VA Adds FGIDs to Growing List of Gulf War Presumptives

(91outcomes.com) - The U.S. Department of Veterans Affairs (VA) has finalized its formal rulemaking process and added functional gastrointestinal (G-I) disorders (excluding structural 
gastrointestinal diseases) to the growing list of conditions 

VA presumes FGIDs to be related to Gulf War service for the purpose of VA service-connected disability claims.

According to VA:  

Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. Specific functional gastrointestinal disorders include, but are not limited to, irritable bowel syndrome, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and 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. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis.  [Note to paragraph (a)(2)(i)(B)(3)]

The new ruling does not include Gastro-Esophageal Reflux Disease (GERD), as some veterans had hoped.  The ruling also excludes structural G-I disorders 

VA received eight comments in relation to the draft rule.  Five were general in nature.  

A sixth recommended VA include GERD or "bowel inflammatory conditions."  VA responded to the comment but denied including inflammatory bowel conditions like Crohn's Disease and Inflammatory Bowel Disease (IBD) based on the IOM recommendations that cover solely functional, and not structural G-I disorder. GERD was therefore also denied inclusion under the new rule.  

A seventh comment was related to disorders based on vibration experienced by Navy Seabees.  VA clarified that the cause of illness is not needed to approve a Gulf War presumptive claim under the new rule and therefore no change to the rule language was needed.

An eight comment recommended VA backdate the date of claim as was done under a legal case, Nehmer v. United States Veterans' Administration.  Because the Nehmer case applied solely to the specifics of that case, VA made no further changes to the rule language.  

Finally, VA did make several changes to the rule language to add clarity.  The changes are discussed in the Federal Register announcement of the final rule.  

Functional G-I Disorders (FGIDs) are the latest, but by no means the only condition on VA's list of Gulf War "presumptives"-- conditions that VA presumes to be related to service in the Gulf War theater of operations anytime after August 2, 1990.  An end date for the Gulf War period has never been determined and so still applies to troops currently serving in Iraq, Saudi Arabia, Kuwait, Qatar,  Bahrain, and the Persian Gulf waters, among others.

Other Gulf War presumptives include:

Undiagnosed or ill defined conditions
Chronic Fatigue Syndrome
Fibromyalgia
Irritable Bowel Syndrome
For Gulf War and Afghanistan War veterans service-connected with any of nine rare endemic diseases, a broad range of symptoms and conditions presumed to be the result of the disease.  The nine diseases include malaria, leishmaniasis, and seven others.
Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease).  The ALS presumptive is broad and applies to any qualifying military service
Multiple Sclerosis (MS), if within seven years of military discharge.  The MS presumptive also applies not just to Gulf War veterans, but to veterans with any qualifying military service. 

In order for VA to  approve a Gulf War veteran's service-connected disability claim for Gulf War presumptives or other service-connected health conditions, the veteran must formally file a claim with VA.  

Veterans who apply should already have documentation that a medical doctor has determined they have the specific presumptive condition or conditions.  

To best support the veteran's VA claim in the case of undiagnosed illness, the medical doctor should have written an opinion in the veteran's medical records detailing the "unexplained" symptoms.  

--Anthony Hardie, Madison, Wis.