The VA has updated the definition for Medically Unexplained Chronic Multi-Symptom Illness (MUCMI). Read the updates here

Medically Unexplained Chronic Multi-Symptom Illness (typically shortened to MUCMI) is the condition label used when symptoms don't fit into a currently known diagnosis or condition. We wrote a whole blog about it here – but today, we'll be covering the VA's recently updated definition for MUCMI and what it means for veterans seeking VA disability benefits.

Here's the most up to date information on how the VA defines MUCMI:

Functional gastrointestinal conditions (FGIDs) are a type of MUCMI

The VA includes functional gastrointestinal conditions (FGIDs) as a part of the MUCMI umbrella. This group of diagnosed conditions are characterized by chronic or recurrent symptoms that are unexplained by examination, and unable to be tied to other injuries or diseases. They can be related to any part of the gastrointestinal tract.

Symptoms of FGIDs that fall under the category of MUCMI can include:

• Abdominal pain

• Substernal burning or pain

• Nausea and vomiting

• Diarrhea

• Constipation

• Indigestion and bloating

• Prolonged fullness after meals

• Painful or difficult swallowing

One important note: FGIDs do not include structural gastrointestinal diseases – they have to be considered functional in order to count. Basically, structural diseases such as Inflammatory Bowel Disease (IBD), GERD, or Crohn's Disease cannot be considered FGIDs / MUCMI because they have a structural or known cause which is commonly seen on x-ray, endoscopy, or via lab tests.

Examples of FGID functional diseases include irritable bowel syndrome (IBS), and symptoms such as dyspepsia, vomiting, constipation, bloating, dysphagia, and abdominal pain syndrome.  These conditions are a medical catch all where doctors are not able to identify where the symptoms are coming from or why they are happening. They will have no evidence on testing or procedures. 

Partially understood conditions cannot qualify as presumptive or MUCMI

Partially understood conditions, such as diabetes or multiple sclerosis (MS), aren't considered "medically unexplainable" by the VA. The VA considers them "partially explained", so therefore they cannot count as presumptive or MUCMI. This means that there is enough medical evidence to point to a more likely cause for why these conditions developed. 

Presumptive SC claims of undiagnosed illness and MUCMI for Persian Gulf veterans

Veterans who served in the Persian Gulf and developed unexplainable medical problems afterward might be eligible for service-connection even if doctors can't produce a clear diagnosis. In order for the claim to qualify, the symptoms of the unexplained condition must last at least 6 months.

This 6 month period of chronicity (long-term illness) begins from the date when the symptoms first began – and they must be backed up by evidence. Veterans should keep a record of their condition through personal journaling and also visits to their physician in order to provide the VA with a chronological timeline.

Lay evidence and personal statements can provide useful context as well, leading to a more compelling and well-balanced claim.

The difficulty with this is that most providers want to find a reason for the symptoms – so depending on how many providers and/or specialists you see, you may end up with multiple guesses on what the diagnosis or condition is. That complicates the case when filing. A well written nexus letter is a great tool to tie everything together. 

New guidelines for how the VA explains MUCMI claim outcomes

According to the M21-1, Part VIII, the VA now states a need to provide adequate reasons for their approval or denial when it comes to undiagnosed illnesses and MUCMI claims. Now, when service-connection is denied, the VA must include for the veteran:

• "A discussion of the specific provisions that were not met under both the presumptive provisions of 38 U.S.C. 1117, as well as any theories of SC raised by the claimant or the evidence, as discussed in M21-1, Part II, Subpart iii, 1.A.2.e, and

• favorable findings, if applicable, specific to the facts of the case."

So, in simpler terms, the VA is legally required to give veterans a full explanation of how their claim decision was made. This is useful, so they can form a plan for next steps – especially if they want to file for a supplemental claim.

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