A Guide Specializing in the “Toxic effects” of todays battle field for all veterans who was deployed since August 1990.

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Where to find the Forms and Resources for your claim

To file a claim for disability compensation, use Veterans Benefits Administration (VBA) form 21-526EZ. 

You may download this form at: http://www.vba.va.gov/pubs/forms/VBA-21-526EZ-ARE.pdf


To make a statement in support of claim, or to get a statement from your friend, comrade, co-worker, or family member, VA Form 21-4138: http://www.va.gov/vaforms/form_detail.asp?FormNo=21-4138 .

To download or print Disability Benefits Questionnaires (DBQs) for your private doctor, go to http://www.benefits.va.gov/COMPENSATION/dbq_disabilityexams.aspOnly doctors may fill out a DBQ.  Please use form 21-4138 for all other statements in support of your claim. 


There are no DBQs for the following medical examinations: Initial Examination for Post-Traumatic Stress Disorder, Hearing Loss and Tinnitus, Residuals of Traumatic Brain Injury, Cold Injury Residuals, Prisoner of War Examination Protocol, Gulf War Medical Examination.


To file a Notice of Disagreement you must use this form.

Notice of Disagreement (Fillable) http://www.vba.va.gov/pubs/forms/VBA-21-0958-ARE.pdf

You can request a copy of your service medical records from the National Personnel Record Center (NPRC) in St. Louis, MO, using a Standard Form 180, Request Pertaining to Military Records.  This form is available from your representative or any VA office.  You can also apply for a copy of your service records online http://www.archives.gov/veterans/military-service-records/ .


The NPRC Fire of July 1973 destroyed many Army and Air Force records of personnel discharged between 1912 and 1964.  If you were discharged after Jan 1, 1964, or if you served in the Navy or Marines, your records were not burned, and you should be able to obtain a copy.  Source: http://www.archives.gov/st-louis/military-personnel/fire-1973.html.


U.S.C Title 38 § 1117, §1118   38 CFR § 3.317

Federal Register / Vol. 60, No. 23 / 2-3-1995

Federal Register / Vol. 68, No. 111 / 6-10-2003

Gutierrez v. Principi (Vet. App. 2004)

What the case is about:

In Gutierrez, the veteran claimed service connected compensation for undiagnosed illnesses incurred during the Persian Gulf War.  The Court found that the veteran was not required to provide evidence linking his current conditions to events during service and the BVA erred by imposing such a nexus requirement. 

Impact on VBA: 

Good training tool.

Summary of the facts and Court's reasons:

In Gutierrez, the veteran claimed service connected compensation for undiagnosed illnesses incurred during the Persian Gulf War.  The veteran filed a claim for "Gulf War Syndrome" as manifested by various symptoms including  joint and muscle pain, dizziness, fatigue, memory loss and a loss of concentration and decreased vision.  Mr. Gutierrez also submitted statements from his wife, his father, and a friend, which essentially noted that the veteran had a decline in his general health since discharge from service.   The Board of Veterans Appeals (BVA) denied the claim finding that the only evidence linking the veteran's "current alleged disabilities to his service or Gulf War Syndrome consist of the veteran's own evidentiary assertions".  The BVA found that such evidence was of limited probative weight.  The BVA noted that although "the veteran is competent to describe manifestations perceivable to a lay party, he is not competent to diagnose himself with disabilities and then associate those disabilities with his active service or with any form of Persian Gulf Syndrome".

In order to establish service connection under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, a claimant must present evidence that he or she is a Persian Gulf veteran who (1) exhibits objective indications; (2) of a chronic disability such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10% or more not later than December 31, 2006; and (4) such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a). 

The Court found that the veteran was not required to provide evidence linking his current conditions to events during service and the BVA erred by imposing such a nexus requirement.  The requirement is that undiagnosed illnesses become manifest to a degree of 10% or more during the presumptive period which ends on December 31, 2006.  The Court noted the reasons or bases the BVA gave for finding that the lay statements of the veteran, his wife, father and friend were "neither competent nor probative of the issues in question" were inadequate.  The medical evidence of record shows that Mr. Gutierrez complained of joint and muscle pain, fatigue, dizziness, sleep problems and loss of concentration but no medical examiner ever provided a medical etiology for these illnesses.  As the BVA correctly noted, the record on appeal does not contain evidence that the veteran's alleged symptoms were related to any current diagnosed disabilities or had a known etiology.  However, his claimed symptoms by history, physical examination, and laboratory tests cannot be related to any known clinical diagnosis in order for compensation to be awarded under section 1117.  As a result, the BVA erred by concluding that the failure of the laboratory tests and studies to diagnose an illness was evidence against Mr. Gutierrez's claim.  The Court found that the BVA made clearly erroneous findings as to certain facts and has provided an inadequate statement of reasons or bases for its decision.  The Court vacated the BVA decision and remanded the claim. 


CAVC case number: No. 01-2105


Stankevich v. Nicholson (Vet. App. 2006)

Joyner v. McDonald, 766 F.3d 1393 (Fed. Cir. 2014)


Eisenet al., 2005 

Kang 2001 JOEM Volume 42, Number 5, May 2001

Dursa 2016 JOEM  Volume 58, Number 1, January 2016

While working a claim rater get help for the M21-1 Manual that is updated daily M21-1  (Live Manual)


Amyotrophic Lateral Sclerosis (ALS) Claim

[CFR 38, §3.318]

What is ALS?

Amyotrophic Lateral Sclerosis (ALS), or Lou Gehrig's disease, kills cells in the brain and spinal cord that control muscle movement, resulting in gradual wasting of the muscles. Fatal in most cases, the disease usually strikes people between ages 40 and 70. The cause of the disease is unknown. ALS does not affect the senses (sight, smell, taste, hearing, touch), bladder or bowel function, or a person's ability to think or reason.

Who may claim service-connection for ALS?

Under most circumstances, if you are a US military veteran diagnosed with ALS, it will be presumptively service-connected. All you need to do is file the claim. The claim will be expedited because ALS is a terminal illness.

Here is the exact language of CFR 38, §3.318(a):

Except as provided in paragraph (b) of this section, the development of amyotrophic lateral sclerosis manifested at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease.

The full section is reprinted in the appendices if you want to look up the exceptions.


  1. Difficulty breathing

  2. Difficulty swallowing

  • Gagging

  • Chokes easily

  1. Head drop due to weak spinal and neck muscles

  2. Muscle cramps

  3. Muscle weakness that slowly gets worse

  • Commonly involves one part of the body first, such as the arm or hand

  • Eventually leads to difficulty lifting, climbing stairs, and walking

  1. Paralysis

  2. Speech problems, such as a slow or abnormal speech pattern

  3. Voice changes, hoarseness

  4. Additional symptoms that may be associated with this disease:

  5. Drooling

  6. Muscle contractions

  7. Muscle spasms

  8. Ankle, feet, and leg swelling

  9. Weight loss

The VA established a national ALS registry to identify veterans with the disease -- regardless of when they served -- and track their health status. Veterans with ALS who enroll will complete an initial telephone interview covering their health and military service and will be interviewed twice yearly thereafter. For more information about the VA's ALS Registry, based at the Durham VA Medical Center, call 1-877-DIAL-ALS (1-877-342-5257) or e-mail ALS@med.va.gov

More Information on ALS


The following organizations support research and in some cases can provide information and support for patients and their families.

ALS Association (ALSA)

27001 Agoura Road Suite 150

Calabasas Hills, CA 91301-5104

info@alsa-national.org http://www.alsa.org

Tel: 818-880-9007 800-782-4747 Fax: 818-880-9006

Les Turner ALS Foundation

8142 North Lawndale Avenue

Skokie, IL 60076

info@lesturnerals.org http://www.lesturnerals.org

Tel: 888-ALS-1107 847-679-3311 Fax: 847-679-9109

Muscular Dystrophy Association

3300 East Sunrise Drive

Tucson, AZ 85718-3208

mda@mdausa.org http://www.mdausa.org/

Tel: 520-529-2000 800-572-1717 Fax: 520-529-5300

Project ALS

511 Avenue of the Americas Suite #341

New York, NY 10011

projectals@aol.com http://www.projectals.org

Tel: 212-969-0329 800-603-0270 Fax: 212-337-9915 

For information on other neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's:

Brain Resources and Information Network (BRAIN)

P.O. Box 5801

Bethesda, Maryland 20824

(800) 352-9424



Cancer Claims & Depleted Uranium


There is no presumptive service connection to cancer for most veterans of post-Vietnam conflicts. If you have a cancer which you believe is related to your military service, but you do not meet the definition of an Agent Orange or Radiation-Exposed Veteran, then you will have the standard burden of proof applied to your claim. You must provide a medical opinion from a doctor stating it is 'at least as likely as not' that your current cancer is related to your claimed in-service exposure.

This may require extensive research to prove your exposure and to back up your doctor's claim of the relationship. Presenting strong evidence of the relationship to your doctor is, in fact, what can make the difference in whether or not that doctor will write the letter for you. Some doctors are not up-to-date on research showing the relationship between a particular exposure and a particular cancer.

Depleted Uranium & Cancer for SWAT veterans

Depleted Uranium (DU) is a mildly radioactive heavy metal that, like lead and mercury, is highly toxic when inhaled or ingested. Its long-term effects remain a subject of debate.

No cancers are presumptive for Iraq, Persian Gulf, or other recent (1990-current) conflict veterans on the basis of their foreign deployments, but the VA does grant service connection on a case-by-case basis. The VA realizes that cancers take decades to manifest - there is no '1 year limit' on symptoms for cancer.

DU is recognized as a possible cause or accelerator of cancer, but the evidence is not yet strong enough to make it presumptive. If a veteran can both make a case that he or she has high exposure to it, such as DU shrapnel fragments in his or her body, and get a doctor's 'as likely as not' statement in support of claim, the veteran may file with a reasonable chance of success.

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.

ALL veterans need to work closely with Department of Veterans Affairs accredited representatives when filing their claims and any follow-up appeals.  The regulation is always changing, and your VSO should be taking classes to be current.  Do not let your claim get denied due to some bad advice given by the “untrained advocates” who are giving out their “personal opinion” and not the current regulation/laws on the internet.  It is very hard to fix errors in the claim once the decision is made, so use this guide with your trained VSO Rep, agent, or lawyer.  If you are planning to start a new claim or planning to reopen a claim, you need to go to the section in “Intent to File” and get this done before reading anything else in this guide

Thank you one and all, 
James A. Bunker, Executive Director & VA Accredited Claims Agent.