Blue Water Navy

I've heard from folks who suffer from MS and are un-aware of the 7 year presumptive rule on MS service connection.
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A new presumptive category was established in the 1970s—Former Prisoners of War
(POWs). POWs from WWII, the Korean War, and the Vietnam era were specifically connected
for various physical and mental health outcomes in 1970 (Public Law 91-376. Sec. 3. 91st Cong.,
2d Sess., 1970). “Problems with nutrition, forced labor, and other inhumane treatment were
deemed to be strong reasons to presume that the conditions were the direct result of captivity”
(Economic Systems Inc, 2004a, p. 20). Clarification for the presumptive periods of Hansen’s
disease (leprosy) and tuberculosis to 3 years as well as multiple sclerosis to 7 years from date of
separation occurred in 1970 (VA, 1970). In 1979, ischemic heart disease (or other cardiovascular
disease) was presumptively associated with service amputation of one lower extremity at or
above the knee or service-connected amputations of both lower extremities at or above the ankles
(VA, 1979).

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MULTIPLE SCLEROSIS
Description
This case study examines the 1962 decision to grant compensation for service-connected disability
to veterans diagnosed with multiple sclerosis (MS) within 7 years of their separation from
the military. This presumption stems from the VA’s interest in compensating disease and disability
that has its onset during military service. Veterans with one of a defined list of chronic diseases
may also be compensated if these are diagnosed within 1 year of separation from the military.
The rationale here is that these diseases are sufficiently insidious and the diagnosis
sufficiently challenging so as to make it impossible to conclude with certainty that the true disease onset did not occur during the period of military service.
Multiple sclerosis was eventually singled out from the other chronic illnesses and the period
of diagnosis extended from 1 year (Veterans’ Chronic and Tropical Diseases Act of 1948. Public
Law 80-748. 80th Cong., 2d Sess.; VA, 1949), to 2 (Act of October 12, 1951. ch. 499, 65 Stat.
421 as cited in VA 1993), to 3 years (Act of August 25, 1959. Public Law 86-187. 86th Cong.,
1st. Sess. as cited in VA, 1993), and eventually to 7 years (Veterans’ Disability Compensation
Increase Act of 1962. Public Law 87-645. 87th Cong., 2d Sess. as cited in VA, 1993) following
separation from military service. The rationale for this extension was the growing scientific evidence
(much of it generated by VA researchers studying veterans) of the long delay between the
onset of MS symptoms and eventual diagnosis, as well as the possibility that environmental factors
may play a role in the etiology of MS. However, these studies also failed to find evidence
that military service contributes to MS risk, and veterans do not appear to have higher rates ofMS than the general population (Berkowitz and Santangelo, 1999; Kurtzke and Page, 1997;
Kurtzke et al. 1979, 1985, 1992; Norman et al., 1983; Page et al., 1993, 1995; VA Multiple Sclerosis
Study Group, 1956, 1957; Wallin et al., 2000).
Lessons Learned
The rationale for the MS presumption reflects two lines of reasoning used in making presumptions.
The first reflects the possibility that MS diagnosed after separation from the military
may, in fact, have been present during military service, and therefore subject to the same compensation
rules as other direct service-connection disabilities. The second acknowledges that the
etiology of MS is unclear and may be related to an environmental exposure received during military
service. Understanding that both of these arguments have been used in the MS case is important,
because the evidence required to support each is very different. In the first case, timing
is the standard (specifically the possibility of disease onset during military service), and evidence
for association between an exposure and outcome is not required. By contrast, in the second case,
evidence from some association between exposure during service and future disease is necessary.
Congress did not call for a systematic review of the scientific literature on this topic; such a
review might have allowed for more evidentiary discussion of the premise behind this presumption
and the type of evidence that might be necessary to support it.