The Gulf War General Medical examination is a comprehensive disability examination and, as such, conducting and reporting this examination can be a lengthy process. C&P examiners conducting Gulf War-related VA examinations should conduct a Gulf War General Medical examination and also follow additional examination protocols as indicated. In the examination report, you must characterize the Veteran’s conditions as belonging to one of four disability patterns that were explained in VA Training Letter 10-01, Adjudicating Claims Based on Service in the Gulf War and Southwest Asia. Sometimes the disability patterns are called categories.

(1) An undiagnosed illness

(2) A medically unexplained chronic multisymptom illness (a diagnosed illness without conclusive pathophysiology or etiology) that is defined by a cluster of signs or symptoms, such as (but not limited to):

    1. Chronic fatigue syndrome (long-term and severe fatigue that is not relieved by rest and is not directly caused by other conditions)
    2. Fibromyalgia (characterized by widespread muscle pain; other symptoms may include insomnia, morning stiffness, headache, and memory problems)
    3. Functional gastrointestinal disorders *

      *Functional gastrointestinal disorders include disorders such as irritable bowel syndrome and a host of other GI conditions but do not include structural gastrointestinal diseases. These disorders are characterized by chronic or recurrent symptoms that are unexplained by structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the GI tract. Symptoms include abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea and constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing.

(3) A diagnosable chronic multisymptom illness with a partially explained etiology

(4) A disease with a clear and specific etiology

Select diagnostic guidelines to access VA guidelines for diagnosing chronic fatigue syndrome or fibromyalgia. You may be asked questions about this content. These diagnostic guidelines can also be accessed in course Resources.

Please note for (2): Chronic fatigue syndrome may be referred to as systemic exertion intolerance disease (SEID) in records.

Please note for (3): Diabetes mellitus (DM) is one example of (3) a diagnosable chronic multi-symptom illness with a partially explained etiology. However, DM and other conditions that fall into the same category are generally not considered to be related to Gulf War service.