--- title: "Part VIII, Subpart ii, Chapter 1, Section A General Information on Presumptive Service Connection (SC) for Persian Gulf Veterans" document: "M-21-1" section: "Part VIII, Subpart ii, Chapter 1, Section A" canonical: "https://veteranai.co/va-regulations/m21-1/viii.ii.1.a-general-information-on-presumptive-service-connection-sc-for" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177434/M21-1-Part-VIII-Subpart-ii-Chapter-1-Section-A-General-Information-on-Presumptive-Service-Connection-SC-for-Persian-Gulf-Veterans" updated: "2026-09-07T14:37:32.098697Z" --- June 6, 2025 ### VIII.ii.1.A.1.a. Regulatory and Statutory History Regarding Compensation for Disabilities Occurring in Persian Gulf Veterans The table below discusses the regulatory and statutory history regarding compensation for disabilities occurring in Persian Gulf Veterans. | **Authority**| **Provisions**| **Effective Date of Change** _Public Law (PL) 103-446_| The PL added a new section, [38 U.S.C. 1117](), authorizing the Department of Veterans Affairs (VA) to compensate any Gulf War Veteran suffering from a chronic disability resulting from an undiagnosed illness or combination of undiagnosed illnesses which manifested either * during active duty in the Southwest Asia theater of operations during the Gulf War, or * to a degree of 10 percent or more within a presumptive period following service in the Southwest Asia theater of operations during the Gulf War. | November 2, 1994 _PL 105-277_ **Note:** This law was codified as [38 U.S.C. 1118]().| Authorized VA to compensate Veterans who served on active duty in the Southwest Asia theater of operations during the Persian Gulf War for any diagnosed or undiagnosed illness that is determined by VA regulation to warrant a presumption of service connection (SC) based on a positive association with exposure to one of the following as a result of such service: * a biological, chemical, or other toxic agent * an environmental or wartime hazard, or * a preventive medication or vaccine. | N/A _PL 107-103_| Expanded the definition of “qualifying chronic disability” under [38 U.S.C. 1117]() to include not only a disability resulting from an undiagnosed illness but also * a medically unexplained chronic multi-symptom illness (MUCMI) that is defined by a cluster of signs and symptoms, and * any diagnosed illness that is determined by VA regulation to warrant presumption of SC. | March 1, 2002 38 CFR 3.317 rulemaking| Updated [38 CFR 3.317]() to clarify that functional gastrointestinal disorders (FGIDs) fall within the scope of the existing presumptions of SC for MUCMIs.| August 15, 2011 _PL 117-168_ , Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022| Enacted the following updates to [38 U.S.C. 1117](): * removed the manifestation period and compensability requirement for Persian Gulf Veterans, allowing for a qualifying chronic disability to manifest to any degree of disability at any time, and * added additional locations associated with undiagnosed illness and MUCMI. In addition to the existing recognized service in the Southwest Asia theater of operations, the PACT Act added the following new service locations: * Afghanistan * Israel * Egypt * Turkey * Syria, and * Jordan. **Note:** Until [38 CFR 3.317]() is updated, the above provisions regarding compensation for Persian Gulf War Veterans are governed by the statutory authority described in [38 U.S.C. 1117]().| August 10, 2022 ** _Reference_** : For more information on presumptive SC, see the [_Effective Date Job Aid for Presumptive Disabilities_](). ### VIII.ii.1.A.1.b. References Governing Persian Gulf Veteran Claims As noted in M21-1, Part VIII, Subpart ii, 1.A.1.a, the PACT Act enacted several changes to the presumptive SC provisions for Persian Gulf Veterans.The table below provides details on references governing the provisions of presumptive SC for Persian Gulf Veterans.| **Provision**| **References** General requirements for presumptive SC| * [38 U.S.C. 1117]() * M21-1, Part VIII, Subpart ii, 1.A.1.c Persian Gulf Veteran status| * [38 U.S.C. 1117]() * M21-1, Part VIII, Subpart ii, 1.A.1.d Qualifying chronic disability * undiagnosed illness, and * MUCMI * [38 CFR 3.317(a)(2)]() * M21-1, Part VIII, Subpart ii, 1.A.1.e-h Chronicity requirements| * [38 CFR 3.317(a)(4)]() * [M21-1, Part VIII, Subpart ii, 1.C.1.b]() Signs or symptoms of undiagnosed illness and MUCMI.| * [38 CFR 3.317(b)]() * M21-1, Part VIII, Subpart ii, 1.A.1.j ### VIII.ii.1.A.1.c. Presumptive SC Under 38 U.S.C. 1117 Under current [38 U.S.C. 1117](), there is a presumption of SC for Persian Gulf Veterans with a qualifying chronic disability that became manifest to any degree at any time. ### VIII.ii.1.A.1.d. Definition: Persian Gulf Veteran Under 38 U.S.C. 1117 A **_Persian Gulf Veteran_** , under [38 U.S.C. 1117](), is a Veteran who served on active duty in the Armed Forces during the Gulf War period in one of the locations listed in the table below.| **Locations**| **Authority** In or the airspace above the following: * Iraq * Oman * Kuwait * Gulf of Aden * Saudi Arabia * Gulf of Oman * the neutral zone between Iraq and Saudi Arabia * Red Sea * Bahrain * Arabian Sea * Qatar * Persian Gulf, or * United Arab Emirates. | [38 CFR 3.317(e)(2)]() In the following (airspace _not_ included): * Afghanistan * Turkey * Israel * Syria * Egypt, or * Jordan. | [38 U.S.C. 1117]() ** _Note_** : Per [38 U.S.C. 101(33)](), the Gulf War period extends from August 2, 1990, through a date yet to be determined by law or Presidential proclamation. **Reference:** For more information on establishing Persian Gulf Veteran status, see [M21-1, Part VIII, Subpart ii, 1.B.1.d](). ### VIII.ii.1.A.1.e. Definition: Qualifying Chronic Disability Under 38 CFR 3.317 ** _Qualifying chronic disability_** , under [38 CFR 3.317](), means a chronic disability resulting from any of the following or any combination of the following: * an undiagnosed illness, or * an MUCMI. **References:** For more information on * determining chronicity, see [M21-1, Part VIII, Subpart ii, 1.C.1.b](), and * rating action to be taken based on specific disability patterns, see [M21-1, Part VIII, Subpart ii, 1.C.1.g](). ### VIII.ii.1.A.1.f. Definition: Undiagnosed Illness An** _undiagnosed illness_** is a type of chronic qualifying disability where qualifying signs and/or symptoms cannot be attributed to any known clinical diagnosis by history, physical examination and laboratory tests. **References:** For more information on * signs and symptoms of undiagnosed illness, see M21-1, Part VIII, Subpart ii, 1.A.1.j, and * reviewing the examiner’s determination of disability pattern, see [M21-1, Part VIII, Subpart ii, 1.B.2.p](). ### VIII.ii.1.A.1.g. Definition: MUCMI A **_medically unexplained chronic multi-symptom illness_**(MUCMI) is a type of chronic qualifying disability in which there is a _diagnosed_ illness that has * _either_ an inconclusive etiology _or_ an inconclusive pathophysiology * overlapping symptoms and signs, and * features such as * fatigue and pain * disability out of proportion to physical findings, and * inconsistent demonstration of laboratory abnormalities. **Note:** A multi-symptom illness is _not_ an MUCMI if _both_ the etiology and the pathology of the illness are partly understood.MUCMIs include but are not limited to * chronic fatigue syndrome * fibromyalgia, or * FGIDs, excluding structural gastrointestinal diseases. **Reference:** For more information on the definition of an MUCMI, see [_Stewart v. Wilkie_](), 30 Vet.App. 383 (2018). ### VIII.ii.1.A.1.h. Definition: FGIDs _**Functional gastrointestinal disorders**_(FGIDs) are a group of diagnosed conditions that are a type of MUCMI. They are characterized by chronic or recurrent symptoms that are * unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease, and * may be related to any part of the gastrointestinal tract. Characteristic FGID symptoms include * abdominal pain * substernal burning or pain * nausea * vomiting * altered bowel habits (including diarrhea, constipation), * indigestion * bloating * postprandial fullness, and * painful or difficult swallowing. FGID diagnoses include but are not limited to * irritable bowel syndrome, and * functional * dyspepsia * vomiting * constipation * bloating * abdominal pain syndrome, or * dysphagia. Diagnosis of a FGID under generally accepted medical principles normally requires * symptom onset at least six months prior to diagnosis, and * 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 [38 CFR 3.317(a)(2)(i)]() to include FGIDs was July 15, 2011.**Reference:** For more information on FGIDs and MUCMIs, see [_Atencio v. O’Rourke_](), 30 Vet.App. 74 (2018). ### VIII.ii.1.A.1.i. Partially Understood Chronic Multi-symptom 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 [38 CFR 3.317](). When adjudicating conditions with partially explained etiology, SC can only be awarded on another basis such as direct SC under [38 CFR 3.303]() or presumptive SC under [38 CFR 3.307]() and [38 CFR 3.309(a)]()._**Reference**_ : For more information on direct SC for non-presumptive disabilities, see the _[PACT Act Implementation Standard Operating Procedure]()_. ### VIII.ii.1.A.1.j. Signs and Symptoms of Undiagnosed Illnesses or MUCMIs [38 CFR 3.317]() specifies the following 13 categories of signs or symptoms that may be manifestations of an undiagnosed illness or an MUCMI: * joint pain * muscle pain * neurological signs or symptoms * headache * neuropsychological signs or symptoms * gastrointestinal signs or symptoms * abnormal weight loss * fatigue * sleep disturbances * respiratory signs and symptoms (upper and lower) * cardiovascular signs or symptoms * skin signs and symptoms, and * menstrual disorders. **Notes:** * The list of categories is not exclusive; signs or symptoms not represented by one of the listed categories may also qualify for consideration under [38 CFR 3.317](). * A disability that is affirmatively shown to have resulted from a cause other than service in a [38 U.S.C. 1117]() location may not be compensated. **Example:** Sleep apnea cannot be presumptively service-connected (SC) under the provisions of [38 CFR 3.317]() since it is a diagnosable condition. If claimed, sleep apnea must be considered on a non-presumptive SC basis.