Section K - Other Compensation Considerations - Updated 9/15/11

Chapter 2 - Rating

Overview
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In this Section
This section contains the following topics:   ''' '''
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65.   Compensation for Paired Organs or Extremities
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Introduction
This topic contains information on compensation for certain paired organs or extremities, including
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 ·      basis for awarding compensation for certain paired organs or extremities under 38 U.S.C. 1160

 ·      criteria for establishing entitlement, and

 ·      effective dates for provisions of the law. 
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Change Date
September 15, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Basis for Awarding Compensation for Certain Paired Organs or Extremities Under 38 U.S.C. 1160
Compensation is payable under 38 U.S.C. 1160 for disabilities involving certain paired organs or extremities, one SC and the other nonservice-connected (NSC), provided the NSC disability is not the result of the Veteran’s own willful misconduct.
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<p class="MsoBlockText">References:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      For more information on special consideration for certain paired organs and extremities, see 38 CFR 3.383.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      For information on prohibitions against duplication of benefits, see M21-1MR, Part IV, Subpart ii, 3.C.9. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 65. Compensation for Paired Organs or Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Criteria for Establishing Entitlement
<p class="MsoBlockText">Consider compensation under 38 U.S.C. 1160 for the following:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      blindness in one eye as a result of SC disability and blindness in the other eye as a result of NSC disability

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     rated at a visual acuity of 20/200 or less in each eye, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     with a peripheral field of vision for each eye of 20 degrees or less.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      loss, or loss of use (L/LOU), of one kidney as a result of SC disability and involvement of the other kidney as a result of NSC disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      deafness compensable to a degree of 10 percent or more in one ear due to SC disability, and deafness that meets the provisions of 38 CFR 3.385 in the other ear due to NSC disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      L/LOU of one hand or one foot as a result of SC disability and L/LOU of the other hand or foot as a result of NSC disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      permanent SC disability of one lung rated 50 percent or more disabling, in combination with NSC disability of the other lung. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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c.   Effective Dates for Provisions of the Law
<p class="MsoBlockText">Use the table below to determine effective dates for the provisions of law that established the criteria establishing entitlement to compensation under 38 U.S.C. 1160. <p class="MsoNormal"> <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 65. Compensation for Paired Organs or Extremities, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="MsoNormal"> <p class="MsoNormal"> <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''

66.   Disability or Death From Use of Alcohol
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Introduction
<p class="MsoBlockText">This topic contains information on disability or death from use of alcohol, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      willful misconduct

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      alcoholism as a primary disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      alcoholism secondary to an SC disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      alcoholism due to personality disorders

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims filed before August 13, 1964, involving the secondary effects of alcohol

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims filed between August 13, 1964, and October 31, 1990, involving the secondary effects of alcohol

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims filed after October 31, 1990, involving the secondary effects of alcohol

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Dependency and Indemnity Compensation (DIC) based on death resulting from an alcohol-related disease or disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      resolving reasonable doubt. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 15, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Willful Misconduct
<p class="MsoBlockText">A disability or death sustained as a direct result of drunkenness is generally considered as being due to willful misconduct.
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<p class="MsoBlockText">

<p class="MsoBlockText">When an individual willingly achieves a drunken state and undertakes tasks for which the drunken state renders him/her physically and mentally unqualified, the individual acts with wanton and reckless disregard of the probable consequences of drinking. Consider the resulting injury or death due to willful misconduct.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on willful misconduct, see M21-1MR, Part III, Subpart v, 1.D. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Alcoholism as a Primary Disability
<p class="MsoBlockText">Alcoholism as a primary disability is not a basis for granting entitlement to or increasing compensation or pension under the laws administered by the Department of Veterans Affairs (VA). <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 66. Disability or Death From Use of Alcohol, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Alcoholism Secondary to an SC Disability
<p class="MsoBlockText">Establish service connection under 38 CFR 3.310(a) for any diseases or disabilities resulting from alcohol abuse, if alcoholism is determined to be secondary to an SC disability.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Alcohol abuse may also be considered a symptom of an SC disability. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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d.   Alcoholism Due to Personality Disorders
<p class="MsoBlockText">Do not consider personality disorders characterized by developmental defects or pathological trends in the personality structure as underlying psychiatric diseases for the purpose of secondary service connection in compensation claims.
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<p class="MsoBlockText">

<p class="MsoBlockText">Alcoholism due to personality disorders

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      may not be the basis for granting or increasing disability compensation, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      may be the basis for a rating of incompetency. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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e.   Claims Filed Before August 13, 1964, Involving the Secondary Effects of Alcohol
<p class="MsoBlockText">The secondary effects of alcohol were considered of willful misconduct origin before August 13, 1964.
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<p class="MsoBlockText">

<p class="MsoBlockText">Do not award benefits under 38 CFR 3.114(a) prior to August 13, 1964, for the secondary effects of alcohol. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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f.   Claims Filed Between August 13, 1964, and October 31, 1990, Involving the Secondary Effects of Alcohol
<p class="MsoBlockText">Organic diseases shown by substantiating evidence as a secondary result of the use of alcohol as a beverage, whether out of compulsion or otherwise, were not considered to have been the result of willful misconduct in claims filed between August 13, 1964, and October 31, 1990.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Secondary results, such as cirrhosis of the liver, gastric ulcer, peripheral neuropathy, or chronic brain syndrome

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      sometimes appear because of indulgence in alcohol, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      may have been the basis for payment of compensation or pension, whether attributable to the chronic use of alcohol or other causes, under regulations then in effect. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 66. Disability or Death From Use of Alcohol, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Claims Filed After October 31, 1990, Involving the Secondary Effects of Alcohol
<p class="MsoBlockText">The granting of service connection for secondary disabilities or death resulting from the abuse of alcohol is prohibited effective November 1, 1990, under the provisions of Public Law (PL) 101-508.
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<p class="MsoBlockText">

<p class="MsoBlockText">Do not consider disabilities or death that results from the abuse of alcohol to have been incurred in the line of duty.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Do not

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      sever service connection that was properly established under regulations previously in effect, or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      award an increase in compensation for the secondary effects of alcohol based on any claim received after October 31, 1990, including a claim

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     for an increased evaluation, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     to add a dependent.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Cost-of-living increases, for which no claim is required, may be paid.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      line of duty and alcohol abuse, see 38 CFR 3.301(d), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the prohibition against increasing compensation for disabilities resulting from the abuse of alcohol, see VAOPGCPREC 02-98. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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h.   DIC Based on Death Resulting From an Alcohol-Related Disease or Disability
<p class="MsoBlockText">Dependency and Indemnity Compensation (DIC) may not be granted based on death in service if the
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      death resulted from an alcohol-related disease or disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      original or reopened claim is received after October 31, 1990. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 66. Disability or Death From Use of Alcohol, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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i.   Resolving Reasonable Doubt
<p class="MsoBlockText">Disabilities generally attributable to alcohol abuse may be due to other causes.
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<p class="MsoBlockText">

<p class="MsoBlockText">Do not deny a claim for service connection for any disability generally attributable to alcohol abuse unless the evidence clearly shows such a causal relationship exists.

<p class="MsoBlockText">

<p class="MsoBlockText">Resolve reasonable doubt in favor of the claimant.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      It is not always possible to determine the cause of a disease or disability.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Any indication that a condition is the result of alcohol abuse may be rebutted by evidence showing some other cause.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on application of the benefit-of-the-doubt rule in compensation cases, see M21-1MR, Part III, Subpart iv, 5.12.d. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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67.   Disability or Death From Use of Drugs
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Introduction
<p class="MsoBlockText">This topic contains information on disability or death from use of drugs, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      willful misconduct

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      willful misconduct and the secondary effects of drug usage prior to November 1, 1990

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims for service connection for the secondary effects of drug usage filed after October 31, 1990, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      drug usage for therapeutic purposes secondary to SC disability. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 15, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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a.   Willful Misconduct
<p class="MsoBlockText">Consider disability or death the result of willful misconduct when the evidence shows
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      drugs were used to enjoy or experience their effects, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      drug usage resulted proximately and immediately in disability or death.

<p class="MsoBlockText">

<p class="MsoBlockText">The progressive and frequent use of drugs, other than for a recognized therapeutic purpose, which results in addiction, is considered willful misconduct. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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b.   Willful Misconduct and the Secondary Effects of Drug Usage Prior to November 1, 1990
<p class="MsoBlockText">Organic diseases and disabilities shown by substantiating evidence as a secondary result of the chronic use of drugs, or infections coinciding with the injection of drugs, were not considered to have been the result of willful misconduct   in claims filed prior to November 1, 1990. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 67. Disability or Death From Use of Drugs, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Claims for Service Connection for Secondary Effects of Drug Usage Filed After October 31, 1990
<p class="MsoBlockText">The grant of service connection for secondary disabilities or death that results from the abuse of drugs is prohibited effective November 1, 1990, under the provisions of PL 101-508.
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<p class="MsoBlockText">

<p class="MsoBlockText">Do not consider disabilities or death resulting from the abuse of drugs to have been incurred in the line of duty.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Do not

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      sever service connection that was properly established under regulations previously in effect, or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      award an increase in compensation for the secondary effects of drug use based on any claim received after October 31, 1990, including a claim

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     for an increased evaluation, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2;tab-stops:list .25in 27.35pt"> -     to add a dependent.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Cost-of-living increases, for which no claim is required, may be paid.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For more information on

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      line of duty and drug abuse, see 38 CFR 3.301(d), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the prohibition against increasing compensation for disabilities resulting from drug usage, see VAOPGCPREC 02-98. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-table-layout-alt:fixed;mso-padding-alt: 0in 5.4pt 0in 5.4pt"
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d.   Drug Usage for Therapeutic Purposes Secondary to SC Disability
<p class="MsoBlockText">Do not consider drug use or addiction to be of misconduct origin or a bar to the awarding or increasing of monetary benefits where the use of drugs or drug addiction is shown by substantiating evidence as
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      arising out of use for recognized therapeutic purposes, or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      secondary to, or resulting from, an SC disability. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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68.   Disability or Death From Use of Tobacco Products
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Introduction
<p class="MsoBlockText">This topic contains information on disability or death from use of tobacco products, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the prohibition against direct service connection

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      disability secondary to a tobacco-related SC disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a claim for a disability secondary to a tobacco-related SC disability

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      secondary service connection for disability or death related to tobacco use after service

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering claims for secondary service connection, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a claim for secondary service connection for a disability related to tobacco use after service. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 15, 2011 <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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a.   Prohibition Against Direct Service Connection
<p class="MsoBlockText">Effective June 9, 1998, the granting of service connection for a disability or death that results from the Veteran’s use of tobacco products in service is prohibited.
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<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information, see 38 CFR 3.300(a). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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b.   Disability Secondary to a Tobacco-Related SC Disability
<p class="MsoBlockText">Under 38 CFR 3.300(c), the establishment of service connection for a disability that develops as a result of a tobacco-related disability, for which service connection was previously granted based on the Veteran’s use of tobacco products during service, is prohibited, if such a claim for service connection is received on or after June 9, 1998. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 68. Disability or Death From Use of Tobacco Products, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Example:   Disability Secondary to a Tobacco-Related SC Disability
<p class="MsoBlockText">Facts:   Service connection for nicotine dependence resulting from tobacco use that began during service was established in 1997. In April 2003, the Veteran claimed that his chronic obstructive pulmonary disease was secondary to SC nicotine dependence.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Deny service connection for chronic obstructive pulmonary disease.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Although service connection was previously established for nicotine dependence, under 38 CFR 3.300(c) the establishment of service connection for a disability that is secondary to a tobacco-related SC disability is prohibited, because the claim was filed after June 9, 1998. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Secondary Service Connection for Disability or Death Related to Tobacco Use After Service
<p class="MsoBlockText">In VAOPGCPREC 6-2003, General Counsel (GC) held that secondary service connection may be established for disability or death related to tobacco use after service that is the result of or aggravated by an SC disability unrelated to tobacco use. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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e.   Considering Claims for Secondary Service Connection
<p class="MsoBlockText">The table below shows the steps involved in considering claims for secondary service connection for disability or death related to tobacco use after service. <p class="MsoNormal"> <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 68. Disability or Death From Use of Tobacco Products, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<p class="MsoNormal"> <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Example:   Secondary Service Connection for a Disability Related to Tobacco Use After Service
<p class="MsoBlockText">Facts:   A Veteran with an SC evaluation for posttraumatic stress disorder (PTSD) claims secondary service connection for tobacco-related emphysema. He states that he started smoking cigarettes after service because of anxiety related to PTSD.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Grant service connection for emphysema on a secondary basis if it is shown that

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      symptoms of PTSD resulted in the Veteran’s use of cigarettes

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cigarette smoking caused by PTSD was a substantial factor in causing (or aggravating) emphysema, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      emphysema (or an increase in its severity) would not have occurred if the Veteran had not smoked cigarettes.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Per VAOPGCPREC 6-2003, secondary service connection may be established for disability related to tobacco use after service that is the result of or aggravated by an SC disability unrelated to tobacco use. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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