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GULF WAR QUESTIONNAIREPeriod of active military, naval, or air service on or after September 19, 2001VA presumes certain chronic, unexplained symptoms existing for 6 months or more are related to Gulf War service without regard to cause. These “presumptive” illnesses must have appeared during active duty in the Southwest Asia theater of military operations or by December 31, 2021 and be at least 10 percent disabling.Have you been diagnosed with any of the following:Chronic Fatigue SyndromeFibromyalgiaFunctional gastrointestinal disorders (a group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract.) Irritable bowel syndrome (IBS), functional dyspepsia, functional vomiting, functional constipation, functional bloating, and functional abdominal pain syndrome. Undiagnosed illnesses with symptoms that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances.Did you have any of the following infectious diseases within 1 year from the date of separation: BrucellosisCampylobacter jejuniCoxiella burnetii (Q fever)MalariaMycobacterium tuberculosis (no time limit)Nontyphoid SalmonellaShigellaVisceral leishmaniasis (no time limit)West Nile virusIf you have had any of the above infectious diseases, have you been diagnosed with any of these diseases:ArthritisCardiovascular, nervous, and respiratory system infectionsChronic meningitis and meninjgoencephalitisDeafnessDemyelinating meningovascular syndromesEpiscleritisFatigue, inattention, amnesia, and depression.Guillain-Barre syndromeHepatic abnormalities, including granulomatous hepatitisMultifocal choroiditisMyelitis-radiculoneuritisNummular keratitisPapilledemaOptic neuritisOrchioepididymitis and infections of the genitourinary systemSensorineural hearing lossSpondylitiesUveitisChronic hepatitisEndocarditisOsteomyelitisPost-Q-fever chronic fatigue syndromeVascular infectionDemyelinating polyneuropathyHematologic manifestationsImmune-complex glomerulonephristisNeurologic disease, neuropsychiatric disease, or bothIrreversible tissue damage from severe forms of pulmonary and extrapulmonary tuberculosisReactive Arthritis (manifested within 3 months of the infection)Delayed presentation of the acute clinical syndromePost-kala-azar dermal leishmaniasis (manifested with 2 years of the infection)Reactivation of visceral leishmaniasis in the context of future immunosuppressionVariable physical, functional, or cognitive disability (West Nile virus)Were you exposed to airborne hazards, including smoke from open burn pits (trash fires) or oil-well fires? Y/NDo you have any embedded fragments (shrapnel) in your body? Y/NIf yes, have you enrolled in the Toxic Embedded Fragments registry? Y/N Contact an OEF/OIF/OND Clinical Coordinator to register.Have you had a Gulf War Registry health exam? Y/N To schedule a registry evaluation, contact an Environmental Health Coordinator at any VA medical facility. ................
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