July 21, 2010                                                                                                       Director (00/21)                                                              In Reply Refer To:  211AAll VA Regional Offices and Centers                                Fast Letter 10-26                                                 SUBJ:  Revisions to 38 C.F.R. § 3.317 to clarify the Meaning of “Medically Unexplained Chronic Multisystem Illness” Related to Gulf War and Southwest Asia Service                              Purpose  This letter provides information on a regulatory change being developed by VA to clarify the  meaning of a diagnosed “medically unexplained chronic multisymptom illness” for disability claims based on Gulf War and Southwest Asia service.                           Background  VA has statutory authority under 38 U.S.C. § 1117 to compensate Veterans for qualifying chronic disabilities resulting from Gulf War and Southwest Asia service when the disability is an “undiagnosed illness” or a diagnosed “medically unexplained chronic multisymptom illness.”  Section 1117 provides the following as examples of qualifying diagnosed multisymptom illnesses:  chronic fatigue syndrome, irritable bowel syndrome, and fibromyalgia.  However, the regulatory language of section 3.317 implementing the statute suggests that these three diagnosed illnesses are an exclusive listing, rather than just examples.                        Regulatory Change VA is revising § 3.317 to clarify that the three listed diagnosed multisymptom illnesses are not exclusive, but rather are examples that can serve to inform VA medical examiners and adjudicators of the general types of medically unexplained chronic multisymptom illnesses that may qualify for service connection under the § 1117 authority.                     Questions Submit questions concerning this fast letter to your Veterans Service Officer (VSO).                                                                                                                                                                                     Bradley G. Mayes               Director Compensation and Pension Service

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