR CLAIMS GULF WAR ILLNESS CMI MUCMI

— GULF WAR CLAIMS — GULF WAR ILLNESS, CMI, MUCMI

GULF WAR ILLNESS • CURRENTLY IS NOT RECOGNIZED AS ITS OWN DISTINCT ILLNESS • I. E. A VETERAN CANNOT MAKE A CLAIM FORG “ ULF WAR ILLNESS” AND HAVE IT RATED BY THE VA AS “GULF WAR ILLNESS” • INSTEAD, GULF WAR VETERANS CAN TRY TO GET SYMPTOMS OFGULF WAR ILLNESS CONNECTED VIA ”UNDIAGNOSED ILLNESS” OR AS A M “ UCMI” • VA THEN LOOKS FOR ANALOGOUS RATING CODE

2017 GAO REPORT • VA DENIED 83% OFGULF WAR CLAIMS FROM 2010 – 2015 • ON AVERAGE, GULF WAR CLAIMS TAKE 4 MONTHS LONGER TO PROCESS THAN OTHER CLAIMS

ISSUES IDENTIFIED IN 2017 GAO REPORT • “GULF WAR ILLNESS” IS NOT WELL UNDERSTOOD • BECAUSE OF THE WIDE ARRAY OF SYMPTOMS • VA EXAMINERS AND ADJUDICATORS ARE NOT WELL TRAINED

• • GAO’S RECOMMENDATIONS FOR VA • •

NATIONAL ACADEMY OF SCIENCES • IN 2013: CONCLUDED THERE IS A “SUFFICIENT ASSOCIATION” BETWEEN SERVICE IN THE GULF WAR AND “CHRONIC MULTISYMPTOM ILLNESS” • (WHICH IS VARIOUSLY CALLED GULF WAR ILLNESS/GULF WAR SYNDROME)

VA CONTRACTED WITH NAS TO DEVELOP CASE DEFINITION 1 OF “CHRONIC MUILTISYMPTOM ILLNESS” • UNABLE TO AGREE ON A NEW CASE DEFINITION, BUT NAS RECOMMENDED VA USE EXISTING CASE DEFINITIONS • NAS ALSO SUGGESTSVA REFER TOC“HRONIC MULTISYMTPOM ILLNESS” AS “GULF WAR ILLNESS” 1“A case definition is a set of standard criteria for classifying whether a person has a particular disease, syndrome, or other health condition. ” “Use of an agreed-upon standard case definition ensures that every case is equivalent, regardless of when or where it occurred, or who identified it. ” (CDC https: //www. cdc. gov/csels/dsepd/ss 1978/lesson 1/section 5. html)

WHY DOES THIS MATTER • RECALL THE PROBLEMS WITH ADJUDICATION IDENTIFIED IN THE REPORT • CMI IS A DIAGNOSTIC ENTITY - MEANING IT SHOULD HAVE A RATING SCHEDULE • ADVOCATES HAVE LONG CALLED FOR A BETTER RATING SCHEDULE FORGULF WAR ILLNESS (2017 CONGRESSIONAL TESTIMONY)

VA’S RESPONSE • VA RESPONDED THAT CURRENT LAW ALREADY PROVIDES FOR GULF WAR VETERANS WITH C “ HRONIC MULTISYMPTOM ILLNESS” BECAUSE OF 38 USC 1117 AND ITS REFERENCE TO “MUCMI” • VA CONFUSESCMI AND MUCMI • MUCMI IS A DESCRIPTION OF A CATEGORY OF ILLNESSES Irritable Bowel Syndrome Chronic Fatigue Syndrome Fibromyalgia “MUCMIS” ANY MEDICALLY UNEXPLAINED CHRONIC MUTLISYMPTOM ILLNESS (A CATEGORY FOR ILLNESSES THAT INVOLVE CLUSTERS OF CHRONIC SYMPTOMS THAT ARE MEDICALLY UNEXPLAINED) • CMI (GULF WAR ILLNESS) IS A DISTINCT ILLNESS • CMI (GULF WAR ILLNESS) FITS IN THECATEGORY OF A “MUCMI” Chronic Multisymptom Illness (Gulf War Illness)

GWI and CFS/IBS have overlapping symptoms, but GWI is distinct Chronic Fatigue Syndrome 38 CFR 4. 88 a FATIGUE + PAIN SYMPTOMS Six (6) or more of the following: Joint Pain Muscle Pain GASTROINTESTIN AL SYMPTOMS FATIGUE SYMPTOMS Diarrhea Fatigue Sleep Problems Nausea Gulf War Illness Symptoms NEUROLOGIC SYMPTOMS SKIN PROBLEMS Rashes Other Problems RESPIRATORY SYMPTOMS Persistent Cough Wheezing Memory Problems Headaches Dizziness Mood Changes Not included • • acute onset of the condition, low grade fever, nonexudative pharyngitis, palpable or tender cervical or axillary lymph nodes, generalized muscle aches or weakness, fatigue lasting 24 hours or longer after exercise, headaches (of a type, severity, or pattern that is different from headaches in the pre-morbid state), • migratory joint pains, • neuropsychologic symptoms, • sleep disturbance. Irritable Bowel Syndrome 38 CFR 4. 114 (7319) • Severe; diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress • Moderate; frequent episodes of bowel disturbance with abdominal distress • Mild; disturbances of bowel function with occasional episodes of abdominal distress

MUCMI VS CMI MUCMI (MEDICALLY UNEXPLAINED CHRONIC MULTISYMPTOM ILLNESS) • CMI (CHRONIC MULTISYMPTOM ILLNESS) • IS A DISTINCT ILLNESS • WHICH HAVE A CLUSTER OF SYMPTOMS THAT NAS HAS CONCLUDED THAT THIS DISTINCT “ ILLNESS” (”DIAGNOSTIC ENTITY” )IS ARE CHRONIC AND MEDICALLY UNEXPLAINED SUFFICIENTLY ASSOCIATED WITH SERVICE IN REFERS TO A BROAD CATEGORY OF ILLNESSES • GULF WAR EXAMPLES: • CHRONIC FATIGUE SYNDROME (CFS) • IRRITABLE BOWEL SYNDROME • FIBROMYALGIA • THESE ARE ONLY EXAMPLES • NAS TOLDVA TO CALLCHRONIC MULTISYMPTOM ILLNESS “GULF WAR ILLNESS” TO AVOID CONFUSION

• BECAUSE NAS HAS CONCLUDED THAT CMI (GULF WAR ILLNESS) IS A DISTINCT ILLNESS INVOLVING A CLUSTER OF SYMPTOMS THAT ARE CMI (GULF WAR ILLNESS) CHRONIC AND MEDICALLY UNEXPLAINED, CMI (GULF WAR ILLNESS) IS A MUCMI AND A VETERAN WITH CMI (GULF WAR ILLNESS) SHOULD QUALIFY FOR PRESUMPTIVE SERVICE CONNECTION • FUTURE ISSUE: PROPER RATING WITH A NEWLY CREATED SCHEDULE