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Determination Letters › Gulf War Illness

Suggested Determination Letter

Gulf War Illness — example determination letter

A suggested DVA determination for Gulf War Illness, pre-written from the matching example Diagnostic Assessment. It sets out the evidence, the diagnosis, the Statement of Principles and every factor met — including the inability to obtain appropriate clinical management — in a form a delegate can adopt as much of as they find useful. The worsening is determined separately, in the same document.

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This is the PDF a veteran receives: Times New Roman, set out as a Reference Determination, with both determinations for Gulf War Illness. It is the same letter shown in full below.

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Reference Determination Content

Suggested draft · fictitious patient

Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.

Gulf War Illness

Evidence

The evidence that I have considered in making this decision includes:

  • Formal Claim with supporting statements;
  • A Statement of your Service from the Department of Defence;
  • Copies of your Service Medical Records.
  • A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
  • A pre-deployment medical examination by the medical officer, Naval health centre, dated 20 November 1990;
  • A ship's medical record of pyridostigmine bromide issue by the medical officer, dated 15 January 1991;
  • A report of proceedings by the commanding officer, guided-missile destroyer, dated 21 February 1991;
  • A divisional officer's report by the divisional officer, dated 25 February 1991;
  • A ship's sick bay record by the medical officer, dated 11 March 1991;
  • An outpatient health record and X-ray reports by the medical officer and radiologist, dated 14 October 1991;
  • An outpatient health record by the medical officer, Naval health centre, dated 22 June 1994;
  • A medical employment classification review by the medical officer, dated 9 February 1998;
  • An MRI brain report by the radiologist, dated 5 August 2014;
  • A specialist assessment by the general physician, dated 12 August 2014;
  • A psychiatric assessment by the consultant psychiatrist, dated 3 September 2014.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

7 July 1987 and 23 January 2001

Gulf War Illness

You have stated that your condition was caused by:

  • living or working in a hostile or life-threatening environment for a period of at least 28 days in the six months before the clinical onset of chronic multisymptom illness
  • experiencing a category 1A stressor in the six months before the clinical onset of chronic multisymptom illness
  • experiencing a category 1B stressor in the six months before the clinical onset of chronic multisymptom illness

Diagnosis: Gulf War Illness

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a specialist assessment by the general physician, dated 12 August 2014.

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Chronic Multisymptom Illness (Reasonable Hypothesis) (No. 3 of 2020)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

  • living or working in a hostile or life-threatening environment for a period of at least 28 days in the six months before the clinical onset of chronic multisymptom illness
  • experiencing a category 1A stressor in the six months before the clinical onset of chronic multisymptom illness
  • experiencing a category 1B stressor in the six months before the clinical onset of chronic multisymptom illness

I have noted your contention as to the cause of this condition. The available evidence indicates, I have noted your contention to the cause of your condition. Your service medical records indicate that you presented to the health facility with overwhelming fatigue not relieved by sleep, aching in the knees, shoulders and hands, muscle pain, headaches, difficulty concentrating and finding words, irritability and broken sleep on 11 March 1991.

The diagnosis was made by a general physician, a specialist physician, on 12 August 2014. You have current symptoms in all three categories: fatigue; mood and cognition, with poor memory, poor concentration, word-finding difficulty, low mood and unrefreshing sleep; and musculoskeletal pain and stiffness in multiple joints and muscles. The symptoms are distressing, caused your medical discharge and continue to prevent full-time work, and they have persisted continuously since March 1991, far longer than six consecutive months. This meets each element of the Statement of Principles definition.

This has then led to further investigations and the diagnosis of your condition of Gulf War Illness. I have accepted your condition of Gulf War Illness.

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that this condition is related to your wartime service.

I have therefore accepted that this condition is related to your service with effect from 6 March 1991.

Gulf War Illness (Worsening)

Evidence

The evidence that I have considered in making this decision includes:

  • Formal Claim with supporting statements;
  • A Statement of your Service from the Department of Defence;
  • Copies of your Service Medical Records.
  • A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
  • A pre-deployment medical examination by the medical officer, Naval health centre, dated 20 November 1990;
  • A ship's medical record of pyridostigmine bromide issue by the medical officer, dated 15 January 1991;
  • A report of proceedings by the commanding officer, guided-missile destroyer, dated 21 February 1991;
  • A divisional officer's report by the divisional officer, dated 25 February 1991;
  • A ship's sick bay record by the medical officer, dated 11 March 1991;
  • An outpatient health record and X-ray reports by the medical officer and radiologist, dated 14 October 1991;
  • An outpatient health record by the medical officer, Naval health centre, dated 22 June 1994;
  • A medical employment classification review by the medical officer, dated 9 February 1998;
  • An MRI brain report by the radiologist, dated 5 August 2014;
  • A specialist assessment by the general physician, dated 12 August 2014;
  • A psychiatric assessment by the consultant psychiatrist, dated 3 September 2014.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

7 July 1987 and 23 January 2001

Gulf War Illness (Worsening)

You have stated that the worsening of your condition was caused by:

  • inability to obtain appropriate clinical management for chronic multisymptom illness

Diagnosis: Gulf War Illness (Worsening)

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a specialist assessment by the general physician, dated 12 August 2014.

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Chronic Multisymptom Illness (Reasonable Hypothesis) (No. 3 of 2020)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

  • inability to obtain appropriate clinical management for chronic multisymptom illness

I have noted your contention as to the cause of this condition. The available evidence indicates, I have noted your contention to the cause of your condition. Your service medical records indicate that you presented to the health facility with overwhelming fatigue not relieved by sleep, aching in the knees, shoulders and hands, muscle pain, headaches, difficulty concentrating and finding words, irritability and broken sleep on 11 March 1991.

The diagnosis was made by a general physician, a specialist physician, on 12 August 2014. You have current symptoms in all three categories: fatigue; mood and cognition, with poor memory, poor concentration, word-finding difficulty, low mood and unrefreshing sleep; and musculoskeletal pain and stiffness in multiple joints and muscles. The symptoms are distressing, caused your medical discharge and continue to prevent full-time work, and they have persisted continuously since March 1991, far longer than six consecutive months. This meets each element of the Statement of Principles definition.

After the condition arose, it was worsened during your service. From your first presentation on 11 March 1991 to the documented worsening on 9 February 1998 you sought help at least 14 times for fatigue, joint and muscle pain, headaches and poor concentration.

This has then led to further investigations and the diagnosis of your condition of Gulf War Illness (Worsening). I have accepted your condition of Gulf War Illness (Worsening).

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that the worsening of this condition is related to your wartime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 11 March 1991.

Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.
Dr Thomas Perkins, Veterans Health Centre

Reviewed by Dr Thomas Perkins

Founding doctor, Veterans Health Centre · former RAAF aviation medical officer · 13 years working exclusively with ADF members and veterans. Full profile →