DISABILITYVA program

Gulf War Illness: Undiagnosed Illness Presumptive

Presumptive service connection for chronic undiagnosed illnesses and medically unexplained chronic multisymptom illnesses for veterans who served in the Southwest Asia theater of operations or in Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan, plus certain infectious diseases for service in the locations VA lists.

Available to veterans who served on or after 8/2/1990 in the Southwest Asia theater or in Afghanistan, Israel, Egypt, Turkey, Syria, or Jordan

View on VA.gov

Step-by-step guide

What VA looks for: An undiagnosed illness

Service in a listed place during the Gulf WarActive duty on or after August 2, 1990, in the Southwest Asia theater: 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, and the airspace above them. Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan also count, not including their airspace, and the Gulf War has no end date yet.
Objective signs of a chronic disabilitySigns a doctor can observe, or other signs someone else can verify, such as time lost from work. The rule names fatigue, skin problems, headaches, muscle or joint pain, nerve symptoms, memory or thinking problems, breathing, sleep, stomach, and heart symptoms, weight loss, and menstrual disorders, and the list is open.
Lasting 6 months or moreThe signs have lasted 6 months or more, or have come and gone over a 6-month period. VA counts from the earliest date the evidence shows them.
No known diagnosis explains itHistory, a physical exam, and lab tests do not tie the symptoms to a known clinical diagnosis. A doctor does not have to rule out every possible diagnosis first.

Source: 38 CFR 3.317(e) (opens in new tab); 38 CFR 3.2(i) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); 38 CFR 3.317(a)(3) (opens in new tab); 38 CFR 3.317(b) (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); 38 CFR 3.317(a)(4) (opens in new tab); 38 CFR 3.317(a)(1)(ii) (opens in new tab); 38 CFR 3.317(a)(2)(i)(A) (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab)

Which kind of claim is this?

An undiagnosed illness
Use this when you have chronic symptoms that no known diagnosis explains, whether they started during your service in a listed place or any time after. VA presumes the connection to service, so no medical opinion linking it to service is needed. Since the PACT Act, the illness counts at any level of severity, with no deadline for when it showed up.
Source: 38 CFR 3.317(a)(2)(i)(A) (opens in new tab); 38 CFR 3.317(e) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); VA Form 21-526EZ (opens in new tab)
A medically unexplained multisymptom illness
Use this when a doctor has diagnosed an illness made up of a cluster of symptoms with no clear cause, such as chronic fatigue syndrome, fibromyalgia, or a functional stomach or bowel disorder like irritable bowel syndrome. VA presumes the connection to service for these too, at any level of severity and with no deadline.
1. Service in a listed place during the Gulf WarThe same service as for an undiagnosed illness, above.
2. An illness with no clear causeChronic fatigue syndrome, fibromyalgia, or a functional stomach or bowel disorder in your records counts by name. Another diagnosed illness counts when a VA examiner classifies it as a multisymptom illness with overlapping symptoms and no conclusive cause or disease process; diabetes, multiple sclerosis, and structural stomach or bowel diseases such as Crohn's disease or GERD do not count under this rule.
3. Lasting 6 months or moreThe same 6-month rule as for an undiagnosed illness, above.
Source: 38 CFR 3.317(a)(2)(i)(B) (opens in new tab); 38 CFR 3.317(a)(2)(ii) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); 38 CFR 3.317(e) (opens in new tab); 38 CFR 3.317(a)(4) (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab)
An infectious disease from service in the region
Nine infectious diseases are presumed to come from service in the Southwest Asia theater, or in Afghanistan on or after September 19, 2001, even with no record of the disease during service. The PACT Act did not change these rules, so the time limits and the 10 percent level still apply.
1. Service in the Southwest Asia theater or AfghanistanActive duty in the Southwest Asia theater during the Gulf War, or in Afghanistan (not its airspace) on or after September 19, 2001. Service in Israel, Egypt, Turkey, Syria, or Jordan does not count for these diseases.
2. One of nine listed diseasesBrucellosis, Campylobacter jejuni, Q fever, malaria, tuberculosis, nontyphoid Salmonella, Shigella, visceral leishmaniasis, or West Nile virus.
3. At 10 percent or more within the time limitMost of these must reach a level VA rates at 10 percent or more within 1 year after you left that service. Malaria can also count later when its incubation period began during that service. Tuberculosis and visceral leishmaniasis have no time limit for reaching the 10 percent level.
Source: 38 CFR 3.317(c)(2) (opens in new tab); 38 CFR 3.317(c)(3) (opens in new tab); 38 CFR 3.317(d) (opens in new tab); M21-1 VIII.ii.1.D (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); 38 CFR 3.317(e) (opens in new tab)

What to gather, and what it shows VA

Documents for this benefit: what each is, what it shows VA, and how VA gets it
Document	What it shows	How VA gets it	Have it?
Separation papers (DD214) The record of your service dates, branch, and character of discharge.	Your service dates	VA will request this for you once you file. You can also get your own copy through eVetRecs, SF180, or milConnect for more recent discharges.	Yes
Service personnel records Records of assignments, deployments, awards, and duty stations.	Where and when you served	VA will request these for you once you file and tell VA where and when you served. VA also checks Defense Department deployment and exposure records. You can get your own copy through eVetRecs or SF180.
Service treatment records Medical records from your time in service, such as sick call notes and separation exams.	Symptoms or an illness that began during service	VA will request these for you once you file. You can also get your own copy through eVetRecs or SF180.
VA medical records Records of care at VA medical centers and clinics, including notes, lab results, and other test results.	Your symptoms over time, and what tests found	VA will request these for you once you file. You can review your own VA records online on VA.gov.
Private medical records Records from doctors, hospitals, labs, and therapists outside VA, including x-rays and test results.	Your symptoms over time, and what tests found	Two routes. Send copies to VA yourself, or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them from each provider. The provider name, dates, and condition go on the VA forms, not into BeneVets.
Your own statement Your written account of your symptoms: when they started, how often they come back, and how they affect work and daily life.	Your symptoms and how long they have lasted	VA Form 21-4138, Statement in Support of Claim. You write it and send it to VA. BeneVets does not collect it.
Statements from people who saw your symptoms Written statements from a spouse, relative, friend, coworker, or fellow service member about the symptoms they saw, when those began, and how long they lasted.	What others saw, and for how long	VA Form 21-10210, Lay/Witness Statement. The witness completes it and it goes to VA with your claim.
Records of time lost from work Leave or attendance records, or a statement from an employer, showing work you missed because of the symptoms.	A sign of the illness that others can verify	You send copies to VA with the claim. VA counts time lost from work as a non-medical sign of these illnesses.
Gulf War Registry exam report The report from a free VA Gulf War Registry health exam, if you had one. It records your exposure history and health concerns.	Your exposures and health concerns at the time	Optional. If you had one, say so on your claim, and VA will request the report from the facility.
VA Gulf War exam A VA exam, such as the Gulf War general medical exam, where the examiner records whether your symptoms fit an undiagnosed illness, an unexplained multisymptom illness, or a diagnosis with a known cause.	Which pattern your symptoms fit	VA orders it when it needs more medical evidence to decide. The bar for ordering one is low: your own description of symptoms plus Gulf War service can be enough.

Records and statements go to VA. BeneVets never asks you to upload or type them here.

Steps, in order

Set your start date
Submit an intent to file online, by phone, by mail on VA Form 21-0966, or in person. You then have 1 year to file the full claim, and VA treats a complete claim filed in that year as filed on the intent to file date.
Source: 38 CFR 3.155(b) (opens in new tab); VA.gov: your intent to file (opens in new tab); VA Form 21-0966 (opens in new tab)
Get free help from a VSO
Free help: an accredited VSO can file this with you. Find one near you in the BeneVets VSO directory at Find an accredited VSO near you. VA also accredits attorneys and claims agents, who can charge fees only for work done after VA issues its initial decision on the claim.
Source: VA.gov: accredited representatives (opens in new tab); 38 CFR 14.636(c) (opens in new tab)
Note where and when you served
Write down each place you served in the region and the months and years you were there. VA Form 21-526EZ asks whether you served in the Gulf War hazard locations and when, by month and year.
Source: VA Form 21-526EZ (opens in new tab); 38 CFR 3.317(e) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab)
List your symptoms on paper
On paper, list each symptom, when it started, and how often it comes back. For pain, name the joints or muscles involved; when a claim does not say, VA tries to call you to ask. Keep the list with your papers; BeneVets does not ask for it.
Source: M21-1 VIII.ii.1.B (opens in new tab); 38 CFR 3.317(b) (opens in new tab)
Gather service records
VA will request your DD214, service treatment records, and personnel records for you once you file. Include any copies you already have. For your own copies, use eVetRecs or SF180.
Source: 38 CFR 3.159(c)(3) (opens in new tab); VA.gov: request your military service records (opens in new tab); Standard Form 180 (SF180) (opens in new tab)
Check your VA records
If you get care at VA, VA pulls those records itself. You can review them on VA.gov, including notes and test results, to see what is already there.
Source: 38 CFR 3.159(c)(2) (opens in new tab); VA.gov: review medical records online (opens in new tab)
Handle private medical records
For each private doctor, hospital, or lab, send copies of the records to VA, or complete VA Form 21-4142 and VA Form 21-4142a so VA can request them.
Source: 38 CFR 3.159(c)(1) (opens in new tab); VA Form 21-4142 (opens in new tab); VA Form 21-4142a (opens in new tab)
Ask witnesses for statements
Ask people who have seen your symptoms whether they will complete VA Form 21-10210 about what they saw, when it began, and how long it has lasted. Your own account goes on VA Form 21-4138.
Source: M21-1 VIII.ii.1.C (opens in new tab); VA Form 21-10210 (opens in new tab); VA Form 21-4138 (opens in new tab)
Gather records of missed work
If the symptoms have cost you time at work, gather leave or attendance records, or ask an employer for a written statement. VA counts time lost from work as a sign of these illnesses.
Source: 38 CFR 3.317(a)(3) (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab)
File your claim
File VA Form 21-526EZ within the year after your intent to file. Answer the toxic exposure questions with the places and dates you served, list each symptom or illness, and note each one as related to Gulf War environmental hazards. If you had a Gulf War Registry exam, say so.
Source: 38 CFR 3.155(b) (opens in new tab); VA Form 21-526EZ (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab)
Go to any exam VA schedules
VA asks for a claim exam only when it needs more information to decide. To reschedule, call the number on your appointment letter at least 48 hours ahead; rescheduling may delay the claim. If you miss the exam on a first claim without good cause, VA rates the claim on the evidence it already has.
Source: VA.gov: VA claim exam (opens in new tab); 38 CFR 3.159(c)(4) (opens in new tab); 38 CFR 3.655(b) (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab)
Track your claim
Track the claim on VA.gov and answer any VA request for more evidence. You can add evidence at any time.
Source: VA.gov: after you file your disability claim (opens in new tab)
Read the decision, issue by issue
Each issue VA decides has its own review options: a Supplemental Claim (VA Form 20-0995), a Higher-Level Review (VA Form 20-0996), or a Board Appeal (VA Form 10182). VA may rate several symptoms together as one issue. A review filed within 1 year of the decision notice keeps the original effective date.
Source: 38 CFR 3.151(c) (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); 38 CFR 3.2500(h) (opens in new tab); VA.gov: decision reviews and appeals (opens in new tab); VA Form 20-0995 (opens in new tab); VA Form 20-0996 (opens in new tab); VA Form 10182 (opens in new tab)

Good to know

The PACT Act removed the date and the 10 percent level

The regulation, 38 CFR 3.317, still says an undiagnosed or multisymptom illness must show up during service in the theater or reach 10 percent by December 31, 2026. Since August 10, 2022, the PACT Act counts these illnesses at any level, even 0 percent, whenever they show up. VA follows the law until it updates the regulation.

Source: 38 CFR 3.317(a)(1)(i) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab)

You can claim symptoms without a diagnosis

You do not need a diagnosis to file. List each symptom on VA Form 21-526EZ, such as fatigue or joint pain, and note it as related to Gulf War environmental hazards. With Gulf War service, VA accepts a claim for these symptoms as substantially complete and helps gather evidence for it, and it looks at the Gulf War rules even when a claim does not mention them.

Source: M21-1 VIII.ii.1.B (opens in new tab); 38 CFR 3.159(c) (opens in new tab); VA Form 21-526EZ (opens in new tab)

Your description of your symptoms carries weight

For these illnesses, your own statement describing your symptoms can be enough for VA to order an exam, and it counts as evidence when medical records show no diagnosis. Statements from people who saw the symptoms can show when they began and how long they lasted. VA does not try to back up a lay statement unless it has reason to doubt it.

Source: M21-1 VIII.ii.1.C (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab)

A diagnosis does not end the Gulf War review on its own

If a doctor has named a condition but it does not explain all of your symptoms, VA can still order a Gulf War exam for the rest. When a diagnosis with a known cause fully explains the symptoms, this rule does not apply. VA then looks at other routes, such as direct service connection, and asks the examiner about toxic exposure during service.

Source: M21-1 VIII.ii.1.B (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab); 38 CFR 3.317(a)(1)(ii) (opens in new tab)

The Gulf War Registry exam is an optional health exam

VA offers a free Gulf War Registry health exam that records your exposures and health concerns. It is optional. Compensation still takes a claim on VA Form 21-526EZ. If you had a registry exam, mention it on your claim; VA requests the report and considers it.

Source: VA.gov: Gulf War Veterans health issues (opens in new tab); M21-1 VIII.ii.1.B (opens in new tab); M21-1 VIII.ii.1.C (opens in new tab); VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); VA Form 21-526EZ (opens in new tab)

When the presumption does not apply

VA does not pay under this rule when there is affirmative evidence that the illness came from a cause other than your service in a listed place, that something after you left the region caused it, or that it came from willful misconduct or alcohol or drug abuse.

Source: 38 CFR 3.317(a)(7) (opens in new tab); M21-1 VIII.ii.1.A (opens in new tab)

Later conditions tied to the infectious diseases

If VA presumes service connection for one of the nine diseases and you are later diagnosed with a condition VA links to it, such as reactive arthritis after Shigella or Guillain-Barre syndrome after malaria, VA asks for a medical opinion on whether the disease caused it. Some of these links have their own time limits.

Source: 38 CFR 3.317(d) (opens in new tab); M21-1 VIII.ii.1.D (opens in new tab)

Denied before?

If VA denied a claim in the past and now treats the condition as presumptive, VA.gov says you can file a Supplemental Claim on VA Form 20-0995.

Source: VA.gov: Gulf War illnesses linked to Southwest Asia service (opens in new tab); VA Form 20-0995 (opens in new tab)

BeneVets is informational and is not an accredited representative. Free help: an accredited VSO can work through VA benefits with you at no cost. Find an accredited VSO near you