Section C - Service Connection for Disabilities Resulting from Exposure to Environmental Hazards or Service in the Republic of Vietnam (RVN) - Updated 12/16/11

Chapter 2 - Rating

Overview


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In this Section
This section contains the following topics:   ''' '''
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8.   Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation
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Introduction
This topic contains information on service connection for disabilities resulting from exposure to ionizing radiation, including the
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 ·      provisions of

 -     Public Law (PL) 98-542, and

 -     PL 102-86, and

 ·      history of time limits for disease manifestation, and

 ·      list of presumptive disabilities under 38 CFR 3.309(d). 
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Change Date
<p class="MsoBlockText">December 13, 2005 {| 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.   Provisions of PL 98-542
<p class="MsoBlockText">Under Public Law (PL) 98-542, the “Veterans’ Dioxin and Radiation Exposure Compensation Standards Act,” which was enacted on October 24, 1984, the following claims that were denied prior to October 24, 1984, are entitled to a de novo review:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims for service connection based upon exposure to ionizing radiation as a consequence of service with the occupation forces of Hiroshima or Nagasaki, Japan, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims for service connection based upon exposure to ionizing radiation in connection with nuclear testing.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      A  de novo  review is a new and complete review of an issue with no deference given to the previous decision.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      It is not necessary for the claimant to submit new and material evidence to reopen these claims. {| 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.   Provisions of PL 102-86
<p class="MsoBlockText">PL 102-86, effective August 14, 1991, extended eligibility to presumptive service connection to individuals engaged in a radiation-risk activity during
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      active duty for training, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      inactive duty training. <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"> 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   History of Time Limits for Disease Manifestation
<p class="MsoBlockText">Originally, in order to establish presumptive service connection, the time limit for a disease listed under 38 CFR 3.309(d) to become manifest to a degree of 10 percent or more was
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      30 years for leukemia, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      40 years for all other diseases.

<p class="MsoBlockText">

<p class="MsoBlockText">Then, the presumptive period was extended to 40 years for leukemia effective August 14, 1991.

<p class="MsoBlockText">

<p class="MsoBlockText">Effective October 1, 1992, a time limit for manifestation is not specified or required for any disease under listed 38 CFR 3.309(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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d.   List of Disabilities Under 38 CFR 3.309(d) for Which Service Connection Is Presumed
<p class="MsoBlockText">The table below lists the disabilities for which service connection is presumed based on a Veteran’s exposure to ionizing radiation under 38 CFR 3.309(d). <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"> 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation, 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"> '''<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"> '''

9.   Service Connection for Disabilities Resulting From Exposure to Asbestos
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Introduction
<p class="MsoBlockText">This topic contains information on service connection for disabilities resulting from exposure to asbestos, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definition of asbestos

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the general effects of asbestos exposure

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      specific details on disease resulting from exposure to asbestos

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      occupational exposure and exposure during World War II (WWII)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the latent period for development of disease

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the diagnostic indicators of asbestosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering service connection for exposure to asbestos during service, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      rating disabilities caused by exposure to asbestos. <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">December 13, 2005 {| 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.   Definition:   Asbestos
<p class="MsoBlockText">Asbestos is a fibrous form of silicate mineral of varied chemical composition and physical configuration, derived from serpentine and amphibole ore bodies.
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<p class="MsoBlockText">

<p class="MsoBlockText">Common materials that may contain asbestos include

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      steam pipes for heating units and boilers

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      ceiling tiles

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      roofing shingles

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      wallboard

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      fire-proofing materials, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      thermal insulation.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Due to concerns about the safety of asbestos, the use of materials containing asbestos has declined in the United States since the 1970s. <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"> 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   General Effects of Asbestos Exposure
<p class="MsoBlockText">Asbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed.
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<p class="MsoBlockText">

<p class="MsoBlockText">Inhalation of asbestos fibers can produce

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      fibrosis, the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      tumors

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pleural effusions and fibrosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pleural plaques

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      mesotheliomas of pleura and peritoneum

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cancers of the

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     lung

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     bronchus

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     gastrointestinal tract

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     larynx

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     pharynx, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     urogenital system, except the prostate.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:   The biological actions of the various fibers differ in some respects, in that

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      chrysotile products

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     have their initial effects on the small airways of the lung

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     cause asbestosis more slowly, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     result in lung cancer more often, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      crocidolite and amosite

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     have more initial effects on the small blood vessels of the lung, alveolar walls, and pleura, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     result more often in mesothelioma. <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"> 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Specific Details on Diseases Resulting From Exposure to Asbestos
<p class="MsoBlockText">Specific effects of exposure to asbestos include
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      lung cancer that

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     originates in the lung parenchyma rather than the bronchi, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     eventually develops in about 50 percent of persons with asbestosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      gastrointestinal cancer that develops in 10 percent of persons with asbestosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      urogenital cancer that develops in 10 percent of persons with asbestosis, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      mesothelioma that develops in 17 percent of persons with asbestosis.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      All persons with significant asbestosis develop cor pulmonale, heart disease secondary to disease of the lung or its blood vessels, and those who do not die from cancer often die from heart failure secondary to cor pulmonale.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Disease-causing exposure to asbestos may be

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     brief, and/or

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     indirect.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Current smokers who have been exposed to asbestos exposure face an increased risk of developing bronchial cancer.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Mesotheliomas are not associated with cigarette smoking. {| 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.   Latent Period for Development of Disease
<p class="MsoBlockText">The latent period for development of disease due to exposure to asbestos ranges from 10 to 45 or more years between first exposure and development of disease. {| 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.   Diagnostic Indicators of Asbestosis
<p class="MsoBlockText">A clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Symptoms and signs include
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      dyspnea on exertion

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      end-respiratory rales over the lower lobes

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      compensatory emphysema

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      clubbing of the fingers at late stages, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods. <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"> '''
 * }

<p class="MapTitleContinued"> 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Occupational Exposures to Asbestos
<p class="MsoBlockText">Some of the major occupations involving exposure to asbestos include
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      mining

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      milling

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      work in shipyards

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      insulation work

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      demolition of old buildings

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      carpentry and construction

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      manufacture and servicing of friction products, such as clutch facings and brake linings, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      manufacture and installation of products, such as

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     roofing and flooring materials

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     asbestos cement sheet and pipe products, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     military equipment.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Exposure to any simple type of asbestos is unusual except in mines and mills where the raw materials are produced. {| 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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g.   Exposure to Asbestos During WWII
<p class="MsoBlockText">High exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers.
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="MsoBlockText">During World War II (WWII), several million people employed in U.S. shipyards and U.S. Navy Veterans were exposed to chrysotile products as well as amosite and crocidolite since these varieties were used extensively in military ship construction.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Many of these people have only recently come to medical attention because of the potentially long latent period between first exposure and development of disease. <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"> '''
 * }

<p class="MapTitleContinued"> 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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h.   Considering Service Connection for Disabilities Resulting From Exposure to Asbestos During Service
<p class="MsoBlockText">When deciding a claim for service connection for a disability resulting from exposure to asbestos
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determine whether or not service records demonstrate the Veteran was exposed to asbestos during service

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      ensure that development is accomplished to determine whether or not the Veteran was exposed to asbestos either before or after service, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determine whether or not a relationship exists between exposure to asbestos and the claimed disease, keeping in mind latency and exposure factors.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      As always, resolve reasonable doubt in the claimant’s favor.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      If assistance in deciding a case is needed, contact the Compensation Service Policy Staff (211). {| 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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i.   Rating Disabilities Caused by Exposure to Asbestos
<p class="MsoBlockText">Use the information below to determine the diagnostic code (DC) to assign when rating disabilities caused by exposure to asbestos. <p class="MsoNormal"> <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"> '''
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|
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10.   Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN)
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Introduction
<p class="MsoBlockText">This topic contains information on service connection for disabilities resulting from exposure to herbicides or based on service in the Republic of Vietnam (RVN), including
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definitions of a herbicide agent and service in the Republic of Vietnam (RVN)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      presuming exposure to a herbicide agent

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determining the last date of herbicide exposure

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the time limits for disease manifestation

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      when to consider direct service connection

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definition of acute  and subacute peripheral neuropathy

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims based on acute and subacute peripheral neuropathy and later-occurring peripheral neuropathy

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the date of presumptive service connection under 38 CFR 3.309(e)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      conditions determined to have no positive association with herbicide exposure

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      considering claims based on service aboard ships offshore the RVN

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      use of the U.S. Army and Joint Services Records Research Center (JSRRC) memorandum in claims of exposure from herbicides being stored or transported on the Veteran’s ship

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      JSRRC memorandum – Herbicide Exposure During Naval Service

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      exposure to herbicides during service aboard the USS Ingersoll

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      verifying herbicide exposure on a factual basis in locations other than in RVN

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      exposure to herbicides along the demilitarized zone in Korea

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      exposure to herbicides in Thailand during the Vietnam Era

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      use of JSRRC’s memorandum in claims based on exposure to herbicides in Thailand

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      memorandum for the record on herbicide use Thailand

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      storage of herbicides on Johnston Island

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Fact Sheet:   Storage of Agent Orange on Johnston Island, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      service connection for non-Hodgkin’s lymphoma (NHL) under 38 CFR 3.313 based on service in the RVN.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      subcategories of NHL qualifying for presumptive service connection. <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">December 16, 2011 <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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a.   Definition:   Herbicide Agent
<p class="MsoBlockText">Under 38 CFR 3.307(a)(6)(i), a herbicide agent is a chemical used in support of the U.S. and allied military operations in the Republic of Vietnam (RVN) during the Vietnam Era, specifically
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      2,4-D

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      2,4,5-T and its contaminant, TCDD (dioxin)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cacodylic acid, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      picloram. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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b.   Definition:   Service in the RVN
<p class="MsoBlockText"> For the purposes of establishing service connection under 38 CFR 3.307(a)(6) and 38 CFR 3.309(e), service in the Republic of Vietnam  (RVN)  means
 * style="width:387.0pt;padding:0in 5.4pt 0in 5.4pt" valign="top" width="516"|

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      service in the RVN or its inland waterways, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      service in other locations if the conditions of service involved duty or visitation in the RVN.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on the definition of service in the RVN, see VAOPGCPREC 27-97. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Presuming Exposure to a Herbicide Agent
<p class="MsoBlockText">Presume that a Veteran who served on active duty in the RVN during the Vietnam Era was exposed to a herbicide agent unless there is affirmative evidence to the contrary.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Any exposure to herbicide agents during service in locations other than the RVN must be established on a factual basis.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on verifying exposure to herbicides in locations other than the RVN, see |M21-1MR, Part IV, Subpart ii, 2.C.10.o through r. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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d.   Determining the Last Date of Herbicide Exposure
<p class="MsoBlockText">Under 38 CFR 3.307(a)(6)(iii), the last date of exposure is the last date on which the Veteran served in the RVN during the Vietnam Era. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Time Limits for Disease Manifestation
<p class="MsoBlockText">In order to establish presumptive service connection, the following diseases listed in 38 CFR 3.309(e) must become manifest to a degree of 10 percent or more within one year of the last date of exposure to herbicides:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      chloracne or other acne-form disease consistent with chloracne

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      porphyria cutanea tarda, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      acute and subacute peripheral neuropathy.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      There is no time limit for the other listed diseases.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Previously, respiratory cancers, cancers of the lung, bronchus, larynx, and trachea had to become manifest within 30 years of last exposure. PL 107-103 eliminated this requirement effective January 1, 2002.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on time limits for manifestation of diseases subject to presumptive service connection, see 38 CFR 3.307(a)(6)(ii). {| 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.   When to Consider Direct Service Connection
<p class="MsoBlockText">Under 38 CFR 3.303(d) the requirements for presumptive service connection do not preclude consideration of direct service connection when a medical nexus (link, relationship, or association) has been provided. <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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g.   Definition:   Acute and Subacute Peripheral Neuropathy
<p class="MsoBlockText">Acute peripheral neuropathy and subacute peripheral neuropathy are transient peripheral neuropathies that
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      appeared within one year of last exposure to an herbicide agent

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      resolved within two years of the date of onset, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      do not include chronic peripheral neuropathy. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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h.   Handling Claims Based on a History of Acute and Subacute Peripheral Neuropathy and Later-Occurring Peripheral Neuropathy
<p class="MsoBlockText">Do not assign a “ zero percent” evaluation based on a history of acute and subacute peripheral neuropathy that
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      manifested within one year of the date of last exposure, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      resolved within two years of the date of onset.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   There can be no valid claim without proof of a present disability.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on what constitutes a valid claim for service connection, see Brammer v. Derwinski, 3 Vet.App. 223 (1992).

<p class="MsoBlockText">

<p class="MsoBlockText">Claims of service connection for later occurring peripheral neuropathy should be evaluated under the ordinary standards governing direct service connection.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Because any acute or subacute peripheral neuropathy will, by definition, resolve within a short time after exposure do not presume any later occurring peripheral neuropathy, whether transient or chronic, to be related to the

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      prior herbicide exposure, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      previously-resolved acute or subacute peripheral neuropathy. <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"> '''
 * }

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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i.   Date   Disabilities Became Subject to Presumptive Service Connection
<p class="MsoBlockText">The table below shows the dates on which the diseases listed in 38 CFR 3.309(e) became subject to presumptive service connection. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), 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">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"> '''

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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j.   Conditions Determined to Have No Positive Association With Herbicide Exposure
<p class="MsoBlockText">Under the Agent Orange Act of 1991, the Secretary receives from the National Academy of Science (NAS) periodic reviews and summaries of the scientific evidence concerning the association between exposure to herbicides and diseases suspected to be associated with those exposures.
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<p class="MsoBlockText">

<p class="MsoBlockText">Based on cumulative scientific data reported by the NAS since 1993, the Secretary has determined that there is no positive association between herbicide exposure and the following conditions:

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      bone cancers

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      brain tumors

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      breast cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      circulatory disorders

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      cognitive and neuropsychiatric effects

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      female reproductive system cancers

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      gastrointestinal and digestive disease, other than Type 2 diabetes mellitus

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      gastrointestinal tract tumors

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      hepatobiliary cancers

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      immune system disorders

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      lipid and lipoprotein disorders

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      nasal and nasopharyngeal cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      chronic persistent peripheral neuropathy

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      renal cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      reproductive effects, such as abnormal sperm parameters and infertility

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      respiratory disorders, other than certain respiratory cancers

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      skin cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      testicular cancer, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      urinary bladder cancer.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   No positive association means that the evidence for an association does not equal or outweigh the evidence against association. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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k.   Considering Claims Based on Service Aboard Ships Offshore the RVN
<p class="MsoBlockText">When a Veteran claims exposure to herbicides during service aboard a Navy or Coast Guard ship that operated on the offshore waters of the RVN, establish exposure on a presumptive basis if
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      evidence shows the ship

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     docked on the shores or piers of the RVN

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     operated temporarily on the RVN inland waterways, or

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     operated on close coastal waters for extended periods, with evidence that

<p class="BulletText3" style="mso-list:l14 level1 lfo7"> §   crew members went ashore, or

<p class="BulletText3" style="mso-list:l14 level1 lfo7"> §   smaller vessels from the ship went ashore regularly with supplies or personnel

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      evidence places the Veteran onboard the ship at the time the ship docked to the shore or pier or operated in inland waterways or on close coastal waters for extended periods, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran has stated that he/she went ashore when the ship docked or operated on close coastal waters for extended periods, if the evidence shows the ship docked to the shore or pier or that crew members were sent ashore when the ship operated on close coastal waters.

<p class="BulletText1" style="margin-left:0in;text-indent:0in;mso-list:none;  tab-stops:.5in">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Service aboard a ship that anchored in an open deep-water harbor, such as Da Nang, Vung Tau, or Cam Ranh Bay, along the RVN coast does not constitute inland waterway service or qualify as docking to the shore and is not sufficient to establish presumptive exposure to herbicides, unless the Veteran served as a coxswain aboard ship and reports going ashore during anchorage.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veterans who served aboard large ocean-going ships that operated on the offshore waters of the RVN are often referred to as “blue water” Veterans because of the blue color of the deep offshore waters. They are distinguished from “brown water” Veterans who served aboard smaller patrol vessels or their supply vessels that operated on the brown-colored rivers, canals, estuaries, and delta areas making up the inland waterways of the RVN.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Brown water Navy and Coast Guard Veterans receive the same presumption of herbicide exposure as Veterans who served on the ground in the RVN.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on Navy vessels that docked to the shore or pier of the RVN or traveled on inland waterways, or operated on close coastal waters for extended periods, see the Compensation Service Intranet at   http://vbaw.vba.va.gov/bl/21/rating/VENavyShip.htm. <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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l.   Use of JSRRC’s Memorandum in Claims of Exposure From Herbicides Being Stored or Transported on Veteran’s Ship
<p class="MsoBlockText">In all cases where a Veteran claims that he/she served on a ship that stored or transported herbicides, regional offices should place a copy of the U.S. Army and Joint Services Records Research Center’s (JSRRC’s) memorandum shown in M21-1MR, Part IV, Subpart ii, 2.C.10.m in the Veteran’s claim folder.
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<p class="MsoBlockText">

<p class="MsoBlockText">This document will

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      substitute for individual inquiries to the Compensation Service’s Agent Orange mailbox and to the JSRRC, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      establish that the JSRRC has no evidence to support a claim of herbicide exposure based solely on shipboard service. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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m.   JSRRC Memorandum – Herbicide Exposure During Naval Service
<p class="MsoBlockText">Below is the JSRRC’s memorandum confirming it has no evidence to support a Veteran’s claim of herbicide exposure during naval service offshore the RVN. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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n.   Exposure to Herbicides During Service Aboard the USS Ingersoll
<p class="MsoBlockText">The National Archives and Records Administration (NARA) has confirmed that the Navy destroyer USS Ingersoll (DD 652) traveled into the inland waterways of RVN on October 24 and 25, 1965. Therefore, according to 38 CFR 3.307, concede exposure to herbicides for crewmembers that served aboard the USS Ingersoll on these dates.
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<p class="MsoBlockText">

<p class="MsoBlockText">If a Veteran alleges herbicide exposure based on duty aboard the USS Ingersoll, request Navy personnel records via the Personnel Information Exchange System (PIES) (request code O19).

<p class="MsoBlockText">

<p class="MsoBlockText">If personnel records are unavailable, or do not confirm a specific shipboard assignment during this timeframe, send a request for a review of NARA records to Compensation Service via e-mail at VAVBAWAS/CO/211/AGENTORANGE. This request should include the Veteran’s

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      name

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      date of birth

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      VA claim number

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Social Security number (SSN), and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      service number, if different than SSN. <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"> '''
 * }

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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o.   Verifying   Herbicide Exposure on a Factual Basis in Locations Other Than in RVN or Korean DMZ
<p class="MsoBlockText">The table below shows how to verify herbicide exposure on a factual basis in locations other than in
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the RVN during the Vietnam Era, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Korea at or near the demilitarized zone (DMZ) between April 1, 1968, and August 31, 1971.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on exposure to herbicides along the Korean DMZ, see

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 2.C.10.p, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.307(a)(6)(iv). <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"> '''
 * }

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<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.   Exposure to Herbicides Along the Korean DMZ
<p class="MsoBlockText">Under 38 CFR 3.307(a)(6)(iv), effective February 24, 2011, extend the presumption of herbicide exposure to any Veteran who served
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      between April 1, 1968, and August 31, 1971, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      in a unit that VA or the Department of Defense (DoD) has determined to have operated in an area in or near the Korean DMZ.

<p class="MsoBlockText">

<p class="MsoBlockText">The table below shows the units or other military entities that DoD has identified as operating in or near the Korean DMZ during the qualifying time period.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Before the amendment of 38 CFR 3.307(a)(6)(iv), effective February 24, 2011, VA conceded exposure to herbicides on a direct basis for Veterans who served between April 1968 and July 1969 in one of the groups listed below. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), 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">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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q.   Herbicide Exposure in Thailand During the Vietnam Era
<p class="MsoBlockText">The Compensation Service has determined that a special consideration of herbicide exposure on a factual basis should be extended to Veterans whose duties placed them on or near the perimeters of Thailand military bases.
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<p class="MsoBlockText">

<p class="MsoBlockText">Follow the steps in the table below to verify exposure to herbicides when a Veteran with service in Thailand during the Vietnam Era claims a disability based on herbicide exposure. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<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"> '''

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<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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r.   Memorandum for Record – Herbicide Use in Thailand
<p class="MsoBlockText">Shown below is the Compensation Service’s “Memorandum for the Record” on herbicide use in Thailand during the Vietnam Era.
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<p class="MsoBlockText">

<p class="MsoBlockText"> Memorandum for the Record 

<p class="MsoBlockText">

<p class="MsoBlockText">Subject:   Herbicide use in Thailand during the Vietnam Era

<p class="MsoBlockText">

<p class="MsoBlockText"> The Compensation Service has reviewed a listing of herbicide use and test sites outside Vietnam provided to our office by the Department of Defense (DoD). This list contains 71 sites within the U.S. and in foreign countries where tactical herbicides, such as Agent Orange, were used, tested, or stored. Testing and evaluations of these tactical herbicides were conducted by or under the direction of the U.S. Army Chemical Corps, Fort Detrick, Maryland. The list does not contain names of individuals. Additionally, it does not contain any references to routine base maintenance activities such as range management, brush clearing, weed killing, etc., because these vegetation control activities were conducted by the Base Civil Engineer and involved the use of commercial herbicides approved by the Armed Forces Pest Control Board. The application of commercial herbicides on military installations was conducted by certified applicators. DoD has advised us that commercial herbicides were routinely purchased by the Base Civil Engineer under federal guidelines and that records of these procurements were generally kept no longer than two years. We have also reviewed a series of official DoD monographs describing in detail the use, testing, and storage of herbicides at various foreign and domestic locations. In addition, the Project CHECO Southeast Asia Report: Base Defense in Thailand, produced during the Vietnam era, has been reviewed.

<p class="MsoBlockText">

<p class="MsoBlockText"> Regarding your Veteran claimant with Thailand service, the DoD list indicates only that limited testing of tactical herbicides was conducted in Thailand from 2 April through 8 September 1964. Specifically, the location identified was the Pranburi Military Reservation associated with the Replacement Training Center of the Royal Thai Army, near Pranburi, Thailand. The Report of these tests noted that 5 civilian and 5 military personnel from Fort Detrick, Maryland conducted the spray operations and subsequent research. This location was not near any U.S. military installation or Royal Thai Air Force Base.

<p class="MsoBlockText">

<p class="MsoBlockText"> Tactical herbicides, such as Agent Orange, were used and stored in Vietnam, not Thailand. We received a letter from the Department of the Air Force stating that, other than the 1964 tests on the Pranburi Military Reservation, there are no records of tactical herbicide storage or use in Thailand. There are records indicating that commercial herbicides were frequently used for vegetation control within the perimeters of air bases during the Vietnam era, but all such use required approval of both the Armed Forces Pest Control Board and the Base Civil Engineer. In Vietnam, tactical herbicides were aerially applied by UC-123 aircraft in Operation RANCH HAND or by helicopters under the control of the U.S. Army Chemical Corps. Base Civil Engineers were not permitted to purchase or apply tactical herbicides. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

<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"> '''

<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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s.   Herbicide Storage on Johnston Island
<p class="MsoBlockText">Herbicides were stored in drums on Johnston Island in the north Pacific between April 1972 and September 1977. Because military contractors were responsible for the inventory, few military personnel who served on Johnston Island had duties involving the direct handling of herbicides.
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<p class="MsoBlockText">

<p class="MsoBlockText">If a Veteran alleges exposure to herbicides during service on Johnston Island, obtain verification of exposure on a factual basis.

<p class="MsoBlockText">

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

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      verifying exposure to herbicides on a factual basis, see M21-1MR, Part IV, Subpart ii, 2.C.10.o, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      storage of herbicides on Johnston Island, see M21-1MR, Part IV, Subpart ii, 2.C.10.t. <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"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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t.   Herbicide Storage on Johnston Island:   Fact Sheet
<p class="MsoBlockText">Below is a fact sheet on the storage of the herbicide Agent Orange on Johnston Island. <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"> '''
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<p class="MapTitleContinued"> 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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u.   Service Connection for NHL Under 38 CFR 3.313 Based on Service in RVN
<p class="MsoBlockText">VA regulations at 38 CFR 3.313 provide for a presumption of service connection for non-Hodgkin’s lymphoma (NHL) based on service in the RVN during the Vietnam Era.
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<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Exposure to herbicides is not a prerequisite for entitlement under 38 CFR 3.313. The claimant needs only to show service in the RVN, which includes the waters offshore. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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v.   Subcategories of NHL Qualifying for Presumptive Service Connection
<p class="MsoBlockText">When 38 CFR 3.313 was promulgated, the U.S. Center for Disease Control identified a number of subcategories that are manifestations of NHL.
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<p class="MsoBlockText">

<p class="MsoBlockText">Extend the presumption of service connection to a Veteran who claims service connection for NHL if

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran had service in the RVN during the Vietnam Era, including naval service in the offshore waters of the RVN, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the medical evidence shows a diagnosis of any of the subcategories of low, intermediate, or high grade lymphoma listed in the table below. <p class="MsoNormal"> <p class="MsoNormal"> <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"> '''
 * }

11.   Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides
<p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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Introduction
<p class="MsoBlockText">This topic contains information on the payment under the Nehmer stipulation, 38 CFR 3.816, for disabilities resulting from exposure to herbicides, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Nehmer stipulation background

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Nehmer class member categories

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definition of a covered herbicide disease

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      entitlement to benefits under 38 CFR 3.816

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      effective dates of awards under 38 CFR 3.816

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of establishing a retroactive effective date

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims that do not specifically mention herbicide exposure

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      an example of a claim in which exposure to herbicides was not specifically mentioned

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims for service connection for

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     porphyria cutanea tarda (PCT), and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     Type 2 diabetes mellitus

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      examples of claims for service connection for Type 2 diabetes mellitus

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      identifying the appropriate survivor of a Nehmer class member

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the action when the appropriate survivor of a Nehmer class member cannot be located, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      identifying other survivors of Nehmer class members. <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.   Nehmer Stipulation Background
<p class="MsoBlockText">38 CFR 3.311a, which became effective on September 25, 1985, was the first VA regulation to provide guidance for the adjudication of claims based on exposure to dioxin.
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<p class="MsoBlockText">

<p class="MsoBlockText">In February 1986, a class action suit entitled Nehmer v. United States Veterans Administration, No''. ''C86-6160 THE (N.D. Cal.), was filed in the United States District Court for the Northern District of California.

<p class="MsoBlockText">

<p class="MsoBlockText">On May 3, 1989, the district court invalidated a portion of 38 CFR 3.311a. All denials after September 24, 1985, that were based on 38 CFR 3.311a were voided, and a moratorium was placed on further denials. The moratorium was lifted on February 15, 1994.

<p class="MsoBlockText">

<p class="MsoBlockText">On September 24, 2003, a new regulation, 38 CFR 3.816, was added to provide guidance in the adjudication of claims under the Nehmer litigation. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Nehmer Class Member Categories
<p class="MsoBlockText">Nehmer class members under 38 CFR 3.816 include a
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veteran who

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     served in the Republic of Vietnam during the Vietnam era, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     has a covered herbicide disease, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      surviving spouse, child, or parent of a deceased Veteran who

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     served in the Republic of Vietnam during the Vietnam era, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     died as the result of a covered herbicide disease. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Covered Herbicide Disease Definition
<p class="MsoBlockText">A covered herbicide disease under 38 CFR 3.816 means a disease for which VA has established a presumption of service connection before October 1, 2002, under the “Agent Orange Act of 1991.”
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<p class="MsoBlockText">

<p class="MsoBlockText">Exception:   Chloracne is not a covered herbicide disease under 38 CFR 3.816.

<p class="MsoBlockText">

<p class="MsoBlockText">The covered herbicide diseases under 38 CFR 3.816 are

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      acute and subacute peripheral neuropathy

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Hodgkin’s disease

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      multiple myeloma

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      non-Hodgkin’s lymphoma

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      porphyria cutanea tarda

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      prostate cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      respiratory cancers (cancer of the lung, bronchus, larynx, or trachea)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      soft-tissue sarcoma, as defined in 38 CFR 3.309(c), and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Type 2 diabetes, also known as type II diabetes mellitus or adult-onset diabetes. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Entitlement to Benefits Under 38 CFR 3.816
<p class="MsoBlockText">A Nehmer class member is entitled to compensation under 38 CFR 3.816 if a claim for service connection for a covered herbicide disease, or DIC based on death caused by a covered herbicide disease, was
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      denied in a decision issued between September 25, 1985, and May 3, 1989

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pending on May 3, 1989, or

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      received between

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     May 3, 1989, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     the effective date of the regulation establishing a presumption of service connection for the covered disease. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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e.   Effective Dates of Awards Under 38 CFR 3.816
<p class="MsoBlockText">The effective date of disability compensation or DIC benefits under 38 CFR 3.816 is the date of receipt of the claim on which the prior denial was based or the date entitlement arose, whichever is later.
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<p class="MsoBlockText">

<p class="MsoBlockText">Exceptions:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      If VA received the prior claim for compensation within one year after the Veteran’s separation from service, the effective date of compensation would be governed by 38 CFR 3.400(b)(2).

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      If VA received the prior claim for DIC within one year after the Veteran’s death, the effective date of DIC would be governed by 38 CFR 3.400(c).

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The provisions of 38 CFR 3.114(a), which limit effective dates to no earlier than the date of a liberalizing law or issue, do not apply to benefits awarded under 38 CFR 3.816.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Whatever the effective date, the actual payment of benefits commences on the first day of the following month in accordance with 38 CFR 3.31. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Example 1:   Initial Claim Denied After September 25, 1985
<p class="MsoBlockText">Situation:   The Veteran’s initial claim for service connection for lung cancer was received on August 4, 1985, and denied on November 19, 1985. Medical evidence showed a diagnosis of lung cancer in July 1985. The Veteran reopened his claim in March 2001.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Establish service connection for lung cancer effective the date the initial claim was received, August 4, 1985.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Since the initial claim for service connection for a covered herbicide disease was denied after September 25, 1985, service connection may be established from the date the initial claim was received, per 38 CFR 3.816.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   If the claim had been denied, to include any appeals, before September 25, 1985, it would be unaffected by the Nehmer stipulation, and the effective date would be governed by 38 CFR 3.114(a). <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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g.   Example 2:   Initial Claim Received Prior to the Effective Date of the Law Establishing a Presumption of Service Connection
<p class="MsoBlockText">Situation:   The Veteran’s initial claim for service connection for lung cancer was received on October 14, 1992, and denied on December 23, 1992. Medical evidence showed a diagnosis of lung cancer in September 1992. The Veteran reopened his claim in March 2001.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Establish service connection for lung cancer effective the date the initial claim was received, October 14, 1992.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Since the claim was received prior to June 9, 1994, the effective date of the law establishing a presumption of service connection for lung cancer under 38 CFR 3.309(e), service connection may be established from the date the initial claim was received, per 38 CFR 3.816. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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h.   Example 3:   Claim for DIC Benefits Received Within One Year of the Veteran’s Death
<p class="MsoBlockText">Situation:   On November 3, 1986, a Veteran who served in the RVN during the Vietnam era died from Hodgkin’s disease. His surviving spouse’s claim for DIC benefits was received on December 10, 1986, and denied on February 12, 1987. The surviving spouse reopened her claim on March 15, 1993.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Establish entitlement to DIC benefits from November 1, 1986, the first day of the month in which the Veteran died.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Since the claim for DIC benefits was received within one year of the Veteran’s death, the effective date is governed by 38 CFR 3.400(b)(2). <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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i.   Handling Claims in Which Exposure to Herbicides Is Not Specifically Mentioned
<p class="MsoBlockText">In its February 11, 1999, order, the district court held that a Nehmer class member’s claim for disability compensation or DIC need only include a request for service connection for a covered herbicide disease to qualify as a Nehmer claim.
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<p class="MsoBlockText">

<p class="MsoBlockText">It is not necessary for the claimant to assert the condition was caused by exposure to herbicides. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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j.   Example:   Establishing an Effective Date When Exposure to Herbicides Is Not Specifically Mentioned   in the Claim
<p class="MsoBlockText">Situation:   A Veteran who served in the RVN during the Vietnam Era filed a claim in 1994, expressly alleging that his prostate cancer was caused by exposure to ionizing radiation before the Veteran’s service in Vietnam. VA denied the claim in 1995. The Veteran reopened the claim in 1997 and service connection was established.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Based on these facts, the effective date must relate back to the 1994 claim, even though the Veteran alleged a different basis for service connection. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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k.   Handling Claims for Service Connection for Porphyria Cutanea Tarda
<p class="MsoBlockText">Under 38 CFR 3.311a(d), which was published on October 21, 1991, sound scientific and medical evidence did not establish a significant statistical association between exposure to herbicides and the development of porphyria cutanea tarda (PCT).
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<p class="MsoBlockText">

<p class="MsoBlockText">When determining the effective date for the establishment of service connection for PCT

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      do not assign an earlier effective date under the Nehmer stipulation, since a denial of service connection for PCT under 38 CFR 3.311a after October 20, 1991, is valid, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      consider an earlier effective date under the Nehmer stipulation for a claim for service connection for PCT that was denied between September 24, 1985, and October 21, 1991. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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l.   Handling Claims for Service Connection for Type 2 Diabetes Mellitus
<p class="MsoBlockText">Effective May 8, 2001, Type 2 diabetes mellitus became subject to presumptive service connection under 38 CFR 3.309(e). Retroactive benefits under the Nehmer review may be warranted for claims filed or denied during the period September 25, 1985, to May 7, 2001.
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<p class="MsoBlockText">

<p class="MsoBlockText">If a prior claim did not involve service connection for Type 2 diabetes mellitus, there generally exists no basis for assigning an earlier effective date. However, a lack of specificity in the initial claim may be clarified by later submissions. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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m.   Example 1:   Claim for Service Connection for Type 2 Diabetes Mellitus
<p class="MsoBlockText">Situation:   In January 1987, a Veteran filed a claim for service connection for   hyperglycemia. In developing the claim, VA obtained medical records indicating that the Veteran was diagnosed with Type 2 diabetes mellitus in February 1987.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Based on these facts, it would be reasonable to treat the January 1987 claim as a claim for service connection for Type 2 diabetes mellitus.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Under Nehmer, benefits may be paid retroactive to the date the initial claim was received or the date the disability arose as determined by the facts of the case, whichever is later. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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n.   Example 2:   Claim for Service Connection for Type 2 Diabetes Mellitus
<p class="MsoBlockText">Situation:   In 1995, a Veteran filed a claim for service connection for hyperglycemia. Medical records obtained by VA indicated that the Veteran did not have Type 2 diabetes mellitus. In 2001, the Veteran filed a second claim for service connection for Type 2 diabetes mellitus, submitting evidence showing that the condition was diagnosed in 1996.
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<p class="MsoBlockText">

<p class="MsoBlockText">Result:   Based on these facts, the 1995 claim is not considered a claim for service connection for Type 2 diabetes mellitus.

<p class="MsoBlockText">

<p class="MsoBlockText">Rationale:   Neither the claim nor the evidence of record (when the 1995 claim was processed) indicated the Veteran had been diagnosed with Type 2 diabetes mellitus. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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o.   Identifying Appropriate Survivor of a Nehmer Class Member
<p class="MsoBlockText">If a Nehmer class member entitled under 38 CFR 3.816(c) and (d) dies before receiving the payment of retroactive benefits, VA will award the unpaid benefits to the first individual or entity in existence in the following order:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      spouse

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      child or children, divided into equal shares if more than one child exists, regardless of age or marital status

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      parents, divided in half if both parents are alive, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      estate.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   The survivor or estate of a Nehmer class member is not required to file an application in order to receive unpaid benefits. {| 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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p.   Action When Appropriate Survivor of Nehmer Class Member Cannot Be Located
<p class="MsoBlockText">Use all available information in the folder to determine an appropriate payee if
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a class member is deceased, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the claims folder does not contain sufficient information to identify an eligible survivor.

<p class="MsoBlockText">

<p class="MsoBlockText">Example:   If an authorized representative or relative is identified in the claims folder, contact this person for information on the existence of a surviving spouse, children, parents, or estate. If this effort fails to identify an appropriate payee, annotate the rating decision, stating that it was not possible to locate any payee eligible for payment under Nehmer. <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"> 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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q.   Identifying Other Survivors of Nehmer Class Members
<p class="MsoBlockText">Before awarding benefits to an identified payee, ask the payee to state whether or not there are any other survivors of the class member who may have an equal or greater entitlement to unpaid benefits.
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<p class="MsoBlockText">

<p class="MsoBlockText">Once benefits have been awarded in full to a payee, do not pay any portion of the amount to any other individual, unless the payment previously released can be recovered. <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"> '''
 * }

12.   Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards
<p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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Introduction
<p class="MsoBlockText">This topic contains information on service connection for disabilities resulting from exposure to other specific environmental hazards, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      locations of   specific environmental hazards identified by the Department of Defense (DoD)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      using DoD records to verify exposure to environmental hazards

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      using alternative records to establish exposure to environmental hazards

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      what to include in VA examination and/or medical opinion requests in environmental hazard claims

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      applying the provisions of 38 CFR 3.317 in claims based on exposure to environmental hazards in Southwest Asia, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      diseases potentially associated with exposure to contaminants present in the Camp Lejeune water supply between 1957 and 1987. <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">December 16, 2011 <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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a.   Locations of Specific Environmental Hazards Identified by DoD
<p class="MsoBlockText"> The Department of Dense (DoD) has identified a number of specific environmental hazards at military installations in Iraq, Afghanistan, and elsewhere that could present health risks.
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<p class="MsoBlockText">

<p class="MsoBlockText"> These hazards include

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      large pit burns throughout Iraq, Afghanistan, and Djibouti on the Horn of Africa

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·         particulate matter in Iraq and Afghanistan

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a large sulfur fire at Mishraq State Sulphur Mine near Mosul, Iraq

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      hexavalent chromium exposure at the Qarmat Ali Water Treatment Plant at Basrah, Iraq

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      contaminated drinking water at Camp LeJeune, North Carolina, 1957 to 1987, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      pollutants from a waste incinerator near the Naval Air Facility (NAF) at Atsugi, Japan.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on processing claims based on exposure to the environmental hazards listed above, see

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Training Letter 10-03, Environmental Hazards in Iraq, Afghanistan, and Other Military Installations, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Training Letter 11-03, Revised, Processing Disability Claims Based on Exposure to Contaminated Drinking Water at Camp Lejeune.<span style="font-size:9.0pt;font-family:"Verdana","sans-serif""> <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"> 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued {| 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.   Using DoD Records to Verify Exposure to Environmental Hazards
<p class="MsoBlockText"> DoD has provided VA a list of those who served at the Qarmat Ali Water Treatment Plant in Basrah, Iraq. If the Veteran is claiming exposure to an environmental hazard at this location, send an e-mail request for verification of service to the following Compensation Service mailbox: VAVBAWAS/CO/211/ENVIRO.
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<p class="MsoBlockText">

<p class="MsoBlockText">If exposure cannot be verified through an official list provided by DoD, review STRs, military personnel records, and all other available for evidence that corroborates the Veteran’s statement of exposure.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Carefully review the Post-Deployment Health Assessment (PDHA) and Discharge Examination,  generally located in the STRs, for exposure information. The PDHA includes specific questions relating to exposure incidents.<span style="font-family:"Arial","sans-serif"">

<p class="MsoBlockText"><span style="font-family:"Arial","sans-serif"">

<p class="MsoBlockText">   Reference:   For more information on using alternative evidence to establish exposure, see M21-1MR, Part IV, Subpart ii, 1.H.32.e. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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c.   Using Alternative Evidence to Establish Exposure to Environmental Hazards
<p class="MsoBlockText">Because military service records will not verify all incidents of exposure, it is important to consider alternative evidence in establishing whether the Veteran participated in or was affected by an in-service exposure incident.
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<p class="MsoBlockText">

<p class="MsoBlockText">Alternative evidence includes

<p class="MsoBlockText"><span style="font-family:"Arial","sans-serif"">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      personal statements

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      buddy statements

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      unit histories

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      news articles, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      other lay evidence

<p class="MsoBlockText"><span style="font-family:"Arial","sans-serif"">

<p class="MsoBlockText">Concede exposure to the claimed environmental hazard if the statements provided by the Veteran and/or others are consistent with the facts, places, and circumstances of the Veteran’s service.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on considering evidence in claims for disability compensation, see

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 U.S.C. 1154(a), and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      38 CFR 3.303(a). <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"> '''
 * }

<p class="MapTitleContinued"> 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   What to Include in VA Examination and/or Medical Opinion Request   in Environmental Hazard Claims
<p class="MsoBlockText">When requesting a medical examination and/or medical opinion for a claim based on exposure to an environmental hazard listed in M21-1MR, Part IV, Subpart ii, 2.C.13.a
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      advise the examiner of the nature of the claimed environmental hazard and the location and timeframe of exposure

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      attach the appropriate Fact Sheet from Training Letter 10-03 to the claims folder to explain the environmental hazard in detail (Exception:   If the claim is based on exposure to contaminated drinking water at Camp Lejeune, attach the notice from Appendix D of Training Letter 11-03.)

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      forward the claims folder to the examiner and ask him/her to

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     review the medical and other evidence in the claims folder, including the Fact Sheet, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     provide an opinion, and rationale for the opinion, as to the likelihood that the Veteran’s claimed disability is related to the hazardous environmental exposure.

<p class="MsoBlockText">

<p class="MsoBlockText">In some cases, an opinion based on a records review only may suffice, but other cases may require a current examination. When initially requesting an opinion only, ask the examiner to schedule an examination if he/she believes it is needed to render the requested medical opinion.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Do not request an examination or medical opinion until exposure has been established. For more information on establishing exposure to a claimed environmental hazard, see M21-1MR, Part IV, Subpart ii, 2.C.13.b and c. {| 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.   Applying the Provisions of 38 CFR 3.317 in Claims Based on Exposure to Environmental Hazards in Southwest Asia
<p class="MsoBlockText">Apply the provisions of 38 CFR 3.317 when rating claims for disabilities resulting from exposure to environmental hazards during service in Southwest Asia if
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the medical evidence reveals the presence of

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     an undiagnosed illness, or

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     a medically unexplained chronic multisymptom illness, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the medical evidence does not provide a sufficient link between this illness and the Veteran’s military service.

<p class="MsoBlockText">

<p class="MsoBlockText">If both criteria stated above are met, develop the claim under the Southwest Asia claim procedures shown in

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 1.E, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 2.D. <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"> 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued {| 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.   Diseases Potentially Associated With Contaminants Found in the Camp Lejeune Water Supply Between 1957 and 1987
<p class="MsoBlockText">The following is a non-exclusive list of diseases potentially associated with contaminants present in the Camp Lejeune water supply between 1957 and 1987:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      esophageal cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      lung cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      breast cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      bladder cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      kidney cancer

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      adult leukemia

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      multiple myeloma

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      myleodisplasic syndromes

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      renal toxicity

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      hepatic steatosis

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      female infertility

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      miscarriage, with exposure during pregnancy

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      scleroderma

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span lang="EN" style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext;mso-ansi-language:EN"> ·      neurobehavioral effects

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Manifestation of any of these diseases in a Veteran with verified Camp Lejeune service between 1957 and 1987 is sufficient to

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     initiate a VA medical examination, and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     request an opinion regarding its relationship to Camp Lejeune service.

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Do not establish service connection for one of these diseases or disabilities unless a competent medical authority, based on the Veteran’s individual case, has determined that it is at least as likely as not that the claimed disease or disability has resulted from exposure to the contaminated water.

<p class="MsoBlockText">

<p class="MsoBlockText">References:   For

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      more information on the contaminants present in the Camp Lejeune water supply between 1957 and 1987, see Appendix   B of Training Letter 11-03

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      more information on obtaining medical opinions, see

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     38 CFR 3.159(c)(4), and

<p class="BulletText2" style="mso-list:l1 level1 lfo8"> -     M21-1MR, Part III, Subpart iv. 3.A.9, and

<p class="BulletText1" style="mso-list:l10 level1 lfo5"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a list of Internet websites describing potential health effects of exposure to chemical contaminants present in the Camp Lejeune water supply between 1957 and 1987, see Appendix C of Training Letter 11-03.
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