Chronic Fatigue Syndrome (CFS) for Gulf War Veterans

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complicated disorder that causes extreme fatigue that lasts for at least six months. Symptoms worsen with physical or mental activity and don’t fully improve with rest.  CFS is commonly seen in Gulf War Veterans, but it is certainly not limited to this group.

CFS can have a significant and debilitating impact on a Veteran’s daily life. The hallmark symptom of chronic fatigue syndrome — profound and persistent fatigue — can make it difficult for Veterans to engage in even basic daily activities, such as getting out of bed, showering, and preparing meals.

CFS often results in reduced stamina and cognitive impairments, making it challenging for Veterans to maintain employment. They may need to take extended sick leaves, reduce work hours, or even leave their jobs altogether. It can also lead to social isolation, forcing Veterans to miss out on social gatherings, family events, and recreational activities. This can impact their mental health, strain their relationships with friends and loved ones, and diminish their quality of life. Medical bills, reduced income due to job loss or reduced work hours, and the cost of alternative treatments can also create a significant financial burden for Veterans with CFS.

Unfortunately, CFS is one of the most difficult disabilities to diagnose and prove, making it even more challenging for Veterans to receive disability compensation from the VA. The primary symptoms of CFS in Gulf War Veterans are lingering exhaustion and tiredness that can last for years after a Veteran has finished their time in the military. 

Chronic Fatigue Syndrome and Gulf War Syndrome: What’s the Connection?

CFS is often referred to under the umbrella of Gulf War Syndrome. Many Gulf War Veterans returned from their time serving in the military exhibiting CFS symptoms, and many of these Veterans also continue to struggle with other troubling symptoms. 

Other symptoms of Gulf War Syndrome that often accompany CFS include:

• Irregular weight loss
• Joint pain and muscle pain
• Headaches
• An irregular menstrual cycle
• Psychological issues like anxiety and depression
• Skin problems
• Breathing problems, including sleep-related respiratory issues like sleep apnea
• Heart problems

The combination of these symptoms, often referred to as Gulf War Syndrome, is described by the VA as a “Chronic Multisymptom Illness.” The VA views these symptoms as grounds for receiving disability compensation if a Veteran can establish a connection between their symptoms and their military service.

Because Gulf War Syndrome and CFS can be so difficult for the VA to assess and diagnose, many Veterans may find the VA denying their disability claims. The VA denies claims based on several factors, but one of the most common is insufficient medical evidence. 

In some situations, chronic fatigue syndrome can be difficult to medically verify. However, that does not mean you should be denied the benefits that you deserve. If the VA has denied you benefits for CFS, you can appeal and prompt the VA to review their decision regarding your claim. Often, we hear from Veterans who have already filed their own appeals or received a denial notice, leading them to feel discouraged from the process entirely. However, we urge Veterans to keep their appeals open and maintain their effective date to ensure they receive all the disability compensation they are entitled to. In this blog, we will look at why CFS is a challenging disability to qualify for and how we can potentially help ease and increase your odds throughout the appeals process.

Applying for CFS Disability Benefits

Because the VA recognizes that chronic fatigue syndrome is a presumptive condition for Gulf War Veterans, there is a lesser level of evidence Veterans must provide the VA to receive service connection. Typically, a Veteran must provide the VA with three critical pieces of information to receive VA disability compensation:

• A medical diagnosis
• An in-service event, injury, or illness
• A medical nexus between the current disability and the in-service event

The first and most vital step in the process is establishing or providing evidence of a valid diagnosis of CFS through a licensed medical practitioner. However, CFS cases are not held to the same standard of proof necessary to establish service connection that most other VA disability claims are held to. According to the VA, chronic fatigue syndrome “must have emerged during active duty in the Southwest Asia theater of military operations by December 31, 2021, and be at least 10 percent disabling” in order to meet the basic qualifications necessary to apply for a CFS-related disability rating.

Additional requirements specified by the VA include debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months, in addition to having all other conditions with similar symptoms being ruled out by physical examinations and lab tests.  Moreover, you must have six or more of the following symptoms:

• Acute onset of the condition
• Low-grade fever
• Sore throat
• Palpable or tender cervical or axillary lymph nodes
• Generalized muscle aches or weakness
• Fatigue lasting 24 hours or longer after exercise
• Headaches
• Migratory joint pain
• Neuropsychological symptoms (such as problems with concentrating, learning, memory, coordination, decision-making, and verbal ability)
• Sleep disturbance

Because the VA places specific requirements on Veterans with CFS, there are numerous pitfalls that a Veteran can run into when filing a claim for disability benefits. Unfortunately, without sticking to the VA’s requirements, you are likely to have your claim denied and end up without the disability benefits that you need and deserve. To avoid a denial of your claim, present the VA with as much medical evidence as possible to verify a link between your symptoms and your military service.

Obtaining a Rating Once Diagnosed

Once you’ve received a certified doctor’s diagnosis confirming you have CFS, and it falls within the parameters of service connectivity, the next step will be ensuring the rating assigned to your disability claim is fair and satisfactory. The VA rates CFS based on the amount of time you are incapacitated and the percentage of reduction in activity caused by it. 

The VA pays attention to how chronic fatigue syndrome affects a Veteran’s life. If your disability has hindered you from working, maintaining healthy relationships with friends and family, or completing everyday tasks, the VA is more likely to view your condition as significantly disabling. The more your CFS and other Gulf War Syndrome symptoms affect your life, the higher your disability rating is likely to be.

Unlike most disability ratings given by the VA, CFS ratings are restricted to 5 levels, as opposed to the 10-level increments normally available. The rating scale is as follows:

• 10% – Signs and symptoms of CFS that wax and wane but result in periods of incapacitation of at least one but less than two weeks total duration per year, or the symptoms are controlled by continuous medication.
• 20% – Signs and symptoms of CFS that are nearly constant and restrict routine daily activities by less than 25 percent of the pre-illness level, or signs and symptoms that wax and wane, resulting in periods of incapacitation of at least two but less than four weeks total duration per year.
• 40% – Signs and symptoms of CFS that are nearly constant and restrict routine daily activities to 50 to 75 percent of the pre-illness level, or the signs and symptoms wax and wane, resulting in periods of incapacitation of at least four but less than six weeks total duration per year.
• 60% – Signs and symptoms of CFS that are nearly constant and restrict routine daily activities to less than 50 percent of the pre-illness level, or signs and symptoms that wax and wane, resulting in periods of incapacitation of at least six weeks total duration per year.
• 100% – Signs and symptoms of CFS that are nearly constant and so severe as to restrict routine daily activities almost completely and which may occasionally preclude self-care.

What If My Rating Is Too Low?

In some cases, the VA will approve a disability claim for chronic fatigue syndrome but will not give a Veteran a disability rating that is high enough. If you received a 10 percent disability rating but feel that you deserved to be rated at 40 percent, for example, you can appeal the VA’s decision and request a review of your claim.

The appeals process involves a decision review, in which the VA may accept additional evidence that can lead to a higher rating. Sometimes, depending on the appeal lane you choose, the VA may pass your claim to a senior official for another review. Going through the appeals process with an experienced attorney could increase your chances of getting a favorable outcome in your claim.

An Independent Medical Examination Can Change the Outcome of Your Claim

If you receive a low disability rating from the VA, you may be able to get your rating changed by presenting further medical evidence. One of the best ways to make a strong case for getting a higher disability rating is to get an independent medical examination (IME).

An independent medical examination involves an evaluation by a doctor who is not affiliated with the VA. When you get an IME, your doctor will review your military records and perform any necessary tests to establish a stronger connection between your disability and your military service. These can be extremely effective if you visit your family doctor, who has treated your condition over time and understands the effects of your disability on your life.

The results of an independent medical examination can be presented to the VA as part of the appeals process. The VA gives every Veteran who applies to receive benefits an in-house examination known as the Compensation & Pension Exam, and the results of this test can have a key role in the outcome of a claim. However, the results of an independent medical examination can help to support your claim if your C&P exam was inconclusive.

Your Claim Might Be Missing Documents That the VA Needs to Review

When processing a disability claim, the VA requires specific documentation from all Veterans. Without these documents, your claim will be denied by default. When you appeal a VA decision, you will have a second chance to present the VA with military personnel records, medical records, and other required documentation whenever a disability claim is filed.

During the VA appeals process, you can also submit additional evidence that can lead to a better outcome for your claim. If specific military records might play a role in the VA’s review of your claim, these records can and should be presented as evidence in support of your claim. Your attorney can help you find and compile military documentation that can help make a strong case for the VA to change its decision.

The Bottom Line

Any time you’re attempting to receive service-connected disability compensation, it may seem stressful and overwhelming. That’s why having a well-versed legal team on your side can make a world of difference. Not only can it drastically increase your chances of obtaining a more favorable rating, but it’ll also help to take some of that stress off your shoulders. 

Veterans Helping Veterans

At Berry Law, our team will fight for you through the entire appeals process, starting at your regional VA office and moving to higher courts if necessary. Throughout making an appeal, one of our lawyers can help you compile evidence, make statements, and present a strong case to the VA. You shouldn’t have to go through the process of making an appeal alone — with a Berry Law attorney on your team, you’ll have the firepower you need to get the support that you need from the VA.

Contact Berry Law today at (888) 682-0751 to get in touch with one of our experienced VA disability lawyers and take the next step in your fight for disability compensation.