Gulf War veterans, fibromyalgia, chronic fatigue and IBS: a claim map

The claim map

A claim map follows one veteran's route: the service, the conditions VA presumes for it, and the conditions that follow from them. The first step counts decisions that name Gulf War service; the second counts all veterans, because few of these decisions include a secondary claim.

Where they served

Gulf War service

Service in the Southwest Asia theater from August 1990 on: Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the UAE, Oman and the nearby waters (38 CFR 3.317)

43,753 Board decisions that name Gulf War service

presumed by law38 CFR 3.317

Step 1 · presumed by law

Fibromyalgia, chronic fatigue syndrome or IBS

23.9% granted

1,359 of 5,681 veterans · all fibromyalgia, chronic fatigue syndrome or ibs claims 20.1%

secondary38 CFR 3.310(a)

Step 2 · claimed secondary to fibromyalgia, chronic fatigue syndrome or ibs (all veterans)

• Sleep apnea DC 6847

  19.3% · 23 of 119

• Migraine / headaches DC 8100

  38.0% · 38 of 100

• Acid reflux (GERD) DC 7206

  16.7% · 12 of 72

• Hemorrhoids DC 7336

  39.4% · 28 of 71

• Depression DC 9434

  48.5% · 16 of 33

• Hypertension DC 7101

  3.2% · 1 of 31

• Anxiety DC 9400

  33.3% · 10 of 30

• Diverticulitis DC 7327

  29.6% · 8 of 27

• Back or neck strain DC 5237

  11.5% · 3 of 26

• Shoulder DC 5201

  8.0% · 2 of 25

• Adjustment disorder DC 9440

  39.1% · 9 of 23

• Knee DC 5257

  10.5% · 2 of 19

• Back (degenerative arthritis) DC 5242

  17.6% · 3 of 17

Step 1 bars: share granted in Board decisions that name Gulf War service; the red mark is all veterans. Step 2 bars: all veterans who claimed the condition secondary to fibromyalgia, chronic fatigue syndrome or ibs. One count per veteran; a remand counts as not granted. Conditions with at least 15 veterans.

Are fibromyalgia, chronic fatigue syndrome and IBS presumptive for Gulf War veterans?

Yes. 38 CFR 3.317 presumes them as medically unexplained chronic multisymptom illnesses for veterans who served in the Southwest Asia theater during the Persian Gulf War. In decisions that name Gulf War service, the Board granted 34.5% of IBS claims, 20.7% of fibromyalgia claims and 10.9% of chronic fatigue syndrome claims.

These are the three named examples of a medically unexplained chronic multisymptom illness in 38 CFR 3.317. Fibromyalgia is rated under DC 5025, chronic fatigue syndrome under DC 6354 and IBS under DC 7319.

Decisions that name Gulf War serviceAll veterans

Irritable bowel syndrome

34.5%

26.8%

Fibromyalgia

20.7%

16.3%

Chronic fatigue syndrome

10.9%

9.7%

Share of decided claims granted; a remand counts as not granted. One count per veteran.

Condition	Granted	Veterans	Share	All veterans
Irritable bowel syndrome	860	2,495	34.5%	26.8%
Fibromyalgia	273	1,321	20.7%	16.3%
Chronic fatigue syndrome	347	3,181	10.9%	9.7%

Gulf War service helps, but the gap is modest. The presumption covers the link to service; the Board still has to find the illness itself.

What is the deadline under 38 CFR 3.317?

The illness must have appeared during service in Southwest Asia, or to a degree of ten percent or more by the end of 2026. That date is set in 38 CFR 3.317 and can be extended, but a claim filed now should show symptoms at a compensable level before it.

A veteran with symptoms that began after service has until the end of 2026 for them to reach a compensable level, unless the date is extended. Medical records that document the symptoms and their severity before then are the safest evidence.

Who counts as a Gulf War veteran?

Someone who served in the Southwest Asia theater during the Persian Gulf War, which began in August 1990 and has no end date yet (38 CFR 3.2(i)). The theater covers Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman and the nearby waters, so later service in Iraq counts too. Afghanistan is covered only for certain infectious diseases.

The page counts decisions that name a place in the theater, 43,753 in all. A mention is not proof of qualifying service, so the counts include some veterans who did not qualify.

Why are so many of these claims still denied?

For 1,632 denials, the Board's note named the diagnosis or another known cause in 70.7% of them: the presumption covers illnesses that cannot be explained by a known clinical diagnosis. A medical link was named in 35.7%.

In recent denials, VA examiners found that the veteran did not meet the criteria for chronic fatigue syndrome, or tied the symptoms to another diagnosis. The diagnosis, and an examiner's view that no other condition explains the symptoms, are what these claims are won and lost on.

What conditions follow from these illnesses?

Across all veterans, migraine claimed secondary to them was granted for 38 of 100 (38.0%) and hemorrhoids for 28 of 71 (39.4%). Sleep apnea (19.3%) and acid reflux (16.7%) were granted less often.

Under 38 CFR 3.310(a), a condition caused by a service-connected one is service connected too. In the Gulf War group, only 288 veterans had a claim secondary to one of these illnesses in the same decision, so the table counts all veterans.

Claimed secondary to the illness	Granted	Veterans	Share
Migraine / headaches	38	100	38.0%
Hemorrhoids	28	71	39.4%
Depression	16	33	48.5%
Anxiety	10	30	33.3%
Sleep apnea	23	119	19.3%
Acid reflux (GERD)	12	72	16.7%
Hypertension	1	31	3.2%

Read the decisions

Recent decisions, with the Board's reasoning as summarized by AI:

• A26040500, April 2026: fibromyalgia granted under 38 CFR 3.317; the veteran was a verified Persian Gulf veteran with a fibromyalgia diagnosis.
• A26039681, April 2026: IBS granted for a veteran who served in Iraq and Kuwait; a VA exam confirmed the IBS, and the Board found the delay in seeking treatment credible.
• A26040523, April 2026: chronic fatigue syndrome denied; the VA examiner found the veteran did not meet the diagnostic criteria.

What the data cannot tell you

The Gulf War group comes from the places each decision names; it is not proof of qualifying service. The second step counts all veterans, not only Gulf War veterans. Denial notes are AI-extracted. These are historical outcomes, not predictions.

For representatives

• Confirm service in the Southwest Asia theater, then the diagnosis; the presumption covers the link to service.
• Document the symptoms at a compensable level before the end of 2026.
• For chronic fatigue syndrome, make sure the diagnosis meets the criteria; most denials turn on the diagnosis.
• Once the illness is service connected, screen for migraine, depression and anxiety.