Section C - Claims for Service Connection for Disabilities Resulting from Ionizing Radiation Exposure Under 38 CFR 3.311 - Updated 7/10/14

Overview
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In this Section
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7.   General Information on Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311
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Introduction
This topic contains general information on claims for disabilities resulting from ionizing radiation exposure under 38 CFR 3.311, including
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 ·      the centralized processing of claims based on radiation exposure

 ·      the provisions of 38 CFR 3.311

 ·      presumptive versus direct service connection

 ·      handling

 -     claims that require a subsequent review under PL 98-542,

 -     claims that require a subsequent review based on dose estimates made before May 8, 2003, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the classified information needed to validate exposure to nuclear radiation, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Department of Veterans Affairs (VA) responsibility for expunging classified military data. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 15, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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a.   Centralized Processing of Claims Based on Radiation Exposure
<p class="MsoBlockText">In October 2006, the Department of Veterans Affairs (VA) centralized the processing of all claims for service connection based on radiation exposure at the Jackson Regional Office (RO).
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<p class="MsoBlockText">

<p class="MsoBlockText">The Jackson RO is responsible for developing and resolving

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      all claims for service connection for disabilities resulting from exposure to ionizing radiation under 38 CFR 3.311, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      all non radiation-related claims received while the radiation issue is pending.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Regional offices of jurisdiction (ROJs) must verify the existence of a radiogenic disease before transferring the claims folder to the Jackson RO.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Following resolution of all pending issues, the Jackson RO will transfer the claims folder back to the ROJ. <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"> 7. General Information on Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Provisions of 38 CFR 3.311
<p class="MsoBlockText">The specific requirements for the adjudication of claims for service connection for disabilities resulting from exposure to ionizing radiation claims are found in 38 CFR 3.311.
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<p class="MsoBlockText">

<p class="MsoBlockText">The provisions of 38 CFR 3.311(b)(1) require that the

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veteran must have been exposed to ionizing radiation as a result of participation in

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     atmospheric testing of nuclear weapons

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the occupation of Hiroshima or Nagasaki, Japan from September 1945 until July 1946, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     other radiation-risk activities as claimed

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veteran must have subsequently developed a radiogenic disease listed in 38 CFR 3.311(b)(2), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      disease first manifested itself within the period specified in 38 CFR 3.311(b)(5). {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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c.   Presumptive Versus Direct Service Connection
<p class="MsoBlockText">A claim for service connection under the provisions of 38 CFR 3.311 is also a claim for service connection under the provisions of 38 CFR 3.303. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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d.   Handling Claims That Require a Subsequent Review Under PL 98-542
<p class="MsoBlockText">A claim for service connection for a disability resulting from exposure to radiation as an atmospheric test participant or a member of the Hiroshima/Nagasaki occupation forces that was denied prior to enactment of Public Law (PL) 98-542, “The Veterans’ Dioxin and Radiation Exposure Compensation Standards Act,” on October 24, 1984, must receive a complete, new and complete review of the evidence (de novo review) if the claim is subsequently reopened.
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<p class="MsoBlockText">

<p class="MsoBlockText">Note:   It is not necessary for the claimant to submit new and material evidence to reopen these claims.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on the initial review of reopened claims for compensation based on radiation exposure, see

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 1.B.5, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      M21-1MR, Part IV, Subpart ii, 1.C.8. <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"> 7. General Information on Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Handling Claims That Require a Subsequent Review Based on Dose Estimates Made Before May 8, 2003
<p class="MsoBlockText">On May 8, 2003, the National Research Council, an independent agency contracted to review the Defense Threat Reduction Agency’s (DTRA) radiation dose estimates, reported that DTRA had underestimated upper bound radiation doses for atmospheric test participants and Hiroshima/Nagasaki occupation forces.
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<p class="MsoBlockText">

<p class="MsoBlockText">When a case is encountered in which a denial was based on a dose estimate provided by DTRA before May 8, 2003, obtain a new dose estimate from DTRA and readjudicate the claim.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   It is not necessary for the claimant to submit new and material evidence to reopen these claims.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on developing dose estimates, see M21-1MR, Part IV, Subpart ii, 1.C.10. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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f.   Handling Classified Information Needed to Validate Exposure to Nuclear Radiation
<p class="MsoBlockText">Veterans seeking benefits in connection with exposure to nuclear radiation are authorized by the Exposure to Nuclear Radiation and DoD Secrecy Agreement to divulge to VA the name, location of their command, duties performed, dates of service, and related information necessary to validate exposure to nuclear radiation.
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<p class="MsoBlockText">

<p class="MsoBlockText">This authorization does not relieve Veterans of responsibility for continuing to protect specific technical information that could contribute to the development of a weapon of mass destruction or the application of nuclear technology.

<p class="MsoBlockText">

<p class="MsoBlockText">Important:   Information relative to military bases where nuclear weapons

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      may be located within the continental U.S. is classified as “Confidential,” and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      were or are located outside the continental U.S. is classified as “Secret” or “Top Secret.”

<p class="MsoBlockText">

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Exposure to Nuclear Radiation and DoD Secrecy Agreement, see M21-1MR, Part IV, Subpart ii, 1.C.12, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      claims for radiogenic diseases under 38 CFR 3.309(d), see M21-1MR, Part IV, Subpart ii, 1.B. <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"> 7. General Information on Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   VA Responsibility for Expunging Classified Military Data
<p class="MsoBlockText">The fact that a Veteran inadvertently reveals classified military information during the course of applying for benefits should not be compounded further by releasing this information within or outside VA in any manner. Cut out (rather than obliterate) any classified information from related documents or statements.
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<p class="MsoBlockText">

<p class="MsoBlockText">When expungement is necessary, prepare a VA Form 27-0820, Report of General Information, for the claims folder and have the form signed by the Veterans Service Center Manager (VSCM) or supervisory designee, not lower than the Assistant VSCM. On the VA 27-0820

<p class="MsoBlockText">

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     kind of evidence removed, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     reason for the record expungement, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      summarize or restate any other expunged facts or statements not referring to specific military bases where radiation exposure allegedly occurred. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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8.   Requesting Information and Evidence From the Claimant
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Introduction
<p class="MsoBlockText">This topic contains information on requesting information and evidence from the claimant, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the minimum evidence required from the claimant for development of exposure to ionizing radiation

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the initial review of claims

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting a diagnosis of the Veteran’s disease

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting a history of the Veteran’s exposure to known carcinogens, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting a history of cancer in the Veteran’s family, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      other information to obtain. <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 5, 2008 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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a.   Evidence Required for Initial Development
<p class="MsoBlockText">Do not initiate development of a claim for service connection for a disability resulting from exposure to ionizing radiation unless
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the dates, places, and circumstances of exposure to ionizing radiation are

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     contained in the claims folder, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     provided by the claimant, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      diagnosis of a radiogenic disease is claimed.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Ask the claimant to provide this information, if it is not of record. <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. Requesting Information and Evidence From the Claimant, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Initial Review of Claims
<p class="MsoBlockText">If a claim is received for service connection for a disability caused by exposure to ionizing radiation and the claim is substantially complete, the pre-determination activity reviews the claim to
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      direct development to determine whether service connection may be established under 38 CFR 3.303, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      determine whether the requirements for consideration of service connection under 38 CFR 3.311 are satisfied.

<p class="MsoBlockText">

<p class="MsoBlockText">Under 38 CFR 3.311(b), the submitted or acquired evidence must show that the Veteran

<p class="MsoBlockText">

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     one of the radiogenic diseases listed in 38 CFR 3.311(b)(2), or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     an unlisted disease for which a medical opinion or medical treatise has been submitted showing a causal relationship between the disease and exposure to radiation, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      was exposed to ionizing radiation

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     while a participant in atmospheric nuclear weapons testing

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     during the post-war occupation of Hiroshima or Nagasaki from September 1945 until July 1, 1946

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     as a prisoner of war (POW) in Japan, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     while performing other service activities, such as work as an x-ray technician, in a reactor plant, or in nuclear medicine or radiography.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   A Veteran will be considered involved in a radiation-risk activity if he/she performed tasks similar to work engaged in by a Department of Energy employee that qualifies the Department of Energy employee as a member of the Special Exposure Cohort under 42 U.S.C. 7384L(14). {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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c.   When to Obtain Information
<p class="MsoBlockText">In all cases, if a substantially complete claim under 38 CFR 3.311 exists, obtain the information listed in M21-1MR, Part IV, Subpart ii, 1.C.8.d -g. <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. Requesting Information and Evidence From the Claimant, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Requesting a Diagnosis of the Disease
<p class="MsoBlockText">Obtain information on the diagnosis of the Veteran’s disease and, if known, the specific cell type and stage.
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<p class="MsoBlockText">

<p class="MsoBlockText">Example:   If the disease is skin cancer, ask the claimant to provide the

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      specific site of each lesion

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      date that the disease was first diagnosed or treated, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      name and address of the physician or facility who

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     made the diagnosis, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     first treated the claimed disease. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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e.   Requesting a History of the Veteran’s Exposure to Known Carcinogens
<p class="MsoBlockText">Obtain information on the Veteran’s history of exposure to known carcinogens, including a post-service occupational history. Ask whether, either before or after service, the Veteran was exposed to a cancer-causing substance.
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<p class="MsoBlockText">

<p class="MsoBlockText">Examples:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      If the claim is for skin cancer, ask the claimant to provide the

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     extent of exposure to the sun (such as sun bathing or occupations requiring the Veteran to work outdoors, and so forth) and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     specific site of each lesion.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Request the Veteran’s smoking history. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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f.   Requesting a History of Cancer in the Veteran’s Family
<p class="MsoBlockText">Obtain information on the history of members of the Veteran’s family who have been diagnosed as having cancer.
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<p class="MsoBlockText">

<p class="MsoBlockText">Example:   Ask whether members of the Veteran’s immediate family, such as parents or siblings, have been diagnosed with diseases such as cancer or leukemia, birth defects, or genetic disorders. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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g.   Other Information to Obtain
<p class="MsoBlockText">Obtain
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the names and addresses of any physicians and facilities who have made subsequent diagnoses or have provided treatment for the claimed disease

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the complete clinical records (not summaries) for all medical care relating to the claimed disease, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      all tissue blocks, slides or other pathology samples, if available. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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9.   Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311
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Introduction
<p class="MsoBlockText">This topic contains information on the process of verifying exposure to ionizing radiation under 38 CFR 3.311, including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      requesting verification from DTRA for the Veteran’s participation in

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     atmospheric nuclear weapons tests, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     involvement in non-U.S. nuclear bomb tests, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     exposure to ionizing radiation by reason of military duties

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      obtaining records of occupational exposure to radiation from

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the Veteran’s service department, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the Atomic Energy Commission (AEC), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      developing claims for service connection based on nasopharyngeal radium irradiation therapy (NRI). <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">July 10, 2014 <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. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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a.   Requesting Verification of Participation in Atmospheric Nuclear Weapons Tests
<p class="MsoBlockText">When requesting verification from DTRA of exposure to ionizing radiation due to the Veteran’s participation in an atmospheric nuclear weapons test, use the Modern Award Processing-Development (MAP-D) system or Personal Computer-Generated Letters (PCGL) to send a letter to DTRA that
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<p class="MsoBlockText">

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     disease being claimed (Note:   If skin cancer is claimed, specify the site of each lesion, type of cancer, and date of diagnosis.)

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     Veteran’s organization or unit of assignment at the time of exposure, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     dates of assignment to the nuclear test site, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      provides a full description of the Veteran’s duties and activities while participating in a radiation-risk activity.

<p class="MsoBlockText">

<p class="MsoBlockText">The letter to DTRA should also include a copy of

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      all available pathology reports that identify the type of cancer and the organ involved, if the disease claimed is a listed radiogenic disease, and/or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease claimed is not among those listed in 38 CFR 3.311(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"> 9. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Requesting Verification of Participation in the American Occupation of Hiroshima or Nagasaki Prior to July 1, 1946
<p class="MsoBlockText">When requesting verification from DTRA of exposure to ionizing radiation as a result of participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946, send a letter to DTRA that provides the following information:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the organization or unit (ship, task group, company or squadron) and rank at the time of exposure

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the duty place and organizational unit from which the Veteran may have been detailed, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the activities and length of time at ground zero (hypocenter).

<p class="MsoBlockText">

<p class="MsoBlockText">The letter to DTRA should include a description from the claimant and from the service records of activities performed during the entire period of exposure including

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      whether or not the Veteran went ashore

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the length of time spent ashore, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the activities performed while ashore.

<p class="MsoBlockText">

<p class="MsoBlockText">For former POWs, also provide DTRA with the following information:

<p class="MsoBlockText">

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

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the date and place of liberation

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the date and method of departure from Japan, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the method of travel within Japan, since the method of travel, such as a specific train over a specific route, can provide critical information in confirming participation.

<p class="MsoBlockText">

<p class="MsoBlockText">The letter to DTRA should also

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      specify the disease being claimed (Note:   If skin cancer is claimed, specify the site of each lesion, type of cancer, and date of diagnosis.), and

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     available pathology reports that identify the type of cancer and the organ involved, if the disease claimed is a listed radiogenic disease, and/or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease is not among those listed under   38 CFR 3.311(b)(2).

<p class="MsoBlockText"> <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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c.   Requesting   Verification of   Involvement in Non-U.S. Nuclear Bomb Tests
<p class="MsoBlockText">PL 103-446 allows for a presumption of service connection for the same radiogenic diseases, regardless of whether the Veteran participated in U.S or non-U.S. nuclear tests.
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<p class="MsoBlockText">

<p class="MsoBlockText">Use the table below to obtain verification of a Veteran’s involvement in non-U.S. nuclear bomb tests. <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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<p class="MapTitleContinued"> 9. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Requesting Verification of Exposure to Ionizing Radiation by Reason of Military Duties
<p class="MsoBlockText">For a claim based on exposure to ionizing radiation by reason of the nature of military duties, such as a radiologist or an x-ray technician, prepare a separate Personnel Information Exchange System (PIES) request to obtain a copy of the record of occupational exposure to ionizing radiation from the
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Military Personnel Record Jacket (MPRJ)

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      service treatment records (STRs), or

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      any other record that contains radiation exposure information.

<p class="MsoBlockText">

<p class="MsoBlockText">Notes:

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      The record of occupational exposure to ionizing radiation used by the service departments include

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     DD Form 1141, Record of Occupational Exposure to Ionizing Radiation

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     NAVMED 6470/10 and NAVMED 6470/11 for the Navy, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the equivalent NRC Form 5.

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Refer a request for information on human radiation experiments to the appropriate Service point of contact identified in M21-1MR, Part IV, Subpart ii, 1.C.9.e. <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. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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e.   Obtaining Records of Occupational Exposure to Radiation From the Veteran’s Service Department
<p class="MsoBlockText">Each branch of service maintains a record of its service members’ occupational exposure to radiation. If evidence of occupational radiation exposure, such as a DD Form 1141, NAVMED 6470/10, NAVMED 6470/11,  or     NRC Form 5, cannot be found in the Veteran’s records or obtained through PIES, prepare a written request for the record. Include the identifying data as required by M21-1MR, Part IV, Subpart ii, 1.C.10.b in the request and send it to the appropriate service department.
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<p class="MsoBlockText">

<p class="MsoBlockText">The table below lists the addresses and telephone numbers to use to obtain records of occupational exposure to radiation from each branch of service. <p class="MsoNormal"> <p class="ContinuedOnNextPa" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">Continued on next page '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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<p class="MapTitleContinued"> 9. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, 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"> 9. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Obtaining Records of Occupational Exposure to Radiation From the AEC
<p class="MsoBlockText">There are instances where military personnel were assigned to the Atomic Energy Commission (AEC) laboratories during the testing period and badged by the AEC facility.
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<p class="MsoBlockText">

<p class="MsoBlockText">Include a search of the Department of Energy central records repository as a part of a comprehensive search for records of occupational exposure to radiation. Send requests for such a search to the following address:

<p class="MsoBlockText">

<p class="MsoBlockText">Address for records from 1945 through present only:

<p class="MsoBlockText">U.S. Department of Energy

<p class="MsoBlockText">National Nuclear Security Administration – Nevada Site Office

<p class="MsoBlockText">P.O. Box 98518

<p class="MsoBlockText">Las Vegas, NV   89193-8518

<p class="MsoBlockText">

<p class="MsoBlockText">Telephone:   (702) 295-1000

<p class="MsoBlockText">

<p class="MsoBlockText">Address for records from 1987 to present:

<p class="MsoBlockText">U.S. Department of Energy

<p class="MsoBlockText">Office of Health Studies (EH-32)

<p class="MsoBlockText">19901 Germantown Road

<p class="MsoBlockText">Germantown, MD   20874

<p class="MsoBlockText">

<p class="MsoBlockText">Telephone:   (301) 903-5728 <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. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Developing Claims for Service Connection Based on NRI
<p class="MsoBlockText">Adjudicate claims for service connection based on in-service treatment involving nasopharyngeal radium irradiation therapy (NRI) under the provisions of 38 CFR 3.311 with dose estimates prepared by the Under Secretary for Health.
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<p class="MsoBlockText">

<p class="MsoBlockText">Review STRs, clinical records, and dental records for any annotation of radium therapy.

<p class="MsoBlockText">

<p class="MsoBlockText">Request STRs that are not already on file. In addition, request information concerning radiation exposure from standard sources, and the following data from the Veteran:

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the date the NRI treatment was administered, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the place where the NRI treatment was administered, including the specific base and medical facility.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   Even when STRs do verify NRI treatments, they may not contain detailed records of radiation doses during treatment. Forward the claim to Compensation Service, Policy Staff (211) if NRI treatment is verified but dose information is not present. Compensation Service will determine whether a dose estimate may be provided by the Veterans Health Administration (VHA).

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For more information on NRI therapy, see the VA Fact Sheet, Nasopharyngeal Radium Therapy, dated September 1997. <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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10.   Obtaining Dosimetry Information
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Introduction
<p class="MsoBlockText">This topic contains information on obtaining dosimetry information, 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:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the initial notification of Compensation service

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the information to include in the initial request to Compensation Service

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      obtaining dosimetry information from DTRA

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      obtaining dosimetry information for individuals outside the scope of DTRA’s Nuclear Test Personnel Review (NTPR) program

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the information to include in the letter to the Service Department requesting dosimetry information

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      handling claims based on radiation exposure in or around Camp Hanford, Washington

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the definitions of not exposed and zero dose, and

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     submitted on behalf of the claimant, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     of “not exposed” or “zero.” <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">March 20, 2011 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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a.   Initial Notification of Compensation Service
<p class="MsoBlockText">Call Compensation Service, Policy Staff (211), at (202) 461-9734   if
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the requirements under 38 CFR 3.311(b) have been met, and

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the development specified in M21-1MR, Part IV, Subpart ii, 1.C.8 has been completed, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     there is evidence sufficient to establish the Veteran was exposed to radiation during service.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   After receiving Compensation Service approval, request a reconstructed radiation dose from DTRA.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For information on obtaining dosimetry estimates from DTRA, see M21-1MR, Part IV, Subpart ii, 1.C.10.c. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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b.   Information to Include in the Initial Request to Compensation Service
<p class="MsoBlockText">Include the following information in the initial request to Compensation Service:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s name and VA claim number

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the nature of the disability, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the location of radiation exposure, such as atmospheric nuclear weapons test, Hiroshima/Nagasaki, and so forth. <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. Obtaining Dosimetry Information, Continued {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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c.   Obtaining Dosimetry   Information From DTRA for Atmospheric Tests, Hiroshima or Nagasaki Occupation, or POW Interment in Japan
<p class="MsoBlockText">For claims involving U.S. atmospheric nuclear weapons tests, occupation of Hiroshima or Nagasaki, or POW interment in Japan, send a request for dosimetry information to the
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<p class="MsoBlockText">

<p class="MsoBlockText">Defense Threat Reduction Agency (DTRA)

<p class="MsoBlockText">Attn:   RD-NTSD

<p class="MsoBlockText">Mail Stop 6201

<p class="MsoBlockText">8725 John J. Kingman Rd.,

<p class="MsoBlockText">Ft. Belvoir, VA   22060-6201

<p class="MsoBlockText">

<p class="MsoBlockText">The letter to DTRA must contain the following information:

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the applicable regulation (38 CFR 3.309(d) or 38 CFR 3.311)

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veteran’s and claimant’s names, addresses, and telephone numbers

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      Veteran’s branch of service, service number, and Social Security number

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      specific organization or unit of assignment at the time of exposure

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      dates of assignment to nuclear test site or Hiroshima/Nagasaki

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      full description of duties and activities while a participant in a radiation-risk activity, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·        specific disease being claimed (Note:   Specify the type of cancer and the organ involved.   If skin cancer is claimed, also specify the site of each lesion and date of diagnosis.)

<p class="MsoBlockText">

<p class="MsoBlockText">The letter must include a copy of

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the claimant’s response to the request for information about the Veteran’s exposure to ionizing radiation

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s statement(s) about the nature of his/her exposure to radiation

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      any military documents supporting participation in a radiation-risk activity, such as a DD Form 214 or military orders

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease is not among those listed under   38 CFR 3.311(b)(2), and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Board of Veterans’ Appeals (BVA) remand, if applicable.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   DTRA only provides confirmation of participation and radiation doses for individuals involved in U.S. atmospheric nuclear testing (1945 to 1960) and the occupation forces of Hiroshima/Nagasaki.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For information on obtaining dosimetry information in cases not handled by DTRA, see M21-1MR, Part IV, Subpart ii, 1.C.10.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"> '''
 * }

<p class="MapTitleContinued"> 10. Obtaining Dosimetry Information, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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d.   Obtaining Dosimetry Information for Individuals Outside the Scope of DTRA’s NTPR Program
<p class="MsoBlockText">For individuals outside the scope of DTRA’s NTPR program, such as x-ray technicians, reactor plant workers, and workers in nuclear medicine, radar, and radiography
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      send a letter requesting dosimetry information to the appropriate Service Department point of contact listed in M21-1MR, Part IV, Subpart ii, 1.C.9.e, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      forward all dosimetry records to Compensation Service, Policy Staff (211), for referral to the Under Secretary for Health, who is responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies.

<p class="NoteText">

<p class="NoteText">Note:   The claims folder should be forwarded to Compensation Service, Policy Staff (211), for review if

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the claim alleges exposure to radiation from medical diagnostic procedures or during medical treatment, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s STRs support this exposure.

<p class="MsoBlockText">

<p class="MsoBlockText">Reference:   For information on what to include in the letter to the Service point of contact, see M21-1MR, Part IV, Subpart ii, 1.C.10.e. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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e.   Information to Include in the Letter to the Service Department Requesting Dosimetry Information
<p class="MsoBlockText">The letter to the Service Department point of contact requesting dosimetry information should include the following:
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the location and dates of the Veteran’s service

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s military unit

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s Military Occupational Specialty (MOS)

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the place(s) where the Veteran worked

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a list of radioactive materials the Veteran worked with (source, strength, and type)

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the number of hours per day the Veteran spent working with radioactive materials and the number of days, weeks, or months of the assignment the Veteran worked with radioactive sources, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the number of hours per day the Veteran spent working with radiation-producing devices and the number days, weeks, or months of the assignment the Veteran worked with radiation-producing devices.

<p class="MsoBlockText">

<p class="MsoBlockText">The letter should also enclose a copy of any available

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      training records associated with radiation training

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      radiation dose records provided by the Veteran, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      medical records showing treatment for any occupational radiation injuries or other records documenting radiation exposure. <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. Obtaining Dosimetry Information, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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f.   Handling Claims Based on Radiation Exposure in or Around Camp Hanford, Washington
<p class="MsoBlockText">Use the table below to determine how to handle claims based on radiation exposure in or around Camp Hanford, Washington. <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. Obtaining Dosimetry Information, Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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g.   Definition:   Not Exposed
<p class="MsoBlockText">Not exposed means
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      there was no potential for exposure to radiation, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran did not enter a radiological environment. {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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h.   Definition:   Zero Dose
<p class="MsoBlockText">Zero dose means there was potential for exposure to radiation, but the dose received was zero. {| 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.   Handling Dose Estimates of Not Exposed or Zero
<p class="MsoBlockText">If the dose estimate received from DTRA is “not exposed” or “zero,” then do not submit the case to Compensation Service.
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<p class="MsoBlockText">

<p class="MsoBlockText">Refer these claims to the RO rating activity for a decision on the issue of service connection for residuals of radiation exposure. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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j.   Handling Dose Estimates Submitted on Behalf of the Claimant
<p class="MsoBlockText">Under 38 CFR 3.311(a)(3), if a dose estimate is submitted on behalf of the claimant, the rating activity must review the estimate to determine whether it is
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      from a credible source, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      at least double the dose provided by official military records.

<p class="MsoBlockText">

<p class="MsoBlockText">If both these criteria are met, the claims folder should be submitted to Compensation Service, Policy Staff (211), for review. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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11.   Referring Claims to Compensation Service, Policy Staff (211)
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Introduction
<p class="MsoBlockText">This topic contains information on referring claims to Compensation Service, Policy Staff (211), including
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<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      consideration of the claim by the rating activity

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the process for referring claims to the Compensation Service, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the information to include in the cover letter of a referral to Compensation Service. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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Change Date
<p class="MsoBlockText">September 5, 2008 {| border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt"
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a.   Consideration of the Claim by the Rating Activity
<p class="MsoBlockText">If the rating activity determines that at least one of the requirements of 38 CFR 3.311(b)(1) is not met, deny the claim by a formal rating decision on the grounds that the disease did not result from exposure to ionizing radiation. Do not refer such cases to Compensation Service unless all of the requirements are met.
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<p class="MsoBlockText">

<p class="MsoBlockText">The rating activity sends claims to Compensation Service, Policy Staff (211), for additional development if the

<p class="MsoBlockText">

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      three requirements under 38 CFR 3.311(b)(1) are met, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      development under this section, M21-1MR, Part IV, Subpart ii, 1.C, is complete. <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. Referring Claims to Compensation Service, Policy Staff (211), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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b.   Process for Referring Claims to Compensation Service
<p class="MsoBlockText">The table below describes the process for referring a claim based on exposure to ionizing radiation to Compensation Service, Policy Staff (211). <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"> 11. Referring Claims to Compensation Service, Policy Staff (211), Continued <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">

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c.   Information to Include in the Cover Letter of a Referral to Compensation Service
<p class="MsoBlockText">Include a cover letter briefly summarizing the following information when referring a claim based on exposure to ionizing radiation to Compensation Service, Policy Staff (211):
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<p class="MsoBlockText">

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

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      circumstances surrounding the exposure, including dates of the exposure

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      a description of the claimed disease, including the specific cell type and stage, if known

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the date the claimed disease first manifested and the time lapse between exposure and the onset of the disease

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

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     age at the time of exposure

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     gender

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     relevant family medical history, and

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     employment history

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the dose assessment, as specified in 38 CFR 3.311(a)(2)(iii), given by

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     DTRA, or

<p class="BulletText2" style="mso-list:l0 level1 lfo2"> -     the applicable service department

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      the Veteran’s history of exposure to known carcinogens or radiation before and after service, including smoking history and, if claiming skin cancer, exposure to the sun, and

<p class="BulletText1" style="mso-list:l1 level1 lfo1"><span style="font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:  Symbol;color:windowtext"> ·      any other information relevant to determining the cause of the disease.

<p class="MsoBlockText">

<p class="MsoBlockText">Note:   The letter should include a copy of all available pathology reports that identify the type of cancer and the organ involved. <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt"> '''<span style="font-size:16.0pt; mso-bidi-font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family: "Times New Roman";color:black;mso-ansi-language:EN-US;mso-fareast-language: EN-US;mso-bidi-language:AR-SA"> '''
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12.   Exhibit 1:   Exposure to Nuclear Radiation and Department of Defense (DoD) Secrecy Agreement
<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 5, 2008 <p class="BlockLine" style="margin-left:0in;mso-border-between:.75pt solid windowtext; mso-padding-between:1.0pt">
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a.   Exposure to Nuclear Radiation and DoD Secrecy Agreement
<p class="MsoBlockText">The Exposure to Nuclear Radiation and DoD Secrecy Agreement is below. <p class="MsoNormal">
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