Skip to content
Truth Veteran

Gulf War Illness VA Rating and 38 CFR 3.317 Criteria

By Truth Veteran Benefits Desk · Reviewed by Truth Veteran Benefits Desk on

The VA evaluates Gulf War illness under 38 CFR 3.317 as a qualifying chronic disability from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI), including chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders. Under 38 CFR 3.317(a)(5), symptoms are rated by analogy under corresponding diagnostic codes—such as DC 6354 for CFS, DC 5025 for fibromyalgia, or DC 7319 for irritable bowel syndrome.

Older veteran reviewing Gulf War Illness medical records and VA disability claim notes at a sunny dining table
On this page

How the VA evaluates Gulf War illness under 38 CFR 3.317

Veterans who served in the Southwest Asia theater of operations and other recognized locations on or after August 2, 1990, often develop chronic multisystem symptoms commonly called Gulf War syndrome. Understanding how a gulf war illness va rating is assigned requires reviewing 38 CFR 3.317 (Compensation for certain disabilities occurring in Persian Gulf veterans), which governs presumptive service connection within the VA disability ratings schedule.

Rather than creating a single code in 38 CFR Part 4, 38 U.S.C. 1117 and 38 CFR 3.317(a)(2)(i) define a qualifying chronic disability as resulting from either (or a combination) of two categories:

  1. An undiagnosed illness (38 CFR 3.317(a)(2)(i)(A)): Objective indications of chronic disability—such as unexplained joint or muscle pain, headaches, fatigue, skin rashes, sleep disturbances, respiratory symptoms, or neurological complaints—that by history, physical exam, and laboratory tests cannot be attributed to any known clinical diagnosis (38 CFR 3.317(a)(1)(ii)).
  2. A medically unexplained chronic multisymptom illness (MUCMI) (38 CFR 3.317(a)(2)(i)(B)): A diagnosed illness defined by a cluster of signs or symptoms without conclusive pathophysiology or etiology, specifically including chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders such as irritable bowel syndrome (IBS).

Under 38 CFR 3.317(a)(5), a qualifying chronic disability is rated using Part 4 evaluation criteria for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. Diagnosed MUCMIs use their dedicated Part 4 codes, while undiagnosed illnesses are rated by analogy under 38 CFR 4.20. Under 38 CFR 3.317(a)(1)(i), the disability must manifest to 10 percent or more (unless it manifested during active service in a qualifying theater).

Gulf War illness rating table (DC 6354, DC 5025, DC 7319, DC 7356, and 38 CFR 4.88b)

Diagnostic Code & ConditionRating %Criteria Under 38 CFR Part 4
DC 6354 — Chronic fatigue syndrome (38 CFR 4.88b)100% / 60% / 40% / 20% / 10%Debilitating fatigue, cognitive impairments (inability to concentrate, forgetfulness, or confusion), or other signs/symptoms: 100%: Nearly constant and so severe as to restrict routine daily activities almost completely and may occasionally preclude self-care. 60%: Nearly constant and restrict routine daily activities to less than 50% of pre-illness level; or wax and wane with incapacitation of at least 6 weeks/year. 40%: Nearly constant and restrict routine daily activities from 50% to 75% of pre-illness level; or wax and wane with incapacitation of at least 4 but less than 6 weeks/year. 20%: Nearly constant and restrict routine daily activities by less than 25% of pre-illness level; or wax and wane with incapacitation of at least 2 but less than 4 weeks/year. 10%: Wax and wane with incapacitation of at least 1 but less than 2 weeks/year; or controlled by continuous medication.
DC 5025 — Fibromyalgia (38 CFR 4.71a)40% / 20% / 10%Widespread musculoskeletal pain and tender points (with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud’s-like symptoms) that are constant, or nearly so, and refractory to therapy (40%); episodic, with exacerbations often precipitated by stress or overexertion, present more than one-third of the time (20%); or require continuous medication for control (10%).
DC 7319 — Irritable bowel syndrome (38 CFR 4.114)30% / 20% / 10%Abdominal pain related to defecation during the previous three months—at least one day per week (30%), at least three days per month (20%), or at least once (10%)—plus two or more of: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.
DC 7356 — GI dysmotility syndrome (38 CFR 4.114)80% / 50% / 30% / 10%80%: Complete dependence on TPN or continuous tube feeding. 50%: Intermittent tube feeding with recurrent emergency treatment for obstruction or regurgitation. 30%: CIPO or motility disorder managed by ambulatory care requiring prescribed dietary management. 10%: Intermittent abdominal pain with epigastric fullness and bloating without structural GI disease.
General Rating Formula for Infectious Diseases (38 CFR 4.88b)100% / 0% + Residuals100% for active disease (for visceral leishmaniasis under DC 6301, 100% continues for 6 months after treatment stops, followed by a mandatory VA exam). 0% after active disease resolves; rate any residual disability within the appropriate body system per 38 CFR 3.317(d).

Effective 2025-12-01, monthly pay for a veteran alone is $180.42 (10%), $356.66 (20%), $552.47 (30%), $795.84 (40%), $1,435.02 (60%), and $3,938.58 (100%).

Key regulatory notes for DC 6354, DC 5025, DC 7319, and DC 7356

  • Chronic fatigue syndrome (38 CFR 4.88a & 4.88b Note): Incapacitation under DC 6354 exists only when a licensed physician prescribes bed rest and treatment. Under 38 CFR 4.88a, a VA diagnosis of CFS requires: (1) new onset of debilitating fatigue reducing daily activity to less than 50% of the usual level for at least six months; (2) exclusion of other clinical conditions by history, exam, and lab tests; and (3) six or more of ten criteria: acute onset; low grade fever; nonexudative pharyngitis; palpable/tender cervical or axillary lymph nodes; generalized muscle aches or weakness; fatigue lasting 24+ hours after exercise; new-pattern headaches; migratory joint pains; neuropsychologic symptoms; and sleep disturbance.
  • Fibromyalgia (38 CFR 4.71a Note): Widespread pain under DC 5025 means pain in both the left and right sides of the body, both above and below the waist, affecting both the axial skeleton (cervical spine, anterior chest, thoracic spine, or low back) and the extremities.
  • Functional GI disorders (38 CFR 3.317(a)(2)(i)(B)(3) & 4.114 Notes): Includes IBS, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia (symptom onset at least 6 months before diagnosis and present at least 3 months before diagnosis). Effective May 19, 2024, DC 7319 covers functional dyspepsia, bloating, constipation, and diarrhea, while DC 7356 covers other § 3.317(a)(2)(i)(B)(3) functional GI illnesses.

Undiagnosed illnesses vs. MUCMIs under 38 CFR 3.317(a)–(b)

Under 38 CFR 3.317(b), signs or symptoms of an undiagnosed illness or MUCMI include 13 categories: (1) fatigue, (2) skin signs/symptoms, (3) headache (rated by analogy to migraine under DC 8100 at 0%–50%), (4) muscle pain, (5) joint pain, (6) neurological signs/symptoms (rated by analogy to peripheral neuropathy), (7) neuropsychological signs/symptoms, (8) respiratory signs/symptoms, (9) sleep disturbances, (10) gastrointestinal signs/symptoms, (11) cardiovascular signs/symptoms, (12) abnormal weight loss, and (13) menstrual disorders.

Under 38 CFR 3.317(a)(3), objective indications include both medical signs perceptible to a physician and non-medical indicators capable of independent verification (lay statements documenting time lost from work, altered appearance or physical abilities, and seeking medical care). Under 38 CFR 3.317(a)(2)(ii), illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, are excluded.

Qualifying locations, chronicity, and the December 31, 2026 date

Under 38 CFR 3.317(e)(2), the Southwest Asia theater of operations covers service on or after August 2, 1990, in Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the UAE, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above them. Under 38 U.S.C. 1117 and VA Gulf War Illness rules, VA also recognizes service on or after August 2, 1990, in Afghanistan, Egypt, Israel, Jordan, Syria, and Turkey (airspace not included).

Two timing rules govern claims under 38 CFR 3.317(a):

  1. Six-month chronicity (38 CFR 3.317(a)(4)): The disability must persist for 6 months or more, including intermittent episodes over a 6-month period.
  2. Elimination of the December 31, 2026 deadline: Although 38 CFR 3.317(a)(1)(i) still prints “not later than December 31, 2026,” the PACT Act of 2022 amended 38 U.S.C. 1117(a)(1)(A) to permanently remove the manifestation deadline. VA.gov confirms qualifying undiagnosed illnesses and MUCMIs are presumptive when diagnosed during active duty or at any time after separation. Under 38 CFR 3.317(a)(7), the presumption is rebutted only by affirmative evidence that the disability was not incurred in qualifying service, resulted from a post-service supervening event, or resulted from willful misconduct or alcohol/drug abuse.

Presumptive infectious diseases (38 CFR 3.317(c)–(d))

Under 38 CFR 3.317(c)(2)–(3), nine infectious diseases are presumptive for service in the Southwest Asia theater (on or after August 2, 1990) or Afghanistan (on or after September 19, 2001):

  • Manifest to 10%+ within 1 year of separation: Brucellosis (DC 6316), Campylobacter jejuni (DC 6330), Coxiella burnetii (Q fever) (DC 6331), Malaria (DC 6304; or when treatises indicate in-service incubation), Nontyphoid Salmonella (DC 6333), Shigella (DC 6334), and West Nile virus (DC 6335).
  • No post-service time limit to manifest to 10%+: Mycobacterium tuberculosis (DC 6311 / 4.88c) and Visceral leishmaniasis (DC 6301).

Under 38 CFR 3.317(d) and the Table to § 3.317, if a veteran presumed service connected for one of these diseases is diagnosed with a listed long-term health effect—such as arthritis, spondylitis, meningitis, sensorineural hearing loss, or fatigue/depression after brucellosis; post-Q-fever CFS, endocarditis, or chronic hepatitis after Q fever; reactive arthritis (within 3 months) after Campylobacter, Salmonella, or Shigella; Guillain-Barré syndrome, hematologic, renal, neurologic, or ophthalmic disease after malaria; post-kala-azar dermal leishmaniasis (within 2 years) after visceral leishmaniasis; or variable physical, functional, or cognitive disability after West Nile virus—the VA must request a medical opinion on causation.

How the C&P exam and VA DBQs measure Gulf War illness

During a C&P exam, clinicians complete forms verified on the VA Public DBQs directory:

  1. Gulf War General Medical Examination DBQ (VA internal form): Evaluates multisystem complaints and whether symptoms represent an undiagnosed illness, a MUCMI, or a known clinical etiology.
  2. Chronic Fatigue Syndrome (CFS) DBQ: Verifies 38 CFR 4.88a criteria, continuous medication (10%), daily activity restriction (<25% for 20%, 50%–75% for 40%, <50% of pre-illness level for 60%, or almost complete restriction for 100%), and annual weeks of physician-prescribed bed rest.
  3. Fibromyalgia DBQ: Documents widespread pain, nine paired bilateral tender point sites, absence of required imaging, continuous medication (10%), presence more than one-third of the time (20%), or constant symptoms refractory to therapy (40%).
  4. Intestinal Conditions DBQ: Documents three-month defecation-related abdominal pain frequency (once for 10%, three days/month for 20%, or one day/week for 30%) and bowel symptoms under DC 7319, or motility impairment under DC 7356.
  5. Persian Gulf and/or Afghanistan Infectious Diseases (Other Than Tuberculosis) DBQ (and Tuberculosis DBQ): Confirms laboratory testing (culture/serology for brucellosis, smears/PCR/antigen for malaria, culture/histopathology for visceral leishmaniasis), active (100%) vs. resolved (0%) status, and residuals.

Secondary conditions (38 CFR 3.310), TDIU, and combined ratings

Under 38 CFR 3.317(a)(6) and 38 CFR 3.310(a), veterans may claim secondary service connection for conditions proximately caused or aggravated by a Gulf War disability—such as secondary depression or anxiety (38 CFR 4.130), GERD (DC 7206) from daily pain medications, or hemorrhoids (DC 7336) from chronic IBS. Under 38 CFR 4.14 (anti-pyramiding), separate ratings are allowed when rated symptoms do not overlap.

If Gulf War disabilities prevent substantially gainful employment, Total Disability based on Individual Unemployability (TDIU) under 38 CFR 4.16 pays at the 100% rate ($3,938.58 per month), and under 38 CFR 4.16(a)(2), disabilities from common etiology count as one disability toward the 60% or 40%/70% thresholds.

Multiple ratings combine under 38 CFR 4.25 (with the bilateral factor in 38 CFR 4.26). Model your rating with our VA combined rating calculator and estimate past-due pay with our VA back pay calculator. Accredited Veterans Service Organizations (VSOs) like the DAV, VFW, and American Legion provide free claims help, while accredited claims agents and attorneys assist with appeals; verify credentials via the VA Office of General Counsel Accreditation Search.

This guide explains the rules; it is not legal or medical advice. VA decisions depend on your records. Free help is available from accredited Veterans Service Organizations.

Frequently asked questions

How does the VA assign a percentage for Gulf War illness?

There is no standalone 'Gulf War illness' code in 38 CFR Part 4. Under 38 CFR 3.317(a)(5) and 38 CFR 4.20, the VA rates qualifying chronic disabilities using Part 4 codes with similar affected functions, localization, or symptoms—including DC 6354 for CFS (10%–100%), DC 5025 for fibromyalgia (10%–40%), and DC 7319 (10%–30%) or DC 7356 (10%–80%) for functional GI disorders.

Did the PACT Act eliminate the December 31, 2026 deadline in 38 CFR 3.317?

Yes. While 38 CFR 3.317(a)(1)(i) still prints December 31, 2026, the PACT Act of 2022 permanently amended 38 U.S.C. 1117 to remove the deadline. VA guidance confirms qualifying undiagnosed illnesses and MUCMIs are presumptive when diagnosed during active duty or at any time after separation.

What is the difference between an undiagnosed illness and a MUCMI under 38 CFR 3.317?

An undiagnosed illness under 38 CFR 3.317(a)(2)(i)(A) involves objective signs or symptoms—such as joint pain, headaches, fatigue, skin rashes, or neurological symptoms in 38 CFR 3.317(b)—not attributable to any known clinical diagnosis. A MUCMI under 38 CFR 3.317(a)(2)(i)(B) is a diagnosed illness without conclusive pathophysiology or etiology, specifically CFS, fibromyalgia, and functional GI disorders.

Why aren't diabetes or multiple sclerosis considered Gulf War illnesses under 38 CFR 3.317?

Under 38 CFR 3.317(a)(2)(ii), a MUCMI is a diagnosed condition without conclusive pathophysiology or etiology. The regulation explicitly states that chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, are not considered medically unexplained.

Which locations qualify for Gulf War illness presumptive service connection?

Under 38 CFR 3.317(e)(2), the Southwest Asia theater includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the UAE, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and airspace above them on or after August 2, 1990. Under 38 U.S.C. 1117, VA also recognizes Afghanistan, Israel, Egypt, Turkey, Syria, and Jordan (excluding airspace).

What are the nine presumptive infectious diseases under 38 CFR 3.317(c)?

Under 38 CFR 3.317(c)(2), the nine presumptive infectious diseases are brucellosis, Campylobacter jejuni, Coxiella burnetii (Q fever), malaria, Mycobacterium tuberculosis, nontyphoid Salmonella, Shigella, visceral leishmaniasis, and West Nile virus. Most must manifest to 10%+ within one year of separation, except visceral leishmaniasis and tuberculosis, which have no time limit.

Sources

  1. 38 CFR 3.317, Compensation for certain disabilities occurring in Persian Gulf veterans
  2. 38 CFR 4.88a, Chronic fatigue syndrome
  3. 38 CFR 4.88b, Schedule of ratings - infectious diseases, immune disorders and nutritional deficiencies (DC 6354)
  4. 38 CFR 4.71a, Schedule of ratings - musculoskeletal system (DC 5025 Fibromyalgia)
  5. 38 CFR 4.114, Schedule of ratings - digestive system (DC 7319 IBS and DC 7356)
  6. 38 CFR 4.20, Analogous ratings
  7. 38 CFR 3.310, Disabilities that are proximately due to, or aggravated by, service-connected disease or injury
  8. 38 CFR 4.16, Total disability ratings for compensation based on unemployability of the individual
  9. 38 CFR 4.25, Combined ratings table
  10. VA Gulf War Illnesses Linked to Southwest Asia Service
  11. VA Public Disability Benefits Questionnaires (CFS, Fibromyalgia, Intestinal, and Persian Gulf Infectious Diseases DBQs)