ALS in Veterans: Symptoms, Diagnosis, and VA Compensation

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive neurodegenerative condition that affects nerve cells in the brain and spinal cord, resulting in muscle weakness, loss of motor function, and respiratory failure.

According to studies cited by the VA and the Department of Defense, veterans are about twice as likely to be diagnosed with ALS compared to civilians. While ALS remains a rare disease in the general population (affecting roughly 1–2 per 100,000 people annually), the elevated risk in military personnel has prompted special attention from the VA.

Due to the significant association of this disease with military service, VA characterizes ALS as a presumptive condition for service connection, meaning veterans diagnosed with ALS may qualify for disability compensation without needing to prove a direct link to a specific in-service event.

What Are the Causes of ALS in Military Veterans?

While the exact cause of ALS is still not fully understood, several environmental and service-related factors have been associated with increased risk among veterans. Possible contributors include:

• Exposure to Environmental Toxins: Veterans may have been exposed to lead, pesticides, and industrial solvents, all of which have been investigated as potential risk factors for ALS.

• Deployment-Related Exposures: Burn pits, Gulf War toxins, and other chemical exposures during deployments may have long-term neurological effects.

• Physical Trauma and Repetitive Injuries: Some studies suggest a correlation between head injuries and the onset of ALS, particularly for veterans in physically demanding or high-risk roles.

• Intense Physical Exertion: Military training and combat often involve extreme physical exertion, which has been studied as a possible ALS trigger, though evidence remains inconclusive.

• Infectious Agents: Exposure to certain enteroviruses or systemic mycoplasma infection during deployment may increase susceptibility.

Due to this range of potential exposures, the VA does not require veterans to pinpoint a specific cause of their condition. Any honorable service in the military qualifies under the presumption rule.

What Are the Symptoms of ALS?

ALS presents gradually and varies between individuals, but common early signs include:

• Muscle Weakness: Particularly in the arms, legs, or speech and swallowing muscles.
• Muscle Twitching (Fasciculations): Particularly in the shoulders, arms, or tongue.
• Slurred or Nasal Speech: Early signs of bulbar-onset ALS.
• Difficulty Swallowing or Chewing: Leading to weight loss or choking.
• Clumsiness or Tripping: Often due to weakened leg muscles.
• Fatigue and Cramping: Especially after routine physical activity.
• Breathing Difficulties: Resulting from weakened diaphragm muscles in later stages.

Symptoms typically worsen over time, and while the progression rate can vary, ALS is universally considered a terminal illness.

How Is ALS Diagnosed?

Diagnosing ALS can be challenging because early symptoms resemble those of other neuromuscular disorders. There is no single test for ALS, so the diagnosis is typically made through a process of elimination using the following:

• Neurological Examination: Evaluates reflexes, muscle strength, coordination, and signs of upper and lower motor neuron involvement.

• Electromyography (EMG): Assesses electrical activity in muscles to detect denervation or muscle response issues.

• Nerve Conduction Studies (NCS): Measures the speed and strength of electrical signals in nerves.

• MRI Scans: Rule out other neurological conditions such as tumors or spinal cord issues.

• Blood and Urine Tests: Used to exclude metabolic or infectious diseases.

• Lumbar Puncture (Spinal Tap): Occasionally used to analyze cerebrospinal fluid.

A confirmed diagnosis of ALS usually requires evidence of both upper and lower motor neuron degeneration in multiple body regions.

The ALS Functional Rating Scale-Revised (ALSFRS-R) is the most commonly used tool to assess the functional impact of ALS. It consists of 12 questions evaluating areas such as:

• Speech: Ranges from normal to loss of useful speech.
• Swallowing: Assesses the risk of choking and the need for a feeding tube.
• Handwriting and Fine Motor Skills: Measures the ability to write and use utensils.
• Walking and Climbing Stairs: Evaluates mobility independence.
• Breathing Function: Assesses respiratory strength and dependence on devices.

Each item is scored from 0 (no ability) to 4 (normal ability), for a maximum score of 48. Lower scores correlate with greater disability. Clinicians may also use respiratory function tests and nutritional status to gauge disease progression.

What Is the Current VA Rating Schedule for ALS?

The VA recognizes the serious and progressive nature of ALS. As such, any veteran diagnosed with ALS is automatically granted a 100% disability rating once service connection is established. This is one of the few conditions with such a designation.

• 100% Rating Upon Diagnosis: No need to demonstrate severity level or functional limitations.

• Effective Date Considerations: Compensation typically starts from the date the claim is filed or the date of diagnosis, whichever is later.

• Special Monthly Compensation (SMC): Additional benefits may be granted depending on the veteran’s level of need (e.g., loss of use of limbs, need for aid and attendance, or inability to speak).

• Dependency and Indemnity Compensation (DIC): If the veteran dies from ALS, surviving spouses and dependents may qualify for DIC benefits.

Thanks to VA regulations, veterans diagnosed with ALS do not need to prove a specific in-service cause. Since 2008, the VA has presumed service connection for ALS in veterans who served on active duty for 90 days or more, provided the diagnosis occurs after discharge.

To qualify for presumptive ALS service connection, a veteran must:

1. Have a Confirmed ALS Diagnosis: Medical records from a neurologist or specialist confirming ALS are required.
2. Have At Least 90 Days of Active Duty: This includes any branch and does not require combat service.
3. File a VA Disability Claim: Include medical documentation and service history.

However, veterans still benefit from providing a well-prepared claim. To ensure a smooth claims process, be sure to include medical records, a Disability Benefits Questionnaire (DBQ) (if available), and witness statements from family, friends, or caregivers that highlight changes in daily functioning.

Veterans who were discharged more than one year prior to diagnosis can still receive presumptive service connection under current regulations.

ALS is a devastating diagnosis, but the VA has put strong systems in place to support affected veterans. With a 100% disability rating upon diagnosis and the presumption of service connection, veterans can access both compensation and essential medical care without enduring the typical hurdles of proving direct service causation.

For more information on filing VA disability claims, read our free eBook: VA Disability Claims: An Essential Guide for U.S. Veterans.