the presence of symptoms sufficient to diagnose the specific disorder at least three months prior to diagnosis. FGIDs do not include structural gastrointestinal diseases, such as Important: inflammatory bowel disease (such as ulcerative colitis or Crohn's disease) and gastroesophageal reflux disease, as these conditions are considered to be organic or structural diseases characterized by abnormalities seen on x-ray, endoscopy, or through laboratory tests. The effective date of the amendment to to include FGIDs was July 15, Note: 2011. k. Examination In general, when a Veteran with GW service claims symptoms fitting the Requirement description of an MUCMI, as described in , before proceeding with a for MUCMIs ensure that an examination with a medical opinion has been decision, obtained. The opinion must classify the symptom as an MUCMI without conclusive pathology or etiology before SC under can be awarded. If the diagnosis shown in medical records involves one of the Exception: MUCMIs described in (chronic fatigue syndrome, fibromyalgia, or functional gastrointestinal disorders), then SC is appropriate and a VA examination may only be necessary to determine current level of severity. Chronic multi-symptom illnesses of partially explained etiology and l. Partially Understood pathophysiology, such as diabetes and multiple sclerosis, are not considered Chronic medically unexplained and cannot be considered a qualifying chronic disability for purposes of . Illnesses When adjudicating conditions with partially explained etiology, SC can only be awarded on another basis such as direct SC under or presumptive SC under and . m. The presumptive period for manifestation of qualifying chronic disability Presumptive under Period for Manifestation begins on the date following last performance of active military, naval, or of Disability air service in the Southwest Asia theater of operations during the GW, and Under 38 CFR extends through December 31, 2016. 3.317 specifies the following 13 categories of signs or symptoms that may be n. Signs and Symptoms of manifestations of an undiagnosed illness or an MUCMI Undiagnosed
the presence of symptoms sufficient to diagnose the specific disorder at least three months prior to diagnosis. Important: FGIDs do not include structural gastrointestinal diseases, such as inflammatory bowel disease (such as ulcerative colitis or Crohn's disease) and gastroesophageal reflux disease, as these conditions are considered to be organic or structural diseases characterized by abnormalities seen on x-ray, endoscopy, or through laboratory tests. Note: The effective date of the amendment to to include FGIDs was July 15, 2011. k. Examination Requirement for MUCMIs In general, when a Veteran with GW service claims symptoms fitting the description of an MUCMI, as described in , before proceeding with a decision, ensure that an examination with a medical opinion has been obtained. The opinion must classify the symptom as an MUCMI without conclusive pathology or etiology before SC under can be awarded. Exception: If the diagnosis shown in medical records involves one of the MUCMIs described in (chronic fatigue syndrome, fibromyalgia, or functional gastrointestinal disorders), then SC is appropriate and a VA examination may only be necessary to determine current level of severity. l. Partially Understood Chronic Illnesses Chronic multi-symptom illnesses of partially explained etiology and pathophysiology, such as diabetes and multiple sclerosis, are not considered medically unexplained and cannot be considered a qualifying chronic disability for purposes of . When adjudicating conditions with partially explained etiology, SC can only be awarded on another basis such as direct SC under or presumptive SC under and . m. Presumptive Period for Manifestation of Disability Under 38 CFR 3.317 The presumptive period for manifestation of qualifying chronic disability under begins on the date following last performance of active military, naval, or air service in the Southwest Asia theater of operations during the GW, and extends through December 31, 2016. n. Signs and Symptoms of Undiagnosed specifies the following 13 categories of signs or symptoms that may be manifestations of an undiagnosed illness or an MUCMI