Section E - Claims Based on Service in Southwest Asia - Updated 9/23/14

Subpart II - Compensation
Chapter 1 - Development

Overview


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In this Section
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18.   Developing Claims Based on Southwest Asia Service
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Introduction
This topic contains information on developing Southwest Asia claims, including
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 ·      initial development action on a new Southwest Asia service claim

 ·      requesting service department records in a Southwest Asia claim, and

 ·      the action to take when the Veteran alleges exposure to environmental hazards but claims no disability. 
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Change Date
September 23, 2014 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Initial Development Action on a New Southwest Asia Service Claim
When preparing the initial development letter for any new claim for service connection for a qualifying disability under 38 CFR 3.317 resulting from service in Southwest Asia
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<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      use the GW special issue paragraphs in Veterans Benefits Management System (VBMS) to request evidence from the Veteran, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      enclose the attachment, “Submitting Evidence for Claims About Gulf War Undiagnosed Illnesses,” if necessary.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on claims for service connection for disabilities associated with service in Southwest Asia, see M21-1MR, Part IV, Subpart ii, 2.D. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 18. Developing Claims Based on Southwest Asia Service, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Requesting Service Department Records in a Southwest Asia Claim
<p class="MsoBlockText">In addition to service treatment records (STRs), request
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      clinical records, if the Veteran furnishes information on the application about specific inpatient treatment, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the dates of service in Southwest Asia during the Gulf War period that began on August 2, 1990, if this information is not already of record.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Concurrently request clinical records and STRs, if both are needed.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Confirm the Veteran’s service in Southwest Asia by calling the Veteran’s Reserve or National Guard unit if

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the Veteran is, or was, at the time of service in Southwest Asia, a member of a Reserve or National Guard unit, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     this information is not received following usual service department requests.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Be sure to document the telephone call to the Veteran’s Reserve or National Guard unit on VA Form 27-0820, Report of General Information .

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on requesting

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      clinical records, see M21-1MR, Part III, Subpart iii, 2.B.12.c, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      STRs, see M21-1MR, Part III, Subpart iii, 2. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   Action to Take When the Veteran Alleges Exposure to Environmental Hazards but Claims No Disability
<p class="MsoBlockText">A claim is not substantially complete if a Veteran alleges exposure to environmental hazards during service, but does not identify the medical condition or symptom for which service connection is claimed. In cases such as these
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      inform the Veteran that he/she must identify a specific disability, since exposure in and of itself is not a disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      ask the Veteran to identify the disability(ies) that resulted from exposure to environmental hazards during service.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Do not

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     process the claim as a denial, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     establish end product (EP) control for the incomplete claim.

<p class="MsoBlockText">Whenever possible, telephone the Veteran to obtain the information needed to substantiate the claim. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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19.   Evidence Required to Process Claims Based on Southwest Asia Service
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Introduction
<p class="MsoBlockText">This topic contains information on the evidence required to process Southwest Asia claims, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting medical evidence in claims under 38 CFR 3.317

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      evidence supporting a claim for service connection for an undiagnosed illness

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nonmedical indications of an undiagnosed disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering lay statements in claims for service connection for an undiagnosed illness

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determining the credibility of a lay statement

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting medical examinations in claims under 38 CFR 3.317, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      notice to examiners in Southwest Asia claims. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 23, 2014 <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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a.   Requesting Medical Evidence in Claims Under 38 CFR 3.317
<p class="MsoBlockText">Request reports of all private and Department of Veterans Affairs (VA) medical treatment that is indicated by the Veteran, both during and after service, including records such as
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      statements or reports from

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     doctors

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     hospitals

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     laboratories

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     medical facilities, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     mental health clinics

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      x-rays, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      physical therapy records.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   If the Veteran indicates that a GW Registry examination has been conducted, request the examination report from the appropriate medical facility. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued">19. Evidence Required to Process Claims Based on Southwest Asia Service, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Evidence Supporting a Claim for Service Connection for an Undiagnosed Illness
<p class="MsoBlockText">If the disability claimed is an undiagnosed illness, evidence supporting the claim may be either medical evidence or nonmedical indications that can be independently observed or verified. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Nonmedical Indications of an Undiagnosed Disability
<p class="MsoBlockText">Nonmedical indications of a disability include
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      events such as time lost from work, and/or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      evidence

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     that a Veteran has sought medical treatment for his or her symptoms, and/or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     affirming changes in the Veteran’s appearance, physical abilities, and mental or emotional attitude.

<p class="MsoBlockText">

<p class="MsoBlockText">The provisions of 38 CFR 3.317 state that the nonmedical indicators must be independently verifiable. This means that it must be possible to obtain verification of the nonmedical indicators from an independent source. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Considering Lay Statements in Claims for Service Connection for an Undiagnosed Illness
<p class="MsoBlockText">Lay statements (statements from persons not trained in a medical profession) may be especially important in cases where an undiagnosed illness
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      is manifested solely by the symptoms which the Veteran reports, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      might not be verifiable by medical examination. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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e.   Determining the Credibility of a Lay Statement
<p class="MsoBlockText">A lay statement that is based on personal observation or experience is credible if the
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      person making the statement   is/was in a position to know the facts attested to

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      statement is sufficiently specific to address the facts, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      statement is not contradicted by evidence of record that is more credible.

<p class="MsoBlockText">

<p class="MsoBlockText">On occasion, the lay statement may require clarification. Generally, however, unless there is reason to doubt the statement’s credibility, do not attempt to corroborate it. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page <span style="font-size:12.0pt;font-family:"Times New Roman","serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA">
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<p class="MsoNormal">   

<p class="MapTitleContinued"> 19. Evidence Required to Process Claims Based on Southwest Asia Service, Continued {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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f.   Requesting Medical Examinations and Opinions in Claims Under 38 CFR 3.317
<p class="MsoBlockText"> The threshold for requiring an examination is low.
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<p class="MsoBlockText">

<p class="MsoBlockText"> A Gulf War examination is necessary for a Veteran who

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      has qualifying service in the Southwest Asia Theater of Operations as defined in 38 CFR 3.317(e) (2) and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      submits medical or lay evidence documenting chronic or recurrent symptoms lasting at least 6 months that fit the description of conditions listed under 38 CFR 3.317(a) (2) (B) or 38 CFR 3.317 (b).

<p class="MsoBlockText">

<p class="MsoBlockText"> Important:    The Veteran does not have to explicitly state that the claim is “due to Gulf War.”   

<p class="MsoBlockText">   

<p class="MsoBlockText"> When the above requirements are met, and there is a current known clinical diagnosis shown in the evidence, an examination is still required unless service connection can be granted for the diagnosis under other provisions.

<p class="MsoBlockText">

<p class="MsoBlockText"> Example:    A Veteran with Southwest Asia service submits a claim for right knee pain. STRs do not show any treatment for the knee. Current medical records show complaints for the last year of knee pain with a diagnosis of right knee strain. A Gulf War examination and opinion must be ordered prior to deciding the claim.

<p class="MsoBlockText">

<p class="MsoBlockText"> If the record contains competent medical evidence of a medically unexplained multi-symptom illness, such as chronic fatigue syndrome during the 38 CFR 3.317 presumptive period, it may be possible to proceed with a grant without a VA examination.

<p class="MsoBlockText">

<p class="MsoBlockText"> Reference  :   For more information on evaluating evidence, see M21-1MR, Part III, Subpart iv, 5.1. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page <span style="font-size:12.0pt;font-family:"Times New Roman","serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA">
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<p class="MsoNormal">

<p class="MapTitleContinued"> 19. Evidence Required to Process Claims Based on Southwest Asia Service, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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<p class="MapTitleContinued">19. Evidence Required to Process Claims Based on Southwest Asia Service, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Notice to Examiners in Southwest Asia Claims
<p class="MsoBlockText">''Please examine this Veteran, who has service in Southwest Asia, for any chronic disability pattern. Please review the claims folder as part of your evaluation and state, with your findings, that it was reviewed. The Veteran has claimed a disability pattern related to  [  insert symptoms described by Veteran]. ''
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<p class="MsoBlockText">Please provide a medical statement explaining whether the Veteran’s disability pattern is: 

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<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      (1) an undiagnosed illness

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      (2) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or 

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      ''(4) a disease with a clear and specific etiology and diagnosis. ''

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<p class="MsoBlockText">If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (3) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (4) a disease with a clear and specific etiology and diagnosis, then please provide a medical opinion, with supporting rational, as to whether it is “at least as likely as not” that the disability pattern or diagnosed disease is related to a specific exposure event experienced by the Veteran during service in Southwest Asia.
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