A lot has been learned about Gulf War Illness (GWI) (aka Gulf War Syndrome) since the 1990s. A lot remains a mystery. With a new generation of veterans resulting from the global war on terrorism, veterans of the first Gulf War who suffer from undiagnosed or poorly diagnosed illnesses may feel like their issues are being put on the back burner. This is not the case. To insure that their needs are being addressed, it is a good idea to revisit the specific problems associated with claims for service-connected disabilities based on Gulf War-related illness.



The first thing to remember is that not all Gulf War veterans have GWI. Gulf War veterans, like veterans of all conflicts (and even peacetime veterans), suffer injuries and the onset or aggravation of illness during their military service. Consequently, direct service connection is available though traditional avenues of veterans' advocacy (for example, direct service connection, disability secondary to a service-connected disorder, or aggravation of a disorder that existed prior to military service). This applies to physical and psychiatric disorders, such as gunshot and shrapnel wounds, orthopedic injuries and Post-traumatic Stress Disorder.

Entitlement to benefits for GWI depends on whether the veteran is a "Gulf War veteran," as defined by VA regulations served on active duty in the Southwest Asia theater of operations during the Gulf War era (August 2, 1990, through a date as yet undetermined).

The next thing to consider is whether the symptoms are indicative of undiagnosed illness. It is important to remember that the presumption of service connection for undiagnosed GWI does not apply to diagnosed conditions. Rather, the presumption requires that a symptom, or constellation of symptoms, defy diagnosis. These symptoms include fatigue, rashes or other dermatological conditions or skin symptoms, headache, muscle pain, joint pain, neurological symptoms, neuropsychiatric symptoms, upper and lower respiratory symptoms, sleep disturbances, gastrointestinal symptoms, cardiovascular symptoms, abnormal weight loss and menstrual disorders, among others. The VA has also added amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) to the list.

As with any claim for service connection, documentation of symptomatology should primarily be from a physician or psychiatrist. The doctor should be made aware of the rule that precludes diagnosed diseases and should also distinguish between those symptoms that might be compatible with a particular diagnosis and those that are not. The veteran may then be able to seek traditional direct service connection for the diagnosed symptoms and presumptive service connection for GWI for the remaining symptoms. When presenting this type of medical evidence to the VA, it is important to emphasize that the doctor's identification of a symptom or group of symptoms does not necessarily constitute a diagnosis (that is, respiratory distress, headache, sleep disturbance, joint pain, chronic sinus trouble).

The VA also can consider a veteran's own descriptions of his or her symptoms, particularly as to when the symptoms first appeared, their severity, and how they affect the veteran's daily routine. Such non-medical indicators include time lost from work, evidence that the veteran sought treatment for the symptoms and changes in the veteran's appearance, behavior, and physical and emotional abilities. Veterans should also keep a daily log or journal of the nature and severity of their symptoms.

VA regulations also requires that the symptoms be chronic, that is, they must persist for at least six months. Disabilities may be considered chronic even if there are intermittent episodes of improvement and worsening.

Another requirement for service connection is that the disability resulting from the undiagnosed illness either appear during deployment in the Southwest Asia theater of operations or become manifest to a degree of 10 percent or more not later than December 31, 2006. The 10 percent threshold refers to the level of disability assigned to service-connected disorders under the VA's schedule of rating disabilities, and means that the severity of the symptoms meets the requirements for the VA's lowest level of disability compensation payments.

The biggest obstacle to a PGW veteran seeking compensation for service-related illness occurs when his or her symptoms have been diagnosed. Some doctors do not like to admit that they do not know what is going on. As a result, some will try to squeeze symptoms into a specific diagnosis. In these cases, the veteran should have the doctor distinguish between diagnosis- related symptoms and other symptoms present (especially overlapping symptoms that might support one diagnosis, but when considered independently or in conjunction with the constellation of symptoms, defies diagnosis). The doctor should be asked if he or she can affirmatively state that a diagnosis cannot be rendered.

A veteran has essentially two options in situations where a diagnosis or diagnoses have been rendered. First, he or she can try to rebut the diagnosis with another doctor's opinion. Second, the veteran can abandon the Gulf War Illness approach and seek benefits under one of the traditional theories of service connection direct, secondary, or aggravation. As a practical matter, once a diagnosis has been rendered, focus on direct service connection by obtaining evidence that links the current disorder to symptoms that manifested during the entire period of active service, and not solely for the period of deployment.

If veterans do not have any medical evidence in support of their claims, then they should request the VA to provide a Gulf War registry examination. The registry is available to any Gulf War veteran and is designed to report and identify illnesses among such veterans.

Gulf War veterans should seek the help of experienced veterans service representatives to help them present their claims to the VA. Service representatives are familiar with the VA laws and procedures that must be satisfied in order to receive an award of service connection. Their services are readily available and are provided without charge.