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?
- Can exposure to depleted uranium projectiles in gun magazines or in other military operations contribute to MS?
- 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?
- Can MS cause heart trouble and what kind of heart trouble can be related to 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?
- How can a Veteran with MS know if their status is "individually unemployable?"
- I am an active duty service member who has just been diagnosed with MS. If I am medically discharged due to MS, do I retain my medical benefits?
- 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?
- How can a member of a Veterans healthcare team assist in expediting the processing of my compensation claim?
- 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?
- I have read numerous things about the benefits of marijuana with MS disabilities. When will the VA if ever begin using marijuana for MS patients?
- Can a Veteran who is rated "total & permanently" disabled at 100% be allowed to work a job? If so, what are the stipulations for this situation?
- How long after the onset of an exacerbation can steroids be given? How often can steroids be given?
- 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. You can go online for more information at http://www.va.gov/agentorange. 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. The War Related Illness and Injury Study Center based at the VAMC in Washington, DC has several research projects that are examining mortality related to brain tumors, ALS, and MS in deployed and nondeployed Gulf War era Veterans. The Longitudinal Health Study of Gulf War Era Veterans involves 30,000 Veterans, making it one of the largest scientific research studies ever undertaken on the health of Veterans. The goal is to find out how the health status of Gulf War Veterans changes over time and if it is better, worse, or the same as non-Gulf War Veterans ten or more years after the war. Specific areas under study are chronic medical conditions, post-traumatic stress disorder, and other psychological conditions, functional status, mortality, general health perceptions, health care utilization, and VA disability compensation between these two Veteran groups. To achieve this goal, researchers are collecting information from 15,000 Gulf War Veterans and 15,000 non-Gulf War military personnel who were in service during 1990-1991. They are presently collecting information from these Veterans through postal questionnaire surveys and telephone interviews. For specific answers to your question, we'll have to refer you to this Gulf War registry project, which is not part of MSCoE. But we can tell you that to determine whether an exposure causes a disease, it must be shown that those exposed have a higher incidence of the disease than those not exposed. When gulf war Veterans were evaluated for a number of neurological diseases, ALS stood out as being possibly increased compared to those not serving in the Gulf War. MS was not a disease that stood out as more common in Gulf War Veterans.
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. (Annals of Neurol 2004;55:65-71)
5. Can exposure to depleted uranium projectiles in gun magazines or in other military operations contribute to MS?
In general, to make an association between any military exposure and the development of MS requires studying a large number of Veterans with and without the exposure, and then showing a significant increase in the occurrence of MS among those with the exposure. These research projects require authorization and special funding from the Department of Defense or the Department of Veterans Affairs and for Veterans to participate in the study over a long period of time. For the last ten years, the VA has studied the effects of military exposure to depleted uranium and has found no association between this military exposure and Veterans developing neurological disorders. For further information you can read: McDiarmid, M.A., et al., Health effects of depleted uranium on exposed Gulf War Veterans: a 10-year follow-up. Journal of Toxicology and Environmental Health, 2004. 67(4): p. 277-96.
6. 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.
7. 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%.
The risk of heart problems, also called cardiovascular disease, is not due to MS directly impacting the cardiovascular system, but more likely through elevation of the cardiac specific risk factors. Epidemiologic studies report that people with MS have a higher rate of mortality from cardiovascular disease than the general population. Cardiac specific risk factors can be divided into two types: 1) nonchangeable and 2) changeable. Some nonchangeable factors include: being over 65 years of age, being male, family history of heart disease, and race. Some racial groups that have a higher likelihood than others to experience heart disease include African American, Mexican American, Native Indian, Native Hawaiian, and some Asian American groups. There are some risk factors that are associated with an increase in heart disease that can be changed or modified. Factors that are changeable include: hypertension, tobacco smoke, elevated cholesterol, physical inactivity, obesity, and diabetes. While all people need to work on the changeable risk factors, if people with MS have one or more of the nonchangeable risk factors, it is important that they pay close attention to their medical needs. With any symptoms suggesting heart disease, people should see their provider for further testing and diagnosis. If there are risks factors that are changeable it is important that you share them with your VA providers. They could help you with changing or modifying those factors to decrease your risk of heart disease.
10. 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.
Individual unemployability (IU) recognizes that the effects of certain SC conditions, while not meeting the VA's criteria for permanent and total disability, may interfere with a Veteran's ability to work and support themselves. The criteria is rather complicated and takes into account a Veteran's education and work history as well as Social Security Disability evaluation(s) and participation in vocational rehabilitation. Individuals who meet the criteria for IU receive benefits equivalent to Veterans who are 100% SC. Since, by definition, a Veteran with IU is unable to secure gainful employment due to the effects of their SC condition(s), a Veteran who successfully returns to the work force will have their benefits reduced to the corresponding level of compensation for their SC disability.
12. I am an active duty service member who has just been diagnosed with MS. If I am medically discharged due to MS do I retain my medical benefits?
As an active duty service member that was just diagnosed with MS, you will be undergoing the Physical Evaluation Board (PEB) to determine your medical status. The PEB can determine one of two things, they could find you fit for duty and return you to full duty status or they could find you unfit for duty and either medically discharge you with disability severance or medically retire you with full retiree benefits which include Tricare. This is dependent on the evaluation assigned for your disability. If you are medically discharged, you can elect to continue your medical coverage through COBRA but you will be required to pay for the coverage. Or you can seek enrollment at the nearest VA Medical Center to continue treatment.
13. 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? Should I check with my primary care physician or my neurologist?
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.
14. How can a member of a Veterans healthcare team assist in expediting the processing of my compensation claim?
The wait for a decision on a claim can be long and frustrating for many Veterans. Social Security and the Department of Veterans Affairs are separate benefit systems with separate processes for establishing disability. Even though they are both federal agencies, they do not work collaboratively. For an individual having difficulty supporting themselves and their family the wait for a decision can seem interminable. One way to potentially speed up the process is for a member of the Veteran's healthcare team to write a letter requesting expedition of the claim based on financial or medical hardship (in some cases, both may apply). Keep in mind that most Veterans submitting claims want them to be processed as soon as possible and many ask for expedition of their claims. It may be helpful to specify the nature of the financial or medical hardship for which you are requesting expedition. Another option is to contact a Veteran's service organization for assistance with the claim; they may be able to determine what is preventing the claim from moving forward and/or advocate on the Veteran's behalf with the ratings team at the Regional Office. Finally, some Veterans write to their local representatives and/or congress people for assistance. In the meantime, it may also be helpful to contact the social worker associated with your health care team. Social workers can assist Veterans with a number of important issues including financial resources, housing, and advanced care planning as well as provide ongoing support. They can also work collaboratively with other community agencies, such as the National MS Society, to meet an individual's needs.
15. 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 VSO in pursuing a claim.
17. I have read numerous things about the benefits of marijuana with MS disabilities. When will the VA, if ever, begin using marijuana for people with MS?
In general, the VA follows the U.S. Food and Drug Administration (FDA) guidelines. The FDA was established by the federal government to evaluate the safety and effectiveness of drugs. If the FDA approves marijuana for some medical use then the VA would be very likely to provide it to patients.
18. Can a Veteran who is rated "total and permanently" disabled at 100% be allowed to work a job? If so, what are the stipulations for this situation?
Generally speaking, Veterans who receive SC compensation for a physical disability, with a few exceptions, CAN work without penalty to their SC compensation. The exceptions are Veterans who have some psychiatric disabilities or Veterans with individual unemployability. If you are SC and fall into one of those two categories, it may be helpful to contact a Veteran's service organization for assistance prior to making a decision about returning to work. Veterans who receive a non-SC VA pension are, by definition, not able to work due to a disability. Further, to qualify for non-SC VA Pension the individual's income must fall below the pension amount for that year. Finally, persons receiving Social Security Disability Income may earn a small income and still be eligible for benefits. Refer to the Social Security website for more information: http://www.ssa.gov/disability/.
19. How long after the onset of an exacerbation can steroids be given? How often can steroids be given?
The earlier they are given the more likely they are to help. There is no fixed cut of time but generally it is desirable to start steroids within days of the onset of an attack and it is unlikely that they will help if started weeks or months after onset. Chronic daily steroid use can lead to hypertension, diabetes, and other serious health problems and should be avoided. High dose steroid treatments lasting days to weeks are generally not given more frequently than 3 to 4 times a year. In some situations, single high doses of steroids may be given once a month.
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.