MUCMI (medically unexplained chronic multisymptom illness) and CMI (chronic multisymptom illness) are disabilities that are characterized by clusters of symptoms, such as fatigue, chronic pain, and digestive problems, rather than a specific diagnosis or cause. Bowing to pressure in 1999, Congress passed the Persian Gulf War Syndrome Compensation Act. This act recognized a presumption of a service connection for MUCMI for Gulf War veterans.
This was supposed to help veterans of the Persian Gulf War to overcome obstacles in proving Gulf War Syndrome, a type of MUCMI, and obtaining VA disability benefits. However, the presumptions have created new hurdles to obtaining VA disability benefits for MUCMI and CMI.
In This Article About MUCMI and Unexplained Vet Illness:
- MUCMI and CMI are Deliberately Vague
- What is CMI (Chronic Multisymptom Illness)?
- Is Gulf War Syndrome Contagious?
- Obtaining VA Disability Benefits for MUCMI and CMI
- How do VA Presumptive Service-Connected Conditions Work?
- Presumed Service Connection for Gulf War Veterans
- What Happens Without the Presumed Service Connection for MUCMI?
- VA Disability Ratings for Medically Unexplained Chronic Multisymptom Illness
- Is there a VA Disability Rating for Chronic Pain?
- What is the Chronic Fatigue Syndrome VA Disability Rating?
- What is the VA Disability Rating for Functional Gastrointestinal Diseases?
- Overcoming the Hurdles to VA Benefits for MUCMI and CMI
MUCMI and CMI are Deliberately Vague
The definition of MUCMI has many parts but is best explained by breaking the acronym into its parts.
- Medically unexplained: There are two main ideas in this phrase. First, the symptoms have no identified cause. Second, the symptoms are “out of proportion to physical findings.” This means that any physical abnormalities, diseases, or conditions are insufficient to explain the symptoms.
- Chronic: Chronic simply means that the symptoms are not fleeting or temporary, but ongoing.
- Multisymptom illness: The illness has overlapping symptoms and signs rather than a single symptom or set of symptoms that are associated with a diagnosable illness.
In defining MUCMIs like Gulf War Syndrome there is one more idea. The symptoms of MUCMI are consistent across the population of veterans who served together in the Southwest Asia Theater of Operations.
Rather than experiencing a hodge-podge of random symptoms with no two Gulf War veterans experiencing the same illness, Gulf War veterans with MUCMIs like Gulf War Syndrome have a very defined set of symptoms. As explained in the VA’s regulations, these symptoms can include chronic fatigue, chronic joint and muscle pain, headaches, respiratory illness, skin disorders, sleep disturbances, weight loss, menstrual disorders, neurological problems, cardiovascular symptoms, and functional digestive problems.
What is CMI (Chronic Multisymptom Illness)?
CMI chronic multisymptom illness encompasses essentially the same concepts as MUCMI. This collection of symptoms is being used by service members and veterans who did not serve in the Southwest Asia Theater of Operations but still experience similar symptoms. For example, Afghanistan is not part of the Southwest Asia Theater of Operations, so veterans of military action in Central Asia have turned to CMI as a concept for claiming veterans’ disability benefits. However, the uphill battle faced by these veterans is that, as of 2020, there is no presumption of service connection between CMI and service in Central Asia like the presumption of service connection between MUCMI and service in Southwest Asia.
Is Gulf War Syndrome Contagious?
Probably not. Although no specific cause has been identified for Gulf War Syndrome, most of the suspected causes are not related to infectious diseases.
Gulf War Syndrome may have been contracted by anyone serving between August 1, 1990, and December 31, 2021, in the countries of Saudi Arabia, Iraq, Kuwait, the neutral zone between Saudi Arabia and Iraq, Qatar, Bahrain, the United Arab Emirates, and Oman. It also includes members of the U.S. Navy and U.S. Marine Corps serving in the Persian Gulf, the Gulf of Aden, the Arabian Sea, the Gulf of Oman, and the Red Sea as well as members of the U.S. Air Force serving in the airspace over any of these locations.
MUCMIs like Gulf War Syndrome may have been caused by a few conditions that you may have experienced while serving.
- Radiation exposure: Depleted uranium ammunition may have given off low-level radiation to service members.
- Environmental exposure: Many chemicals in the air, water, and soil in the Southwest Asia Theater of Operations could be linked to the symptoms of Gulf War Syndrome, including chemical weapons, like nerve agents, smoke from burning oil wells, particulates in the air, and burn pits. Particulate matter is becoming a bigger issue for veterans.
Conversely, there has been no microbe identified with the symptoms of Gulf War Syndrome and it is not passed from Gulf War Veterans to others who did not serve in the Southwest Asia Theater of Operations. Therefore, it appears highly unlikely that Gulf War Syndrome is contagious.
Obtaining VA Disability Benefits for MUCMI and CMI
The two steps to filing a VA disability benefits claim are to identify a disability and establish that it is connected to your service. However, when dealing with MUCMI and Gulf War Syndrome, these steps blur together. This is because of the inherent contradiction introduced by the words “medically unexplained.” This puts veterans in a bind – once they have a diagnosis sufficient to seek VA disability benefits, they are at risk of losing the MUCMI service connection presumption because their condition is now “medically explained.”
How do VA Presumptive Service-Connected Conditions Work?
For various classes of veterans, the VA has defined sets of presumptive service-connected conditions. When an eligible veteran suffers from one of the presumptive service-connected conditions, the veteran is not required to prove a service connection even if the condition first manifests itself years later. Rather, if the veteran’s service records show that the veteran served during the eligible period in the eligible regions, a connection between the listed condition and the veteran’s service is presumed.
In theory, this is supposed to relieve the burden of veterans to prove that a disability is service-connected either because it is so obvious, or because proof is so difficult. For example, POWs have a presumption of service connection for diseases caused by malnutrition and parasites. This is because of the obvious connection.
Conversely, Gulf War veterans have a presumption of service connection for MUCMIs. This is because of the difficulties of proof. Since no cause is known for MUCMIs, they cannot be connected to conditions experienced during service in the Gulf War time period.
Presumed Service Connection for Gulf War Veterans
Since Gulf War veterans need to walk a tightrope, it is useful to look at what has worked and what has not worked in obtaining VA disability benefits for MUCMI medically unexplained chronic multisymptom illness and CMI chronic multisymptom illness.
In one case, a veteran’s joint and muscle pain was denied the MUCMI presumptive service connection because the doctor had identified the cause as degenerative disc disease and knee strain. The specificity of the diagnosis allowed the VA to overcome the presumption of service connection because the source of the joint and muscle pain was medically explained.
Conversely, in another case, a veteran’s hand, hip, and ankle pain were allowed the MUCMI presumption service connection because he had a non-specific diagnosis showing that his pain could not be explained by “medical history, physical examination, or laboratory tests.”
The difference in outcomes is almost entirely attributable to the medical records. One identified a cause for the veteran’s pain while the other documented the pain without identifying a cause. Thus, to be eligible for the MUCMI presumption of service connection, the medical records must show a history that does not identify the specific cause of the symptoms.
What Happens Without the Presumed Service Connection for MUCMI?
If your claim is not eligible for the presumed service connection, either because your diagnosis identifies a medical cause for your symptoms or because you did not serve in the Southwest Asia Theater of Operations, you can still file a VA disability claim. However, you will need to establish a service connection for your disability.
There are three ways to establish a service connection.
- Manifested during service: If the symptoms were documented to have begun during your service, they are service connected.
- Worsened by service: If the symptoms were documented to have begun before service, but were worsened by your service, they are service connected. Be aware, however, that the VA may require you to identify a cause of your disability because the VA does not pay disability benefits for illnesses or conditions that worsened due to a natural progression of the illness or condition.
- Diagnosed after service: If the symptoms were first diagnosed after your discharge, you may still be able to obtain benefits if they were caused by your service. Typically, this is shown by military medical records that show the symptoms are either tied to an injury or accident that occurred during your military service or were misdiagnosed during your military service and were only correctly diagnosed after discharge.
If any of these standards can be met, you may be able to claim VA disability benefits even if you are ineligible to use the MUCMI presumed service connection for Gulf War veterans.
VA Disability Ratings for Medically Unexplained Chronic Multisymptom Illness
Service-connected conditions are rated based on a ratings schedule in the VA’s regulations. These ratings are broken down by body part or system, then by disability to that body part or system.
There is no ratings schedule for Gulf War Syndrome or MUCMI. Rather, the overall rating for Gulf War Syndrome or MUCMI would be arrived at by determining individual ratings for each symptom and aggregating them using VA math.
For example, if a veteran’s MUCMI is characterized by chronic joint pain in the back, neck, and hands, chronic fatigue, and gastroesophageal reflux disease (GERD), a separate rating would be determined for each of the five symptoms and these would be aggregated together to arrive at an overall VA disability rating. Just keep in mind that VA math is not simple arithmetic. Five disabilities rated at 10% give an overall disability rating of 40%, not 50%.
Is there a VA Disability Rating for Chronic Pain?
No, but you can get VA disability for chronic pain. A recent court decision can help a veteran with MUCMI obtain a VA disability rating for chronic pain. In a 2018 case, a court of appeals reversed a longstanding VA policy of rejecting disability claims that alleged pain without identifying the underlying source of the pain.
After this case, the VA had to change its policy to allow claims that only alleged pain as a functional impairment. This means that a veteran who experiences chronic debilitating pain that cannot be explained by a physical cause, such as rheumatoid arthritis or physical injury, can obtain a disability rating based on the body parts affected by the pain.
What is the Chronic Fatigue Syndrome VA Disability Rating?
Chronic fatigue syndrome does have a separate ratings schedule. According to this table, chronic fatigue syndrome VA disability ratings range from 10% to 100% depending on the frequency and severity of symptoms and the impact on the veteran’s ability to perform self-care and other routine daily activities.
For veterans who have not been diagnosed with chronic fatigue syndrome to avoid losing the MUCMI presumption but still experience chronic fatigue, the VA’s policy in rating non-listed disabilities is to use the closest analogous rating table that captures the same symptomology. Thus, even if you have not been diagnosed with chronic fatigue syndrome, chronic fatigue as part of MUCMI would be rated using the same ratings schedule.
What is the VA Disability Rating for Functional Gastrointestinal Diseases?
When the VA regulation on MUCMI refers to “functional gastrointestinal diseases,” it is not referring to a single condition or disability. Rather, it refers to gastrointestinal diseases in which the structure of the organ is normal, and the function is impaired. This is distinguished from “structural gastrointestinal diseases” in which the functional impairment is caused by structural damage or deformity.
GERD, as an example, is common among Gulf War veterans with Gulf War Syndrome or other MUCMI. GERD results when the function of the sphincter between the stomach and esophagus malfunctions, allowing acid into the esophagus. This is also known as acid reflux or heartburn.
The disability ratings for GERD are arrived at by using the ratings table for hiatal hernia because the disabilities produce similar symptoms. The disability ratings vary from 10% to 60% depending on the frequency and severity of pain, swallowing difficulties, heartburn, and vomiting, as well as the presence of blood in the vomit or stool.
Overcoming the Hurdles to VA Benefits for MUCMI and CMI
As noted above, the presumptive service connection for Gulf War veterans with MUCMI poses a structural hurdle to obtaining VA disability benefits. You need a diagnosis to file a VA disability claim, but if the diagnosis is too specific, you might not be allowed to use the presumption of service connection for MUCMI.
Moreover, there is skepticism within the VA about undiagnosed Gulf War illnesses such as chronic fatigue and chronic pain. Since the very definition of MUCMI is that the symptoms are not measurable using any test or examination and present themselves out of proportion to any physical disability, there is some belief that Gulf War veterans are just making up their symptoms.
As a result, you should be prepared for a battle with the VA to get your VA disability benefits for MUCMI medically unexplained chronic multisymptom illness or CMI chronic multisymptom illness. These types of claims have had a very high denial rate in the past and this is likely to continue.
To discuss your strategy for obtaining for MUCMI and CMI. VA benefits, contact a VA attorney who is familiar with Gulf War Syndrome and other MUCMIs. A VA attorney can assist you regardless of your current location or whether you were deployed during your military service.
There isn’t a general difference, but MUCMI is being used more for troops that served in the Persian Gulf and CMI is used for troops that served elsewhere — like Afghanistan — but are showing the same symptoms.
The VA looks at the nearest affected body part ratings. If the MUCMI affects the lungs, they use the ratings for lung disabilities. If it is similar to arthritis or depression, the VA will use those rating tables.