What is Presumptive Service Connection for VA Compensation?
For presumptive service connection, there is no need to establish a link between the incurrence in service and the current condition. The link is presumed if the claim is for the 120 or so presumptive service connected conditions listed in the regulations.
However, evidence must establish that the claimant had the particular duty assignment or was in the particular location in order for the presumption to apply. There are various categories of presumptive service connected claims which we will discuss here.
Establishing Presumptive Service Connection
Ninety days of service is required for certain defined presumptive conditions manifesting within one year after service and for tropical diseases. If a current disease or condition is considered presumptive service-connected, there is no need to establish a nexus or link between that disease or condition and active duty service. It is automatically considered to be caused by service.
It is important to note that some VA-listed presumptive conditions may not actually be the result of service, but many years after discharge may be the result of other non-service health developments. In this case, even though the presumptive condition manifests itself after service, it is necessary that the in-service presumptions apply or there is no benefit. In order to be service-connected, many presumptive conditions must have manifest within a certain period of time after leaving the service – usually to a degree of 10% disability within the first year.
For those presumptive conditions where there is no time limit, and the condition has been recently diagnosed and the time between discharge and the claim is significant, the Regional Office will question whether the condition is service-connected. In this case, a continuity of symptoms must be produced to show that the condition would have been or was manifest – meeting the proper time frame – even though it was not diagnosed. Diagnosis is not required, only evidence of manifesting. For some presumptive conditions – such as Agent Orange or ionizing radiation or exposure to hazards causing Gulf War Syndrome – there does not have to be a continuity of symptoms, nor do they have to show up within 1 year of discharge. Symptoms from these conditions could show up many years after discharge. 38 CFR 3.303
Presumptive Conditions Which Must Manifest within One Year of Discharge
The conditions listed below must have manifested within one year of discharge to a degree of 10% disability or more. There are a few exceptions such as Hansen's disease which follow different rules for when manifestation must occur.
- Anemia, primary,
- Atrophy, Progressive muscular,
- Brain hemorrhage,
- Brain thrombosis,
- Calculi of the kidney, bladder, or gallbladder,
- Cardiovascular-renal disease, including hypertension,
- Cirrhosis of the liver,
- Diabetes mellitus,
- Encephalitis lethargica residuals,
- Endocarditis (this term covers all forms of valvular heart disease),
- Hansen's disease,
- Hodgkin's disease,
- Lupus erythematosus, systemic,
- Myasthenia gravis,
- Other organic diseases of the nervous system,
- Osteitis de Formans (Paget's disease),
- Palsy, bulbar,
- Paralysis agitans,
- Purpura idiopathic, hemorrhagic,
- Raynaud's disease,
- Sclerosis, amyotrophic lateral,
- Sclerosis, multiple,
- Thromboangiitis obliterans (Buerger's disease),
- Tuberculosis, active,
- Tumors, malignant, or of the brain or spinal cord or peripheral nerves, and
- Ulcers, peptic
Tropical Diseases That Must Show up Soon after Discharge
- Blackwater fever,
- Leishmaniasis, including kala-azar,
- Oroya fever,
- Yaws, and
- Yellow fever
Qualifying periods of service for the following infectious diseases include active military, naval, or air service in the Southwest Asia theater of operations during the Gulf War period of August 2, 1990, to July 30, 1991, or active military, naval, or air service on or after September 19, 2001, in Afghanistan.
- Campylobacter jejuni,
- Coxiella burnetti (Q fever),
- Mycobacterium tuberculosis,
- Nontyphoid Salmonella,
- Visceral leishmaniasis, and
- West Nile virus.
Presumptive Conditions That Can Show up Any Time after Discharge
Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's Disease can appear any time after separation from service and will always result in an award for compensation. It is automatic.
Presumptive Conditions Caused by Ionizing Radiation
Careful attention is paid to whether the veteran was actually exposed to radiation to a degree to cause a number of conditions which are mostly cancers. Exposure is generally assumed to be related to nuclear detonations or experiments of which there is a specific list and the veteran must prove he was involved at the time. Manifestation of these diseases or disorders can occur generally any time after a certain prescribed period of time, depending on the condition. Manifesting does not mean medical diagnosis, only that evidence shows the existence.
Because service connection is presumed, it is not required to produce evidence for service connection – only evidence of the manifestation of the disorder or disease. That said, the claimant must provide evidence of being in the defined locations where the claimant was presumably exposed to ionizing radiation and in sufficient doses to result in one of the chronic conditions on the list. This might prove a difficult task. Here is the list.
- All forms of leukemia (except for chronic lymphocytic leukemia);
- cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary tract (renal pelvis, ureter, urinary bladder and urethra), brain, bone, lung, colon, and ovary;
- bronchiolo-alveolar carcinoma;
- multiple myeloma;
- lymphomas (other than Hodgkin's disease), and
- primary liver cancer (except if cirrhosis or hepatitis B is indicated).
Presumptive Conditions Caused by Exposure to Herbicide in Vietnam (Agent Orange)
The veteran must have 90 continuous days or more of service. Herbicides were used in Vietnam to defoliate trees in order to remove cover for the enemy. During the manufacturing process, significance amounts of harmful contaminants called dioxins were produced. Different blends of herbicides were used but the most common was one called "Agent Orange." Being on the ground in Vietnam, during the war or on the inland waterways is sufficient for presumption for service connection. Harmful exposure other than the automatic "boots on the ground" for Vietnam is generally considered to be inhalation and not topical.
Exposure also occurred in Thailand, the demilitarized zone in Korea and on certain ships anchored offshore within the territorial limits of Vietnam (12 mile limit). In addition, numerous storage, spraying operations, testing and loading sites – outside the country and inside the US – could have resulted in exposure. Also any aircrews flying C123 aircraft – which were used for dispersal – anywhere in the world up through 1987 are also considered to have been exposed to the herbicide. Aircrew exposure does not require active duty service as members of the Air Force Reserve flew these aircraft for a number of years up through 1987 well after the Vietnam war was over.
The claimant must prove that he or she was exposed to Agent Orange. Proving that the claimant was in Vietnam or in any other locations where VA recognizes there was exposure to Agent Orange is relatively easy, based on service records. Being exposed to Agent Orange under other circumstances might be a difficult task to prove. These following illnesses are presumed by VA to be service-connected for Agent Orange veterans:
- AL amyloidosis,
- chloracne or other acne Form disease similar to chloracne – 10% < 1 year,
- porphyria cutanea tarda – 10% < 1 year,
- soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma,
- Kaposi's sarcoma or mesothelioma),
- Hodgkin's disease,
- multiple myeloma,
- respiratory cancers (lung, bronchus, larynx, trachea),
- non-Hodgkin's lymphoma,
- prostate cancer,
- acute and subacute peripheral neuropathy – 10% < 1 year,
- diabetes mellitus (Type 2),
- all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia),
- Parkinson's disease, and
- ischemic heart disease.
Gulf War Illness
Veterans may receive Disability Compensation for chronic disabilities resulting from undiagnosed illnesses and/or medically unexplained chronic multi-symptom illnesses defined by a cluster of signs or symptoms. A disability is chronic if it has existed at least 6 months.
The undiagnosed illnesses must have appeared either during active service in the Southwest Asia Theater of Operations during the Gulf War period of Aug. 2, 1990, to July 31, 1991, or to a degree of at least 10 percent at any time since then through Dec. 31, 2021.
This theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations.
Because service connection is presumed, it is not required to produce evidence for service connection – only evidence of the manifestation of the disorder or disease. That said, the claimant must provide evidence of being in the service in the particular theater of operation. Disability has to become manifest to 10% or more from the time of active duty and no later than December 31, 2021.
Of the 700,000 servicemembers deployed to the Gulf War in 1990 and 1991, 36.5 percent were experiencing some symptoms of Gulf War illness in 2005, according to a previous NAS study. The federal government spent more than $500 million on research related to Gulf War veterans from 1994 to 2014, but there have been few findings about Gulf War illness and specific chemical agents that could be causing it, according to the NAS study from February.
Examples of symptoms of an undiagnosed illness and medically unexplained chronic multi-symptom illness defined by a cluster of signs and symptoms include:
- chronic fatigue syndrome,
- irritable bowel syndrome,
- signs or symptoms involving the skin,
- skin disorders,
- muscle pain,
- joint pain,
- neurological signs or symptoms,
- neuropsychological signs or symptoms,
- signs or symptoms involving the respiratory system (upper or lower),
- sleep disturbances,
- gastrointestinal signs or symptoms,
- cardiovascular signs or symptoms,
- abnormal weight loss, and
- menstrual disorders.
From the 1950s through the 1980s, people living or working at the U.S. Marine Corps Base Camp Lejeune, North Carolina, were potentially exposed to drinking water contaminated with industrial solvents, benzene, and other chemicals.
VA has established a presumptive service connection for Veterans, Reservists, and National Guard members exposed to contaminants in the water supply at Camp Lejeune from August 1, 1953 through December 31, 1987 who later developed one of the following eight diseases:
- Adult leukemia,
- Aplastic anemia and other myelodysplastic syndromes,
- Bladder cancer,
- Kidney cancer,
- Liver cancer,
- Multiple myeloma,
- Non-Hodgkin's lymphoma, and
- Parkinson's disease
Presently, these conditions are the only ones for which there is sufficient scientific and medical evidence to support the creation of presumptions; however, VA will continue to review relevant information as it becomes available.
Veterans who are experiencing other health conditions that they think may be related to contaminated water at Camp Lejeune are encouraged to contact their primary care provider and to file a claim. VA reviews and decides Disability Compensation claims on a case-by-case basis.
In accordance with the 2012 Camp Lejeune health care law, VA provides cost-free health care for certain conditions to Veterans who served at least 30 days of active duty at Camp Lejeune from January 1, 1957 and December 31, 1987.
Qualifying health conditions include:
- Esophageal cancer,
- Breast cancer,
- Kidney cancer,
- Multiple myeloma,
- Renal toxicity,
- Female infertility,
- Non-Hodgkin's lymphoma,
- Lung cancer,
- Bladder cancer,
- Myelodysplastic syndromes,
- Hepatic steatosis,
- Miscarriage, and
- Neurobehavioral effects
Veterans eligible for health care under the 2012 Camp Lejeune health care law may enroll in VA health care and receive medical services for the 15 covered health conditions at no cost (including copayments).
Family members of Veterans who also resided at Camp Lejeune during the qualifying period are eligible for reimbursement of out-of-pocket medical expenses related to the 15 covered health conditions. VA can pay treatment costs that remain after payment from other health plans.
A List of Presumptive Conditions for Exposure to Mustard Gas or Lewisite
We do not provide this list here as it is rare to find a claimant who has had this exposure.
A List of Presumptive Conditions for Being a Prisoner of War
The veteran must have 90 continuous days or more of service. There are 20 diseases or disorders considered service-connected for a prisoner of war depending on the length of imprisonment and manifested any time after separation to a disabling degree of 10% or more. Manifesting does not necessarily mean medical diagnosis, only that evidence shows the existence. Because service connection is presumed, it is not required to produce evidence for service connection – only evidence of the manifestation of the disorder or disease. Evidence must be provided that shows the claimant was a prisoner of war for the prescribed amount of imprisonment. Here is the list.
- any of the anxiety states,
- dysthymic disorder,
- organic residuals of frostbite,
- post-traumatic osteoarthritis,
- atherosclerotic heart disease or hypertensive vascular disease and their complications,
- stroke and its complications,
- residuals of stroke, and
- effective October 10, 2008, osteoporosis if the veteran has post-traumatic stress disorder (PTSD).
For former POWs who were imprisoned for at least 30 days, the following conditions are also presumed to be service-connected:
- chronic dysentery,
- malnutrition (including optic atrophy associated with malnutrition),
- pellagra and/or other nutritional deficiencies,
- irritable bowel syndrome,
- peptic ulcer disease,
- peripheral neuropathy except where related to infectious causes,
- cirrhosis of the liver, and
- effective September 28, 2009, osteoporosis.
Where Disability Compensation is claimed by a former prisoner of war, omission of history or findings from clinical records made upon repatriation is not determinative of service connection, particularly if evidence of comrades in support of the incurrence of the disability during confinement is available. Special attention will be given to any disability first reported after discharge, especially if poorly defined and not obviously of intercurrent origin. The circumstances attendant upon the individual veteran's confinement and the duration thereof will be associated with pertinent medical principles in determining whether disability manifested subsequent to service is etiologically related to the prisoner of war experience.
Iraq and Afghanistan war veterans are presumed to have been exposed to harmful substances from very large burn pits that were used instead of landfills to dispose of all types of unwanted waste material from bases in Iraq and Afghanistan. This exposure has resulted in development of certain conditions.
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