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Chronic Fatigue as a Medically Unexplained Chronic Multisymptom Illness

Mike D


I was found to have Chronic Fatigue Syndrome (CFS) as a Medically Unexplained Chronic Multisymptom Illness (MUCMI) and was awarded a 40% evaluation in 2011.  I suppose I was lucky in that respect knowing how many vets are denied this condition.  However, a future exam completed in April 2016, found that my condition was due to "poor sleep quality" and "insomnia," which contraindicated the 2011 evaluation.   The VA cannot terminate service connection (SC) based on a single exam, so I'm scheduled for a future exam in Oct 2017, and depending upon the outcome of that exam, the VA will either terminate or continue the SC for CFS.  I'm having difficulty wrapping my head around how my CFS can be attributed to military service as a MUCMI,  and then, not.  The April 2016 examiner attributed the condition to "poor sleep quality" and "insomnia," which are symptoms of CFS.  This begs the question; was the first examiner too incompetent to discern "poor sleep quality" and "insomnia" from unexplained etiology? While my condition has grown markedly worse over the years, the VA now claims my CFS has improved based on this recent examination.  I, as the veteran dealing with CFS, know that is a patently ridiculous determination.  The condition has not improved!!!   

When I reported to the Washington DC VAMC for my exam in April 2016, the physician greeted me by telling me there was no such thing as "Gulf War Illness".  While the VA does not use that terminology, it is colloquially used to describe MUCMIs associated with the Gulf War - the phrase "Gulf War" being an adjective to delineate association with that war, and not the name of an illness or disease.  The examiner seemed hell-bent on "correcting" the record based on his belief that there is no such thing as a MUCMI (he based on his analysis that I had no exposures to cause it and thus it must be caused by something else not associated with the Gulf War) - DUH!! - that's why it's unexplained

Pursuant to the November 30, 2015 update of M21-1, Part IV, Subpart ii, Section D, if you are diagnosed with CFS during the presumptive period (Aug 1990 - Dec 2016), and you were in a designated Gulf War location, and there is no known etiology explaining the symptomatology, then the condition is PRESUMED to be associated with military service.  Additionally, M21-1, IV.ii.D.3 instructs the RVSRs to follow "normal procedures for reduction of benefits or severance of SC outlined in M21-1, Part 1, 2." and cites an example of a grant of compensation under 38 CFR 3.317 where one examiner granted SC for a MUCMI and a second attributed the condition to a "clinically diagnosed condition with a clear etiology."  My interpretation of M21-1, IV.ii.D.3 is that there is no VA standard regarding MUCMI, but rather rests upon the opinion of the most recent examiner, regardless of previous opinions.  Is "poor sleep quality" and "insomnia" a clear etiology? It reeks of a catch-all to me.

While I expect to lose this portion of my benefits at the end of 2017, there is essentially nothing I can do about it in the interim.  I know I can take the DBQ to my TRICARE doctor and ask her to complete it, but the burden is on me to convince her, a MD, that it's a MUCMI, and not co-morbid with some innocuous pan-etiology like "poor sleep quality."  But I must wait for the VA to give me 60 days to lose the benefit before I can contest anything - at this time, the VA will argue I have nothing to contest since nothing has changed.


Edited by Mike D
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Status of Your Claim

Gathering of Evidence

Submitted:  05/05/2016 (Compensation)

Estimated Completion:  08/08/2016 - 10/21/2016 

Disabilities Claimed:

hyperarousal (Secondary), concentrating (Secondary), Emotional detachment (Secondary), fatigue gulf war undiagnosed illness (Secondary), neurological disorder (Secondary), Insomnia (Secondary), irritable bowel syndrome (Secondary), Gulf War Undiagnosed Illness (New), fibromyalgia (Secondary), fatigue (Secondary), depression (Secondary), headaches (Secondary), sleep disturbances (Secondary), neuropsychological signs or symptoms (Secondary), Gulf War Unexplained Chronic Multi-Symptom Illness (New)


Current Status:  Gathering of Evidence 


How do I change this to presumptive: I am currently being diagnosed by a Neurologist for sleep problems and he's treating me for insomnia. They can't figure out why I can't stay awake. Should I have structured this claim another way to insure presumptive was identified and or CFS.



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