### Veterans Benefits Administration M21-1, Part III

**Department of Veterans Affairs Change 124**

**Washington, DC 20420 August 11, 2004**

Veterans Benefits Manual M21-1, Part III, "Authorization and Clerical
Procedures," is changed as follows:

**Pages 5-II-1 and 5-II-2:** Remove these pages and substitute paged
5-II-1 and 5-II-2 attached.

**Pages 5-II-7 and 5-II-8:** Remove these pages and substitute pages
5-II-7 and 5-II-8 attached.

**Pages 5-B-19 and 5-B-20:** Remove these pages and substitute pages
5-B-19 and 5-B-20 attached.

Paragraphs 5.11c(3) and 5.12d(4)(a) and Exhibit B-13 are revised to show
the correct mailing address for the Defense Threat Reduction Agency.
Paragraph 5.12d(4)(a) is also reorganized for clarity.

> By Direction of the Under Secretary for Benefits

Renée L. Szybala, Director

Compensation and Pension Service

Distribution: RPC: 2068

FD: EX: ASO and AR (included in RPC 2068)

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## August 11, 2004 M21-1, Part III

**Change 124**

# SUBCHAPTER II. COMPENSATION CLAIMS FOR SPECIAL DISABILITIES

**5.10 CLAIMS BASED ON EXPOSURE TO HERBICIDES CONTAINING DIOXIN (2, 3,
7, 8**

##### TETRACHLORODIBENZO-P-DIOXIN) DURING SERVICE IN THE REPUBLIC OF VIETNAM

a\. **General.** When initially corresponding with a veteran claiming
disability resulting from exposure to herbicides while in the Republic
of Vietnam, inform him or her of the availability of hospital
examination and treatment. Inform the veteran that if he or she has
already had the herbicide examination or been treated for herbicide
exposure, he or she should submit a copy of the examination or treatment
report or submit the name of the VA facility performing the examination
or treatment so that the regional office may obtain a copy of the
examination report.

b\. **No Specific Disability Claimed.** If the veteran alleges herbicide
exposure but claims no disability, inform the veteran that mere exposure
is not a disability. Tell the veteran to specify the disabilities
resulting from herbicide exposure and to submit medical evidence of the
earliest manifestations of symptoms together with evidence of continuity
of treatment. Process as a denial without a rating decision and take the
end product at that point.

c\. **Presumption of Service Connection.** The Agent Orange Act of 1991
(Public Law 102-4) establishes a presumption of service connection for
veterans with service in Vietnam during the Vietnam era who subsequently
develop, to a degree of 10% or more, Hodgkin's disease, multiple
myeloma, non-Hodgkin\'s lymphoma (NHL), acute and subacute peripheral
neuropathy, porphyria cutanea tarda, prostate cancer, respiratory
cancers (cancers of the lung, bronchus, larynx or trachea), soft-tissue
sarcoma or chloracne or other acneiform disease consistent with
chloracne, diabetes mellitus (type 2), and chronic lymphocytic leukemia.
Public Law 104-275 provided that effective January 1, 1997, the
applicable service dates for purposes of the presumption of exposure to
herbicides are from January 9, 1962, to May 7, 1975. Qualifying skin
conditions must have become manifest to a degree of 10% or more within 1
year of the last date of service within the Republic of Vietnam. Even a
few hours in Vietnam during the Vietnam era may be sufficient to service
connect subsequently developed presumptive conditions based on exposure
to herbicides.

**Note:** Under 38 CFR 3.313, service in Vietnam together with the
development of NHL after service is sufficient to establish service
connection for that disease. It does not have to be at least 10%
disabling. The term \"service in Vietnam\" includes service in the
waters offshore, or service in other locations if the conditions of
service involved duty or visitation in Vietnam. There is no requirement
for a specified length of service, duty or visitation in Vietnam under
38 CFR 3.313.

\(1\) **Development.** If the claimant alleges Vietnam service, review
the DD Form 214 or other evidence in file to confirm such service. If
necessary, develop with the service department and ask the claimant to
submit evidence to show Vietnam service or to obtain confirming buddy
statements. The claim cannot be denied based on a lack of verification
of Vietnam service until the claimant has had 60 days to respond to the
request and the 30-day follow-up period exhausted. Additionally, if
Federal records were requested, continue to follow-up *until* the
requested records are received or a formal response is received that the
records are unavailable.

***Note:*** Contact the US Armed Services Center for Unit Records
Research (CURR) for verification of Vietnam service if the veteran and
the service department have been unable to determine such service. See
M21-1, Part III, 5.14c(3)(a) for CURR's mailing address.

d\. **Birth Defects.**

\(1\) Spina Bifida: Claims for benefits for a child suffering from spina
bifida and other birth defects are discussed in M21-1MR, Part VI,
Chapter 18.

> \(2\) Claims for additional benefits by women Vietnam veterans due to
> certain birth defects of a natural child have been authorized under PL
> 106-419. Please refer to FL 00-90 for processing claims of this type.

**5-II-1**

# M21-1, Part III August 11, 2004

#### Change 124

\(3\) The law limits the birth defects for which we may pay benefits.
Claims for benefits from birth defects resulting from a familial
disorder, a birth-related injury, or a fetal or neonatal infirmity with
well-established causes, should be denied as not authorized by law.

**5.11 PRESUMPTIVE SERVICE CONNECTION UNDER 38 U.S.C. 1112 FOR
RADIOGENIC DISEASES**

a\. **General.** Several radiogenic diseases are subject to presumptive
service connection in both live and death cases under PL 100-321. This
law became effective May 1, 1988. The only radiation risk activities
which can be considered for presumptive service connection are
participation in atmospheric nuclear weapons testing, post-war
occupation of Hiroshima or Nagasaki, and internment as a POW in Japan.
Prior to August 14, 1991, the presumption applied only to veterans
exposed to ionizing radiation while on active duty. However, PL 102-86,
enacted on that date, extended the presumption to include persons
exposed while on active duty for training or inactive duty for training.
A specified disease which became manifest in a radiation-exposed veteran
is considered to have been incurred or aggravated during the veteran\'s
service.

b\. **Diseases Specific to Radiation-Exposed Veterans.** There are two
sets of radiogenic conditions

with separate development paths. Conditions considered presumptive under
38 CFR 3.309 are considered service-connected for any veteran who
participated in a radiation activity (38 CFR 3.309(d)(3)(ii)) while
serving on active duty, active duty for training, or inactive duty for
training. Service connection for other radiogenic conditions can also be
granted but require development for a reconstructed dose estimate. Those
conditions are in 38 CFR 3.311.

c\. **Development**

\(1\) Before undertaking development of a claim, the following criteria
must be met:

\(a\) One of the presumptive radiogenic diseases listed above must be
shown to exist by medical evidence.

\(b\) It must be alleged the disability was the result of participation
in a radiation-risk activity.

\(2\) If one of the above criteria is not met, no further development
under this law is warranted. In such cases, consider the claim as any
other claim for direct service connection under 38 CFR 3.303 or 38 CFR
3.311. The denial of benefits under all applicable laws and regulations,
if warranted, will be accomplished by a rating decision.

\(3\) The Department of Defense is the source of information concerning
the veteran\'s participation in radiation-risk activity. As with a claim
for direct service connection, requests for verification of U.S.
atmospheric nuclear weapons test participation, occupational force
involvement or internment as a POW in Japan subject to the same
conditions as occupational forces are to be sent to: Defense Threat
Reduction Agency (DTRA) at the following address: Attn: TDND-NTPR 8725
John J. Kingman Rd., Mail Stop 6201 Ft. Belvoir, VA 22060-6201. NTPR
identifies the Nuclear Test Personnel Review Program. Verification
requests pertaining to *non-U.S.* test participation should be processed
in accordance with paragraph 5.12e below.

\(4\) A sample development letter is shown as exhibit B.13. Development
letters to DTRA must contain the following information:

\(a\) Veteran\'s and claimant\'s names.

\(b\) Veteran\'s military service number.

(c) Veteran\'s Social Security number.

**5-II-2**

**August 11, 2004 M21-1, Part III**

#  Change 124

d\. **Dosimetry Information**

\(1\) If the requirements under 38 CFR 3.311(b) have been met and the
development specified by subparagraphs b and c above has been completed
or there is evidence sufficient to establish the veteran\'s presence
where radiation exposure existed, telephone Central Office Compensation
and Pension Service, Policy Staff (211), at (202) 273-7210.

\(2\) Note that the DTRA's Nuclear Test Personnel Review (NTPR) Program
only provides dose estimates for individuals involved in U.S.
atmospheric nuclear testing and the occupation of Hiroshima/Nagasaki.
For all other dose estimates, the VARO will request all records
concerning the veteran's exposure to ionizing radiation from the
Services. When received, the VARO will forward the records to the
Compensation and Pension Service, Policy Staff (211), for referral to
the Under Secretary for Health, who will be responsible for preparation
of a dose estimate, to the extent feasible, based on available
methodologies.

\(3\) The initial request to the Compensation and Pension Service should
include the following:

-   File number

-   Social Security number

-   Service number

-   Period of service

-   Claimant\'s current telephone number and address

-   Veteran\'s date and place of birth

-   Nature of disability.

\(4\) For claims involving U.S. atmospheric nuclear weapons tests,
occupation of Hiroshima or Nagasaki, or POW interment in Japan, request
information regarding those tests from the following sources. Enclose a
copy of the claimant's response to the request for ionizing radiation
exposure information.

\(a\) After receiving the approval of the Compensation and Pension
Service, send a letter requesting dosimetry information to the DTRA at
the following address:

Defense Threat Reduction Agency (DTRA)

Attn: TDND-NTPR

8725 John J. Kingman Rd., Mail Stop 6201

Ft. Belvoir, VA 22060-6201

**NOTE:** DTRA accepts requests for U.S. atmospheric nuclear test
participants (exposures through 1962) for non-presumptive claims without
respect to any specific participation periods.

\(b\) For individuals outside the scope of DTRA's NTPR program (i.e.,
X-ray technicians, reactor plant workers, nuclear medicine, radar,
radiography, etc.), a letter requesting dose information should be
written to the appropriate Service point of contact listed in Section
5.12(c)(5).

\(5\) If a dose estimate was submitted on behalf of the claimant \[38
CFR 3.311(a)(3)(ii)\], the rating activity will compare this estimate
with the response from the DoD or service departments or with official
military records and initiate additional development if needed.

\(6\) However, if the dose estimate received from the DTRA is "not
exposed," or "zero," then the case is not to be submitted to the
Compensation and Pension Service (see *Wandel v. West*, No. 94-1110,
April 7, 1998). Such a claim should be submitted to the RO rating
activity for a decision on the issue of service connection for residuals
of radiation exposure. "Not exposed" means there was no potential for
receiving a radiation dose. No radiological environment was entered to
receive a dose. "Zero dose" means there was a potential for a radiation
dose but the amount received was zero.

**5-II-7**

**M21-1, Part III August 11, 2004**

**Change 124**

e\. **Development for U.S. Veterans Involved in Non-U.S. Nuclear Bomb
Tests**

\(1\) Public Law 103-446 established veterans\' entitlement to the same
radiogenic conditions for participants in non-U.S. nuclear tests as for
participants in U.S. nuclear tests. See the sample questionnaire in
Exhibit B.16. Develop radiation dose information for non-U.S. test
participants, using the addresses and telephone numbers shown below.

\(2\) All requests involving *non-U.S. test participation* must be
clearly annotated. DTRA is not responsible for requests involving
non-U.S. test participants and will return these requests to the RO.

\(3\) For non-U.S. test participants involved in *flight missions*,
contact:

HQAFTAC

ATTN: IGO

1030 South Highway A1A

Patrick AFB, FL 32925-3002

Telephone: (321) 494-6867

FAX: (321) 494-2319

\(4\) For all other non-U.S. test participants, contact the appropriate
Service points of contact

identified in Section 5.12(c)(5).

f\. **Nasopharyngeal Radium Irradiation**

\(1\) Claims for service connection based on in-service treatment
involving nasopharyngeal radium

irradiation therapy (NRI) should be adjudicated under the provisions of
38 C.F.R. 3.311 with dose estimates prepared by the Under Secretary for
Health.

\(2\) Review the service medical, clinical and dental records for any
annotation of radium therapy. Even when service medical records do
verify NRI treatments, they may not contain detailed records of
radiation doses during treatment. If NRI treatment is verified, lack of
dose information should not prevent you from forwarding the claim to the
Compensation and Pension Service, Policy Staff (211). If service medical
records are not yet in file, request them. Also request information
concerning radiation exposure from standard sources. Be sure to ask the
veteran to furnish the date, place and the specific base and medical
facility where the NRI treatment was administered.

\(3\) The Department of Defense Radiation Experiments Command Center
(RECC) is responsible for

researching records from NPRC to respond to inquiries related to human
radiation experiments. As part of this responsibility, RECC has
researched radiation exposure involving NRI treatment at the Naval
Submarine Base, New London, CT for the period between 1944 and 1946.
RECC does *not* have records for veterans treated at other locations or
during other time periods. Those records should be requested through
regular sources. The request to RECC must furnish as much specific
information as possible to allow identification and research of records.
Request for information from RECC should be sent to the following
address:

Department of Defense

Radiation Experiments Command Center

ATTN: VARO NRI Information Inquiry

6801 Telegraph Rd.

Alexandria, VA 22310-33998.

**5-II-8**

**August 11, 2004 M21-1, Part III**

**Change 124**

**Appendix B**

**Exhibit B-12**

**Sample Development Letter to Service Department for Verification of
Claimed In-Service Stressor**

\[Address of Service Department\]

We are attempting to verify a veteran's claimed in-service traumatic
stressor(s). Information enclosed has been provided by the veteran or
the service department, or both, and includes the following:

FULL NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CLAIM NUMBER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SOCIAL SECURITY NUMBER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SERVICE NUMBER:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

REGIONAL OFFICE AND ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

UNITS OF ASSIGNMENT, COMPANY, BATALLION, REGIMENT, DIVISION:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TYPE, PLACE AND DATE OF THE SPECIFIC STRESS INCIDENT(S) CLAIMED.
PARAPHRASE THE MEDICAL EVIDENCE DESCRIBING THE STRESSOR WHICH IS LINKED
TO THE ACTUAL DIAGNOSIS:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NAMES OF OTHER PERSONS INVOLVED IN OR AWARE OF THE INCIDENT (OR NAMES OF
CLOSE FRIENDS KILLED IN ACTION)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Also enclosed is a copy of a report of contact or a copy of the
veteran's statement involving the incident, and a copy of a DD Form 20
from the St. Louis NPRC, if available.

Any information you can provide will be greatly appreciated.

> Sincerely yours,
>
> \[Name and Title of Veterans Service Center Manager\]

**5-B-19**

**M21-1, Part III August 11, 2004**

**Change 124**

**Appendix B**

**Exhibit B-13**

**SUGGESTED LETTER TO USE TO REQUEST PARTICIPATION OR RADIATION DOSE
INFORMATION FROM THE DEFENSE THREAT REDUCTION AGENCY**

Defense Threat Reduction Agency 00/21

Attn: TDND/NTPR C 12 345 679

8725 John J. Kingman Rd., Mail Stop 6201 JONES, John A.

Ft Belvoir, VA 22060-6201

Dear Sir/Madam:

We have received a claim for service connection under provisions of 38
C.F.R. 3.309 for conditions allegedly due to radiation risk activity.

Veteran's identifying information:

> Full name: John A. Jones
>
> VA Claim No: C 12 345 679
>
> Social Security No: 234 56 7890
>
> Branch of Service: Navy
>
> Assigned Unit: USS SEVERN (AO-61)

The veteran, Mr. Jones, participated in OPERATION CROSSROADS (ABLE &
BAKER) FROM July 7, 1946, to August 24, 1946. His duties and activities
included COOK.

The alleged radiogenic disease is SKIN CANCER \[specific site of lesion
must be included\]. A copy of the claimant's statement is enclosed.

The claimant's name and address is:

> John A. Jones
>
> 793 Smith St.
>
> Hometown, CA 92027
>
> Telephone:

Please verify the veteran's participation in the radiation risk activity
described above and provide the associated radiation dose. If no
individual radiation dose record is available, please provide a dose
reconstruction for his unit.

Please send your reply to \[give regional office address, as shown
below\]:

> Department of Veterans Affairs
>
> Regional Office
>
> 2022 Camino Del Rio North
>
> San Diego, CA 92108

Your assistance in this matter is appreciated.

> Sincerely yours,
>
> \[Name and Title of Veterans Service Center Manager\]

**5-B-20**