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Paragraph (c) of §3.317 grants presumptive service connection for nine infectious diseases which are endemic to many parts of the world, including Iraq, Afghanistan, and the Persian Gulf. Please read this chapter carefully if it may apply to you; the requirements for presumptive service connection are not the same for each disease.
The nine diseases are Brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), Malaria, Mycobacterium tuberculosis, Nontyphoid Salmonella, Shigella, Visceral leishmaniasis, and West Nile virus. The manifestation time limits – based on how long each disease may take to incubate – are different, so they are divided up accordingly below.
Many of these diseases can lead to other health issues down the road. Getting the initial disease on the record and connected to your service ASAP protects your rights and your ability to take care of yourself later on.
38 CFR §3.317(c) applies to all veterans who served in the Gulf War from Aug 2, 1990 until today (day of this book 2017) and all veterans who served in Afghanistan after September 19, 2001. To say “an OEF veteran” would not work, as some operations of OEF were in place other than in Afghanistan.
If you served in some other overseas location and have one of the nine diseases, you may still file a claim under the normal standards using 38 CFR §§ 3.303, §3.307, §3.309 you simply have a higher burden of proof. Remember this if the symptoms started in the service and continued after service, shown by you going for treatment.
Is there a time limit for the symptoms to manifest?
Yes, most of these have one year to manifest, and some may be longer. In most cases, there is a time limit for listing for some presumption of service-connection, and only a few do not have one. However, if there is medical evidence or a doctor's opinion to validate your claim of service-connection, you should file even if you do not meet the presumptive deadline. The VA has a legal obligation to consider a valid claim on its merits, but it will hold you to a higher standard of evidence if you miss the presumptive window.
Most veterans have one year from their final date of separation to manifest symptoms of the following diseases to meet 3.317(c) guidelines for presumptive service-connection of:
Coxiella burnetii (Q fever)
West Nile virus
As with all presumptives, the disease must be considered to “have become manifest to a degree of 10 percent or more within one year from the date of separation” to qualify. It is important to get it service-connected as soon as you can, even if it doesn't bother you much today. You don't know when secondary health issues will follow or how bad they will get.
Is Malaria limited to one year, or not?
Malaria is also limited to one year after your discharge for the time being, and it must manifest to a degree of 10 percent in that time. The VA reserves the right to allow a longer presumptive period in the future, without a new law from Congress, if research supports that.
These two diseases have no time limit to manifest
Recall the chapter on Intent to File and the ways to show service connection. This will come in handy again.
38 CFR §3.317(d) addresses the long-term health consequences of the diseases named in §3.317(c). They are not presumptively service-connected at this time. However, the VA recognizes a potential connection between the infectious disease (listed in column A in the table below) and the associated long-term health effects beside it (in column B). Once you have your rating for one of the nine infectious diseases, you should look at the long-term effects associated with it. If any of those impact your own health, then you should seek out medical opinions and pursue a claim.
Before granting any of these secondary claims, the VA must receive a medical opinion from a doctor that: 'it is at least as likely as not that the condition was caused by the veteran having had the associated disease' (in column A). Therefore, you need the WRIISC and the research on why the illness is in column B.
Do not file the claim until you
have the much-needed doctor opinion for the VA, or you may get a doctor's
statement on your own and submit it with your claim. While the VA may still
get a second opinion from its own doctor, your claim will be stronger with a
doctor supporting your 'at least as likely as not' position. The VA's
doctor is more likely to agree with your claim if you already have a doctor
Table of Associated Long Term Health Effects
Here is the full table from 38 CFR §3.317(d) showing the associations which were found by the Institute of Medicine at the National Academy of Sciences:
Table to § 3.317—Long-Term Health Effects Potentially Associated With Infectious Diseases
Infectious Disease Long Term Health Effects
Cardiovascular, nervous, and respiratory system infections.
Chronic meningitis and meningoencephalitis.
Demyelinating meningovascular syndromes.
Fatigue, inattention, amnesia, and depression.
Hepatic abnormalities, including granulomatous hepatitis.
Orchioepididymitis and infections of the genitourinary system.
Sensorineural hearing loss.
Campylobacter jejuni Guillain-Barr syndrome if manifest within 2 months of the infection Reactive Arthritis if manifest within 3 months of the infection.
Uveitis if manifest within 1 month of the infection.
Coxiella burnetii Chronic hepatitis.
(Q fever) Endocarditis.
Post-Q-fever chronic fatigue syndrome.
Malaria Demyelinating polyneuropathy.
Hematologic manifestations (particularly anemia after falciparum
malaria and splenic rupture after vivax malaria).
Neurologic disease, neuropsychiatric disease, or both.
Ophthalmologic manifestations, particularly retinal hemorrhage
Renal disease, especially nephrotic syndrome.
Mycobacterium Active tuberculosis.
tuberculosis Long-term adverse health outcomes due to irreversible tissue
Damage from severe forms of pulmonary and extrapulmonary
Tuberculosis and active tuberculosis.
Nontyphoid Salmonella Reactive Arthritis if manifest within 3 months of the infection.
Shigella Hemolytic-uremic syndrome if manifest within 1 month of the
Reactive Arthritis if manifest within 3 months of the infection.
Visceral leishmaniasis Delayed presentation of the acute clinical syndrome.
Post-kala-azar dermal leishmaniasis if manifest within 2 years of
Reactivation of visceral leishmaniasis in the context of future
West Nile virus Variable physical, functional, or cognitive disability.
It is important to remember that if you have an illness that is listed in “A” and you get it service connected, you and your health care provider need to be aware that the illnesses/long term health effects that are in column “B” can develop later on. You will still need a nexus statement from your doctor for the claim of secondary. The statement needs to have a good medical rational using research or medical knowledge from experts. You and your VSO can just use this section of the CFR when filing the claim for the secondary issues.
It is very important that after you have a C&P exam you get with your VSO and look over the exam right away. If there are, any statements that are wrong, let your VSO know. Then your VSO can address this in a statement on why the exam is inadequate.
There can be a number of reasons for an inadequate exam, but you need to address them before you get your rating decision and / or Statement of the Case (SOC). If you wish to appeal, you have to do this before you go to the Board and keep it up if you go to the court. This is covered more in our section on NOD.
Updated November, 2017 V3.0
Distribution and Disclaimer
Gulf War Illness (GWI) is a generic term for a variety of medical problems which will be discussed in detail. This guide is not a review of the protocols for medical treatment of GWI; that goal is all too elusive. The primary purpose of this guide is to assist the veteran -- who believes he or she is afflicted with GWI -- with procedures for filing a claim for disability with the Department of Veterans Affairs and enhancing the probability of success in that endeavor.
Gulf War Illness is not something you can claim under 38 USC 1117. GWI is only a term to describe the symptoms veterans have from their service in the Gulf War. The VA and DOD are working on a case definition for it to be diagnosed as medically unexplained chronic multi-symptom illness, but this has not happened yet. It should be done soon.
The contents of this guide are for informational purposes only. Every effort is made to achieve accuracy, but neither the National Gulf War Resource Center, Inc. nor its principals assume responsibility for the accuracy or veracity of the information contained herein.
This guide is distributed freely to veterans, Veteran Service Organizations, accredited VA Agents, lawyers, and others interested in helping those who are ill, injured, or disabled due to the Gulf War. Any other use requires the written authorization of the National Gulf War Resource Center (NGWRC) or sources used in this guide.
Thank you one and all,
James A. Bunker, Executive Director & VA Accredited Claims Agent.