Under the direction of Congress, VA entered into an agreement with the Institute of Medicine of the National Academy of Sciences (NAS) that would have NAS periodically review and evaluate scientific evidence regarding associations or lack of associations between illnesses and exposure to toxic agents, environmental or wartime hazards, or preventive medicines or vaccines to which Veterans may have been exposed during service, including service in the Southwest Asia theater of operations during the Persian Gulf War.

Based on the 2006 and 2010 NAS reports cited in a 2011 Notice in the Federal Register, VA determined that a number of conditions, for example, cancer, psychiatric disorders, and cardiovascular diseases, are not subject to presumptive service connection based on Gulf War service. If future evidence links any of these or other illnesses to exposures associated with Gulf War service, VA may establish presumptions of service connection for such illnesses.

The most important guidance for you as examiners is to follow the provisions of 38 CFR 3.317 regarding conditions that are subject to presumptive service connection.