Multiple Sclerosis Centers of Excellence
Frequently Asked Questions
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 SC Veterans with help in either acquiring or financing motorized or non-motorized wheelchairs?
- If I have MS, what is the risk that my children will have MS?
- Why is the first attack of MS severe for some people and mild for others? Does the severity of the first attack predict the future?
- I am a SC MS Veteran diagnosed 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?
- What determines whether an exacerbation will remit?
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 chemical and its relationship to health. However, if you were honorably discharged from the military, you are eligible for medical services with the VA.
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.
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
At the present time, there are no accurate estimates of the prevalence or incidence of MS within the VA population. Part of the problem is that most Veterans do not receive their care within the VA health care system so tracking down all cases would be very difficult and costly. There have been estimates of the relative risk for MS within different VA cohorts with the most recent publication listed below. Prevalence estimates within VA healthcare users are being refined by the MS Centers of Excellence at the present time. Also, the National MS Society has a committee addressing how to initiate a nationwide prevalence survey of the US. (Wallin et al. Ann Neurol. 2004 Jan;55(1):65-71)
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 SC Veterans with help in either acquiring or financing motorized or non-motorized wheelchairs.
SC 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 his/her 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.
The risk to the general population, with no one else in the family with MS is 0.1%. The risk to a child of a mother with MS is 3-4%. The risk to an identical twin of someone with MS is 31%.
8. Why is the first attack of MS severe for some people and mild for others? Does the severity of the first attack predict the future?
We do not know why the first attack can be severe for some people and mild for others, in fact we really do not know why any attack is severe or mild. It partly depends on where in the brain, spinal cord, or nerves to the eyes the attack occurs and how much damage occurs. But why these vary between people and even between attacks in the same person is unknown. When looking at lots of people with MS, the type and severity of the first attack is one thing that seems to help predict the course MS will follow. People whose first attack is just sensory symptoms (numbness and tingling) or optic neuritis tend on average to have a milder form of MS than people who have weakness or imbalance with their first attack. However, this applies only to large groups of people and there are lots of exceptions. So, it is very difficult to predict how severe an individual's MS is going to be based just on how severe or mild the first attack is.
9. I am a SC MS Veteran diagnosed 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?
To re-open a claim simply submit a Statement in Support of Claim (VA form 21-4138) to the Regional Office. The Regional Office typically considers the primary care provider's and neurologist's documentation of the MS and related conditions in the medical record when evaluating a claim. Veterans may also wish to consider applying for Special Monthly Compensation (SMC), also known as Aid and Attendance, at the same time. These are additional funds granted to Veterans who are 100% SC and require assistance with activities of daily living such as bathing, dressing, toileting, etc. These additional funds are intended to provide the means to hire someone to provide the necessary care. Aid and Attendance varies in amount depending on the degree of impairment of the individual Veteran. To apply for Aid and Attendance, a VA physician must complete the Exam for Housebound Status or Permanent Need for Regular Aid & Attendance (VA form 21-2680). Even though you do not currently have a 100% SC rating, they can evaluate your request once the rating decision is made. Finally, it is often helpful to enlist the aid of a Veteran's service organization in submitting and monitoring your claim.
10. 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%.
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.
About 80% of exacerbations are followed by remission. This means that 20% of the time people with MS will not fully recover from an exacerbation and will be left with permanent impairment. In general, the chances of permanent deficits increase with age, disease duration, and number of prior exacerbations.
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