The regulatory definition of a Persian Gulf Veteran provided in 38 CFR 3.317 includes service in a large area of Southwest Asia, but does not include Afghanistan or Djibouti. A Gulf War General Medical examination is not conducted for Veterans based only on service in Afghanistan, and Afghanistan service is not considered for undiagnosed illnesses. However, a relevant C&P examination may be conducted for Veterans of Afghanistan or Djibouti for conditions related to environmental hazard exposures. Generally, VA examinations are ordered for all claims received within one year of separation from the military, unless the evidence is sufficient for deciding the claim. This includes a general medical examination and any specialty examinations deemed necessary.

However, in claims received more than one year after separation from service, a VA examination will ordinarily be ordered for environmental-hazard claims when the evidence of record contains the following three elements:

Element 1: Evidence of a current diagnosed disability or persistent or recurrent symptoms of disability.

Element 2: Evidence that the Veteran was exposed to an in-service exposure event or incident, including a Veteran’s lay evidence. For the purposes of this element, exposure to certain environmental hazards can be conceded on a case-by-case basis.

Element 3: Evidence that the claimed disability or symptoms may be associated with the in-service exposure event.

Note: In cases where evidence showing continuity of symptoms is strong, medical examinations and/or opinions may not be necessary. Furthermore, in some cases an opinion based only on a record review will be sufficient; in other cases, an examination will be required.

When an examination is requested, the examiner should be informed of the Veteran’s service, along with the location and nature of the environmental hazard to which the Veteran was exposed, and given pertinent Fact Sheets (based on Training Letter 10-03, Environmental Hazards in Iraq, Afghanistan, and Other Military Installations) about exposures. The claims file should be forwarded to the examiner for review. The examiner should state whether it is more likely, less likely, or at least as likely as not that a Veteran’s claimed condition is related to the hazardous environmental exposure and support the opinion with a rationale.