Multiple Sclerosis Centers of Excellence
Frequently Asked Questions Relating to Military Service
To ask a question send an email to: MSCentersofExcellence@va.gov.
- Does getting MS have any connection with being exposed to Agent Orange?
- How did the seven year presumptive rule come about for MS?
- Has the diagnosis of MS been related to the Persian Gulf Illness?
- What is the most current incidence and prevalence rates of MS in the Veteran population?
- What effect does the vast array of vaccinations like Malaria, Hepatitis A and B, and others that military personnel receive during their tour of duty contribute to the development of MS?
- Does the VA have a program for providing service-connected Veterans with help in either acquiring or financing motorized or non-motorized wheelchairs?
- I am a service-connected Veteran diagnosed with MS in 1992 at 70% (I required a cane or crutches). Now I'm almost totally wheelchair bound (90-95%). How do I go about getting re-rated?
- I have diabetes in addition to MS. May both be used to determine my level of eligibility for benefits and services?
- How does a compensation and pension examiner determine "loss of use" for a Veteran with MS?
1. Does getting MS have any connection with being exposed to agent orange?
At this time, there is no demonstrated connection between Agent Orange and MS. Due to a variety of disorders that are connected to Agent Orange, the VA has created a website that addresses questions, and has a research program dedicated to studying this exposure and its relationship to health. However, if you were honorably discharged from the military, you are eligible for medical services with the VA.
2. How did the seven year presumptive rule come about for MS?
Service-connection is given for disabilities that were not diagnosed on active duty, but “presumed” to have begun in service. For certain select disabilities, if they manifest to a compensable degree (warrants at least a 10% rating) within one year of leaving active duty, a Veteran can still get service-connection for them. The one-year presumptive conditions include hypertension, arthritis, and diabetes, among several others, all listed in Code of Federal Regulations (CFR) 38, 3.309. There are also a few disabilities with longer presumptive periods, such as MS, which is seven years and awarded a 30% rating.
MS is a diagnosis based on history and neurological exam. Symptoms often occur years before a diagnosis is made. Neurologic symptoms occurring within seven years of discharge, regardless of date of diagnosis, can be used to support service-connection for MS. The Paralyzed Veterans of America (PVA) are strong advocates for Veterans receiving the benefits they deserve and are familiar with the VA health care system. They are a great resource for Veterans wanting to better understand their options for MS service-connection. The PVA healthcare hotline is 800-232-1782. The Disabled American Veterans (DAV) are also a great resource. Visit their Find Your Local Office webpage to find your local DAV National Service Officer.
3. Has the diagnosis of MS been related to the Persian Gulf Illness?
At the present time, there is no firm evidence to suggest that Gulf War Veterans are at increased risk for MS or demyelinating diseases in general.
- MS Epidemiology: Military Cohorts and Big Data
- Combat-Related Chemical Exposure and the Link to MS and Other Neurological Diseases
4. What is the most current incidence and prevalence rates of MS in the Veteran population?
At the present time, there are no accurate estimates of the prevalence or incidence of MS for the entire Veteran population. Part of the problem is that only about 40% of Veterans receive their care within the VA Health Care System (VHA) so tracking down all cases would be very difficult and costly. We do know that around 20,000 Veterans with MS are seen each year in the VHA. Based on work recently published reporting a larger national estimate of MS prevalence (that VHA contributed to) we have determined that the prevalence of MS within VHA users increased from a rate of 141 per 100,000 Veterans in 1999 to a rate of 262 per 100,000 Veterans in 2014. Work continues in this regard and we hope to be able to report, in a peer-reviewed journal, the prevalence of Veterans with MS soon.
5. What effect does the vast array of vaccinations like Malaria, Hepatitis A and B, and others that military personnel receive during their tour of duty contribute to the development of MS?
In the civilian population, vaccinations have been carefully studied over a long period of time and no evidence has been found of increased risk of developing MS. These results generalize to the military population as well.
6. Does the VA have a program for providing service-connected Veterans with help in either acquiring or financing motorized or non-motorized wheelchairs?
Service-connected Veterans with MS or other disorders that result in mobility issues necessitating a wheelchair are issued one that meets their needs. The VA provides medically necessary equipment like motorized wheelchairs, scooters, and other aids to help with mobility for eligible Veterans with MS. In some cases, fatigue may be a severe enough impairment to warrant power mobility (scooters or motorized wheelchairs). A Veteran who would like to be evaluated for scooters or other power mobility equipment should have their VA primary care provider send a consult to their facility’s wheelchair clinic or physical or occupational therapy units to consider the best mobility device for their life needs. In addition to medical equipment, the physical therapist and/or occupational therapist can also help you develop strategies that will help you conserve your energy.
7. I am a service-connected Veteran diagnosed with MS in 1992 at 70% (I required a cane or crutches). Now I'm almost totally wheelchair bound (90-95%). How do I go about getting re-rated?
We encourage Veterans to work closely with their VA MS care providers and social workers when they would like to be re-rated for MS disability. We also encourage Veterans to work with a recognized Veteran Service Organizations (VSO). A VSO will require you to complete a VA Form 21-22 (see list of Recognized Service Organizations on page 3). A VSO will submit your claim and advocate, navigate, and case manage the claim on your behalf, as well as work closely with your MS care providers and MS social worker. The claims process can be complicated and at times frustrating, so it is important to work closely with your MS Team and a designated VSO.
There are many advantages of working with a VSO:
- They have access to the Veterans Benefits Administration (VBA) system and can track and manage your claim.
- A VSO will check in with your MS provider and MS social worker, and will know when to request a re-exam called a Disability Benefits Questionnaire (DBQ) and submit on your behalf to the VBA.
- A VSO can advise and advocate for you during the claims process.
Veterans may also wish to consider applying for other benefits including, but not limited to, Special Monthly Compensation (SMC), also known as Aid and Attendance. A VSO can help to apply for these benefits on your behalf with the VBA.
8. I have diabetes in addition to MS. May both be used to determine my level of eligibility for benefits and services?
Yes. For example, a Veteran might have 30% eligibility for MS and 20% eligibility for diabetes, which combines to 40%. Notice that 30% and 20% do not add up to 50% in this case. The VA Schedule for Rating Disabilities "combines" the evaluations rather than "adds" the evaluations. It works this way: the first (largest) rating is 30%. That means you are 30% disabled and 70% able. If you have another disability, say 20%, then it is 20% of the remaining 70% of your abilities or 14%. 30% plus 14% equals 44% which rounds down to 40%.
9. How does a compensation and pension examiner determine "loss of use" for a Veteran with MS?
Compensation and pension examiners base their decisions on several factors, including review of the medical record, an interview with the Veteran, and exam findings or observations during the appointment. Documentation from a neurologist or physiatrist describing the degree of mobility impairment could be useful in establishing "loss of use." The physician could either write a detailed note for the Veteran's medical record or write a letter submitted with a "Statement in Support of Claim" at the time a Veteran requests that their claim be re-evaluated. It may also be helpful to enlist the assistance of a Veteran Service Officer in pursuing a claim.
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