February 25, 2005M21-1, Part III
(2) GW Registry Exam. If a veteran has submitted a VA From 21-526 which does not include the question asking the veteran if he or she wants medical or other information included in the Gulf Health Registry, the regional office must send a letter to the veteran providing the opportunity to have his or her medical or other records included in the registry. The text of the letter is included in exhibit B.6. If the veteran indicates that the GW Registry examination has been conducted, request the examination report from the appropriate medical facility.
(3) Lay Evidence. If the veteran alleges that a disability began after military service, request evidence to establish that fact. If the disability claimed is an undiagnosed condition, the evidence may be either medical evidence or nonmedical indications that can be independently observed or verified.
(a) Nonmedical indications include—but are not limited to—such events as time lost from work, evidence that a veteran has sought medical treatment for his or her symptoms, and evidence affirming changes in the veteran’s appearance, physical abilities, and mental or emotional attitude. Lay statements may be especially important in cases where an undiagnosed illness is manifested solely by the symptoms which the veteran reports and which might not be verifiable by medical examination.
(b) Lay evidence from a person making a statement from personal observation or experience is credible if the person was in a position to know the facts attested to, if the statement is sufficiently specific to address the facts, and if the evidence is not contradicted by evidence of record which is more credible. Provisions of 38 CFR 3.317 state that the nonmedical indicators must be capable of independent verification. This means that if we were to seek verification from an independent source, it would be possible to obtain that verification.
(c) On occasion, the lay statement may request clarification. Generally, however, unless there is reason to doubt the credibility of evidence, do not develop for corroboration.
(d) See exhibits B.7 and B.8 for use in developing lay evidence.
e. Medical Examination Needed. When an undiagnosed illness is claimed, a thorough medical examination report is essential to rule out known diagnoses and provide—where possible—an accurate picture of disability for rating purposes. Specialist examinations will be ordered as appropriate (e.g., pulmonary function studies when breathing problems are claimed; neurological evaluation for headaches; psychiatric/neuropsychiatric examinations for memory loss or fatigue). If multiple joint or muscle pain is alleged, ask the veteran to identify specific areas affected. When nonspecific complaints are presented, the examiner must address these issues.
(1) Are there clinical, objective indicators for the following symptoms:
(a) fatigue _________ Yes __________ No
(b) joint pain _________ Yes __________ No
(c) [List all alleged symptoms.]
(2) Are any of the aforementioned symptoms attributable to a “known” clinical diagnosis? Please specify.
f. No Residual Disability. A claim based on exposure only, with no residual disability claimed as a result of that exposure, will require clarification. Inform the claimant that he or she must identify a specific disability, as exposure in and of itself is not a disability. If a specific condition is subsequently claimed, fully develop as an environmental hazard or undiagnosed illness claim.