What are Undiagnosed Illnesses and Medically Unexplained Chronic Multi-symptom Illness (MUCMI)

This refers to chronic disability resulting from an undiagnosed illness or combination of undiagnosed illnesses or medically unexplained chronic multisymptom illnesses that exists for six months or more.

Who qualifies for these benefits?

Veterans who served in the following locations, including the airspace above them, from August 2, 1990:

• Iraq
• Kuwait
• Saudi Arabia
• the neutral zone between Iraq and Saudi Arabia
• Bahrain
• Qatar
• the United Arab Emirates
• Oman
• the Gulf of Aden
• the Gulf of Oman
• the Persian Gulf
• the Arabian Sea
• the Red Sea

Veterans who served in the following locations, excluding the airspace above them, from August 2, 1990:

• Afghanistan
• Egypt
• Israel
• Jordan
• Turkey
• Syria

What are the presumptive disabilities under this law?

• Undiagnosed illnesses
• Medically Unexplained Chronic Multi-symptom Illness (MUCMI)

1. Undiagnosed Illness

Undiagnosed illnesses are a cluster of medically unexplained chronic symptoms, existing for six months or more, which cannot be explained by a medical diagnosis. It is akin to the more popular term “Gulf War syndrome”.

However, it is important to remember that you do not want to file a claim for “an undiagnosed illness” or “Gulf War syndrome”. If you do, VA will treat your claim as in incomplete claim and ask you to specify a disability.

If you submit a claim, you must describe your symptoms. You can state that you believe they were caused by your Gulf War service, but you must describe your symptoms.

Signs or symptoms of undiagnosed illness (and medically unexplained chronic multisymptom illnesses) include, but are not limited to the following:

• Fatigue
• Signs or symptoms involving skin
• Headache
• Muscle pain
• Joint pain
• Neurological signs or symptoms
• Neuropsychological signs or symptoms
• Signs or symptoms involving the respiratory system (upper or lower)
• Sleep disturbances
• Gastrointestinal signs or symptoms
• Cardiovascular signs or symptoms
• Abnormal weight loss
• Menstrual disorders

2. MUCMI

The term medically unexplained chronic multi-symptom illness on the other hand, means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.

This includes:

• Chronic fatigue syndrome
• Fibromyalgia
• Functional gastrointestinal disorders (FGID) (excluding structural gastrointestinal diseases)
  • FGID includes:
    • Irritable bowel syndrome
    • Functional dyspepsia
    • Functional vomiting
    • Functional constipation
    • Functional bloating
    • Functional abdominal pain syndrome
    • Functional dysphagia

These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing.

Structural gastrointestinal disorders, on the other hand, are NOT covered under this law. These include inflammatory bowel disease (IBD) such as ulcerative colitis and Crohn’s disease as these conditions are considered to be organic or structural diseases which can be confirmed by abnormalities seen on x-ray, endoscopy, or through laboratory tests.

What is not considered a MUCMI?

Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained.

The Court has ruled that an illness can count as a medically unexplained chronic multisymptom illness (MUCMI) if doctors don’t fully understand either what causes it (etiology) or how it works in the body (pathophysiology).

You don’t need both parts to be unclear – just one is enough.

If both the cause and how it works in the body are partly understood, then it is not a MUCMI.

But if only one of those is partly understood, it can still be a MUCMI.

The Court also said that each Veteran’s case must be looked at individually.

Even if doctors partly understand the illness in general, it might still be “medically unexplained” for a specific Veteran if the cause or how it affects that person’s body is unclear.

Finally, the Court said that general medical articles or studies can’t prove what caused a Veteran’s illness by themselves.

If the cause of an illness is completely proven by science, then it’s not medically unexplained. But if the cause isn’t proven with full certainty, then the VA must look closely at the Veteran’s particular case to decide if it’s medically unexplained.

Are these disabilities presumptive?

Yes, undiagnosed illnesses and MUCMI’s are considered presumptive disabilities.

Meaning, if you have a disability that is classified as an undiagnosed illness or a MUCMI, and you have qualifying service as shown above, then VA will presume that your disability is caused by your service.

Prior to the PACT Act, it was required that the above disabilities should have manifested to 10 percent or more before they could be considered presumptive. However, the PACT Act removed this requirement. Service connection on a presumptive basis for undiagnosed illnesses and MUCMI’s can now be established even if they are rated 0%.

Important links, regulations and case law

38 CFR 3.317

38 USC 1117

Stewart v Wilkie

Complete list of recognized Gulf War and Southwest Asia locations for Presumptive Conditions