### Section C. Service Connection for Disabilities Resulting From Exposure to Environmental Hazards

#### Overview

+------------+---------------------------------------------------------+
| #          | > This section contains the following topics:           |
| #### In th |                                                         |
| is Section |                                                         |
+------------+---------------------------------------------------------+

  ------------ ---------------------------------------------- ------------
  Topic        Topic Name                                     See Page

  8            Service Connection for Disabilities Resulting  2-C-2
               From Exposure to Ionizing Radiation            

  9            Service Connection for Disabilities Resulting  2-C-5
               From Exposure to Asbestos                      

  10           General Information on Establishing Service    2-C-10
               Connection for Disabilities Resulting From     
               Exposure to Herbicide Agents                   

  11           Payment Under the Nehmer Stipulation for       2-C-21
               Disabilities Resulting From Exposure to        
               Herbicide Agents                               

  12           Payment to the Survivors or Estate of a Nehmer 2-C-27
               Class Member                                   
  ------------ ---------------------------------------------- ------------

#### 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on service connection |
| troduction | > for disabilities resulting from exposure to ionizing  |
|            | > radiation, including the                              |
|            |                                                         |
|            | -   provisions of                                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   *Public Law (PL) 98-542*, and                       |
|            |                                                         |
|            | -   *PL 102-86*, and                                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   history of time limits for disease manifestation,   |
|            |     and                                                 |
|            |                                                         |
|            | -   list of presumptive disabilities under 38 CFR       |
|            |     3.309(d).                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Under *Public Law (PL) 98-542*, the "*Veterans'       |
| ## a. Prov | > Dioxin and Radiation Exposure Compensation Standards  |
| isions of  | > Act*," which was enacted on October 24, 1984, the     |
| PL 98-542  | > following claims that were denied *prior* to October  |
|            | > 24, 1984, are entitled to a *de novo* review:         |
|            |                                                         |
|            | -   claims for service connection based upon exposure   |
|            |     to ionizing radiation as a consequence of service   |
|            |     with the occupation forces of Hiroshima or          |
|            |     Nagasaki, Japan, or                                 |
|            |                                                         |
|            | -   claims for service connection based upon exposure   |
|            |     to ionizing radiation in connection with nuclear    |
|            |     testing.                                            |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   A *de novo* review is a new and complete review of  |
|            |     an issue with no deference given to the previous    |
|            |     decision.                                           |
|            |                                                         |
|            | -   It is not necessary for the claimant to submit new  |
|            |     and material evidence to reopen these claims.       |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > *PL 102-86*, effective August 14, 1991, extended      |
| ### b. Pro | > eligibility to presumptive service connection to      |
| visions of | > individuals engaged in a radiation-risk activity      |
|  PL 102-86 | > during                                                |
|            |                                                         |
|            | -   active duty for training, or                        |
|            |                                                         |
|            | -   inactive duty training.                             |
+------------+---------------------------------------------------------+

Continued on next page

8\. Service Connection for Disabilities Resulting From Exposure to
Ionizing Radiation, Continued

+------------+---------------------------------------------------------+
| ##### c    | > Originally, in order to establish presumptive service |
| . History  | > connection, the time limit for a disease listed under |
| of Time Li | > [38 CFR                                               |
| mits for D | > 3.309(d)](http://                                     |
| isease Man | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC) |
| ifestation | > to become manifest to a degree of 10 percent or more  |
|            | > was                                                   |
|            |                                                         |
|            | -   30 years for leukemia, and                          |
|            |                                                         |
|            | -   40 years for all other diseases.                    |
|            |                                                         |
|            | > Then, the presumptive period was extended to 40 years |
|            | > for leukemia effective August 14, 1991.               |
|            | >                                                       |
|            | > Effective October 1, 1992, a time limit for           |
|            | > manifestation is *not* specified or required for any  |
|            | > disease under listed [38 CFR                          |
|            | > 3.309(d)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > The table below lists the disabilities for which      |
| ### d. Lis | > service connection is presumed based on a veteran's   |
| t of Disab | > exposure to ionizing radiation under [38 CFR          |
| ilities Un | > 3.309(d)](http://w                                    |
| der 38 CFR | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC). |
|  3.309(d)  |                                                         |
| for Which  |                                                         |
| Service Co |                                                         |
| nnection I |                                                         |
| s Presumed |                                                         |
+------------+---------------------------------------------------------+

+--------------+-------------------------------------------------------+
| Public Law   | Presumptive Disabilities Under 38 CFR 3.309(d)        |
| or Federal   |                                                       |
| Register     |                                                       |
| Citation     |                                                       |
+--------------+-------------------------------------------------------+
| *PL 100-321* | -   Cancer of the                                     |
| effective    |                                                       |
| May 1, 1988  | ```{=html}                                            |
|              | <!-- -->                                              |
|              | ```                                                   |
|              | -   bile ducts                                        |
|              |                                                       |
|              | -   breast                                            |
|              |                                                       |
|              | -   esophagus                                         |
|              |                                                       |
|              | -   gall bladder                                      |
|              |                                                       |
|              | -   pancreas                                          |
|              |                                                       |
|              | -   pharynx                                           |
|              |                                                       |
|              | -   small intestine                                   |
|              |                                                       |
|              | -   stomach, and                                      |
|              |                                                       |
|              | -   thyroid                                           |
|              |                                                       |
|              | ```{=html}                                            |
|              | <!-- -->                                              |
|              | ```                                                   |
|              | -   leukemia, other than chronic lymphocytic leukemia |
|              |                                                       |
|              | -   lymphomas, except Hodgkin's disease               |
|              |                                                       |
|              | -   multiple myeloma, and                             |
|              |                                                       |
|              | -   primary liver cancer, except if cirrhosis or      |
|              |     hepatitis B is indicated.                         |
+--------------+-------------------------------------------------------+

Continued on next page

8\. Service Connection for Disabilities Resulting From Exposure to
Ionizing Radiation, Continued

  -----------------------------------------------------------------------
  d\. List of Disabilities Under 38 CFR 3.309(d) for Which Service
  Connection Is Presumed (continued)

  -----------------------------------------------------------------------

+--------------+-------------------------------------------------------+
| Public Law   | Presumptive Disabilities Under 38 CFR 3.309(d)        |
| or Federal   |                                                       |
| Register     |                                                       |
| Citation     |                                                       |
+--------------+-------------------------------------------------------+
| *PL 102-578* | Cancer of the                                         |
| effective    |                                                       |
| October 1,   | -   salivary gland, and                               |
| 1992         |                                                       |
|              | -   urinary tract.                                    |
|              |                                                       |
|              | ***Note***: The term *urinary tract* refers to the    |
|              |                                                       |
|              | -   kidneys                                           |
|              |                                                       |
|              | -   renal pelves                                      |
|              |                                                       |
|              | -   ureters                                           |
|              |                                                       |
|              | -   urinary bladder, and                              |
|              |                                                       |
|              | -   urethra.                                          |
+--------------+-------------------------------------------------------+
| *67 FR       | -   Bronchiolo-alveolar carcinoma, and                |
| 3612-3616*   |                                                       |
|              | -   cancer of the                                     |
| effective    |                                                       |
| March 26,    | ```{=html}                                            |
| 2002         | <!-- -->                                              |
|              | ```                                                   |
|              | -   bone                                              |
|              |                                                       |
|              | -   brain                                             |
|              |                                                       |
|              | -   colon                                             |
|              |                                                       |
|              | -   lung, and                                         |
|              |                                                       |
|              | -   ovary.                                            |
+--------------+-------------------------------------------------------+

#### 9. Service Connection for Disabilities Resulting From Exposure to Asbestos

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on service connection |
| troduction | > for disabilities resulting from exposure to asbestos, |
|            | > including                                             |
|            |                                                         |
|            | -   the definition of ***asbestos***                    |
|            |                                                         |
|            | -   the general effects of asbestos exposure            |
|            |                                                         |
|            | -   specific details on disease resulting from exposure |
|            |     to asbestos                                         |
|            |                                                         |
|            | -   occupational exposure and exposure during World War |
|            |     II (WWII)                                           |
|            |                                                         |
|            | -   the latent period for development of disease        |
|            |                                                         |
|            | -   the diagnostic indicators of asbestosis             |
|            |                                                         |
|            | -   considering service connection for exposure to      |
|            |     asbestos during service, and                        |
|            |                                                         |
|            | -   rating disabilities caused by exposure to asbestos. |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a. D | > ***Asbestos*** is a fibrous form of silicate mineral  |
| efinition: | > of varied chemical composition and physical           |
|  Asbestos  | > configuration, derived from serpentine and amphibole  |
|            | > ore bodies.                                           |
|            | >                                                       |
|            | > Common materials that may contain asbestos include    |
|            |                                                         |
|            | -   steam pipes for heating units and boilers           |
|            |                                                         |
|            | -   ceiling tiles                                       |
|            |                                                         |
|            | -   roofing shingles                                    |
|            |                                                         |
|            | -   wallboard                                           |
|            |                                                         |
|            | -   fire-proofing materials, and                        |
|            |                                                         |
|            | -   thermal insulation.                                 |
|            |                                                         |
|            | > ***Note***: Due to concerns about the safety of       |
|            | > asbestos, the use of materials containing asbestos    |
|            | > has declined in the United States since the 1970s.    |
+------------+---------------------------------------------------------+

Continued on next page

9\. Service Connection for Disabilities Resulting From Exposure to
Asbestos, Continued

+------------+---------------------------------------------------------+
| #####      | > Asbestos fiber masses have a tendency to break easily |
|  b. Genera | > into tiny dust particles that can float in the air,   |
| l Effects  | > stick to clothes, and may be inhaled or swallowed.    |
| of Asbesto | >                                                       |
| s Exposure | > Inhalation of asbestos fibers can produce             |
|            |                                                         |
|            | -   fibrosis, the most commonly occurring of which is   |
|            |     interstitial pulmonary fibrosis, or asbestosis      |
|            |                                                         |
|            | -   tumors                                              |
|            |                                                         |
|            | -   pleural effusions and fibrosis                      |
|            |                                                         |
|            | -   pleural plaques                                     |
|            |                                                         |
|            | -   mesotheliomas of pleura and peritoneum              |
|            |                                                         |
|            | -   cancers of the                                      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   lung                                                |
|            |                                                         |
|            | -   bronchus                                            |
|            |                                                         |
|            | -   gastrointestinal tract                              |
|            |                                                         |
|            | -   larynx                                              |
|            |                                                         |
|            | -   pharynx, and                                        |
|            |                                                         |
|            | -   urogenital system, except the prostate.             |
|            |                                                         |
|            | > ***Notes***: The biological actions of the various    |
|            | > fibers differ in some respects, in that               |
|            |                                                         |
|            | -   chrysotile products                                 |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   have their initial effects on the small airways of  |
|            |     the lung                                            |
|            |                                                         |
|            | -   cause asbestosis more slowly, and                   |
|            |                                                         |
|            | -   result in lung cancer more often, and               |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   crocidolite and amosite                             |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   have more initial effects on the small blood        |
|            |     vessels of the lung, alveolar walls, and pleura,    |
|            |     and                                                 |
|            |                                                         |
|            | -   result more often in mesothelioma.                  |
+------------+---------------------------------------------------------+

Continued on next page

9\. Service Connection for Disabilities Resulting From Exposure to
Asbestos, Continued

+------------+---------------------------------------------------------+
| ###        | > Specific effects of exposure to asbestos include      |
| ## c. Spec |                                                         |
| ific Detai | -   lung cancer that                                    |
| ls on Dise |                                                         |
| ases Resul | ```{=html}                                              |
| ting From  | <!-- -->                                                |
| Exposure t | ```                                                     |
| o Asbestos | -   originates in the lung parenchyma rather than the   |
|            |     bronchi, and                                        |
|            |                                                         |
|            | -   eventually develops in about 50 percent of persons  |
|            |     with asbestosis                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   gastrointestinal cancer that develops in 10 percent |
|            |     of persons with asbestosis                          |
|            |                                                         |
|            | -   urogenital cancer that develops in 10 percent of    |
|            |     persons with asbestosis, and                        |
|            |                                                         |
|            | -   mesothelioma that develops in 17 percent of persons |
|            |     with asbestosis.                                    |
|            |                                                         |
|            | > ***Important***:                                      |
|            |                                                         |
|            | -   All persons with significant asbestosis develop cor |
|            |     pulmonale, heart disease secondary to disease of    |
|            |     the lung or its blood vessels, and those who do not |
|            |     die from cancer often die from heart failure        |
|            |     secondary to cor pulmonale.                         |
|            |                                                         |
|            | -   Disease-causing exposure to asbestos may be         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   brief, and/or                                       |
|            |                                                         |
|            | -   indirect.                                           |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   Current smokers who have been exposed to asbestos   |
|            |     exposure face an increased risk of developing       |
|            |     bronchial cancer.                                   |
|            |                                                         |
|            | -   Mesotheliomas are not associated with cigarette     |
|            |     smoking.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### d.   | > The latent period for development of disease due to   |
| Latent Per | > exposure to asbestos ranges from 10 to 45 or more     |
| iod for De | > years between first exposure and development of       |
| velopment  | > disease.                                              |
| of Disease |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ####       | > A clinical diagnosis of asbestosis requires a history |
| # e. Diagn | > of exposure and radiographic evidence of parenchymal  |
| ostic Indi | > lung disease. Symptoms and signs include              |
| cators of  |                                                         |
| Asbestosis | -   dyspnea on exertion                                 |
|            |                                                         |
|            | -   end-respiratory rales over the lower lobes          |
|            |                                                         |
|            | -   compensatory emphysema                              |
|            |                                                         |
|            | -   clubbing of the fingers at late stages, and         |
|            |                                                         |
|            | -   pulmonary function impairment and cor pulmonale     |
|            |     that can be demonstrated by instrumental methods.   |
+------------+---------------------------------------------------------+

Continued on next page

9\. Service Connection for Disabilities Resulting From Exposure to
Asbestos, Continued

+------------+---------------------------------------------------------+
| ###        | > Some of the major occupations involving exposure to   |
| ## f. Occu | > asbestos include                                      |
| pational E |                                                         |
| xposures t | -   mining                                              |
| o Asbestos |                                                         |
|            | -   milling                                             |
|            |                                                         |
|            | -   work in shipyards                                   |
|            |                                                         |
|            | -   insulation work                                     |
|            |                                                         |
|            | -   demolition of old buildings                         |
|            |                                                         |
|            | -   carpentry and construction                          |
|            |                                                         |
|            | -   manufacture and servicing of friction products,     |
|            |     such as clutch facings and brake linings, and       |
|            |                                                         |
|            | -   manufacture and installation of products, such as   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   roofing and flooring materials                      |
|            |                                                         |
|            | -   asbestos cement sheet and pipe products, and        |
|            |                                                         |
|            | -   military equipment.                                 |
|            |                                                         |
|            | > ***Note***: Exposure to any simple type of asbestos   |
|            | > is unusual except in mines and mills where the raw    |
|            | > materials are produced.                               |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > High exposure to asbestos and a high prevalence of    |
| #### g. Ex | > disease have been noted in insulation and shipyard    |
| posure to  | > workers.                                              |
| Asbestos D | >                                                       |
| uring WWII | > During World War II (WWII), several million people    |
|            | > employed in U.S. shipyards and U.S. Navy veterans     |
|            | > were exposed to chrysotile products as well as        |
|            | > amosite and crocidolite since these varieties were    |
|            | > used extensively in military ship construction.       |
|            | >                                                       |
|            | > ***Important***: Many of these people have only       |
|            | > recently come to medical attention because of the     |
|            | > potentially long latent period between first exposure |
|            | > and development of disease.                           |
+------------+---------------------------------------------------------+

Continued on next page

9\. Service Connection for Disabilities Resulting From Exposure to
Asbestos, Continued

+------------+---------------------------------------------------------+
| ##### h    | > When deciding a claim for service connection for a    |
| . Consider | > disability resulting from exposure to asbestos        |
| ing Servic |                                                         |
| e Connecti | -   determine whether or not service records            |
| on for Dis |     demonstrate the veteran was exposed to asbestos     |
| abilities  |     during service                                      |
| Resulting  |                                                         |
| From Expos | -   ensure that development is accomplished to          |
| ure to Asb |     determine whether or not the veteran was exposed to |
| estos Duri |     asbestos either before or after service, and        |
| ng Service |                                                         |
|            | -   determine whether or not a relationship exists      |
|            |     between exposure to asbestos and the claimed        |
|            |     disease, keeping in mind latency and exposure       |
|            |     factors.                                            |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   As always, resolve reasonable doubt in the          |
|            |     claimant's favor.                                   |
|            |                                                         |
|            | -   If assistance in deciding a case is needed, contact |
|            |     the Compensation and Pension (C&P) Service Policy   |
|            |     Staff (211).                                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### i.   | > Use the information below to determine the diagnostic |
| Rating Dis | > code (DC) to assign when rating disabilities caused   |
| abilities  | > by exposure to asbestos.                              |
| Caused by  |                                                         |
| Exposure t |                                                         |
| o Asbestos |                                                         |
+------------+---------------------------------------------------------+

+-------------------------------------+--------------------------------+
| If the condition is ...             | Then rate ...                  |
+-------------------------------------+--------------------------------+
| asbestosis                          | under DC 6833.                 |
+-------------------------------------+--------------------------------+
| -   pleural effusions               | analogous to asbestosis under  |
|                                     | DC 6833.                       |
| -   fibrosis, or                    |                                |
|                                     |                                |
| -   pleural plaques                 |                                |
+-------------------------------------+--------------------------------+
| cancer                              | under the DC for the           |
|                                     | appropriate body system.       |
+-------------------------------------+--------------------------------+
| mesothelioma of pleura              | analogous to DC 6819.          |
+-------------------------------------+--------------------------------+
| mesothelioma of peritoneum          | analogous to DC 7343.          |
+-------------------------------------+--------------------------------+

#### 10. General Information on Establishing Service Connection for Disabilities Resulting From Exposure to Herbicide Agents

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on            |
| troduction | > establishing service connection for disabilities      |
|            | > resulting from exposure to herbicide agents,          |
|            | > including                                             |
|            |                                                         |
|            | -   the definitions of a ***herbicide agent*** and      |
|            |     ***service in the Republic of Vietnam***            |
|            |                                                         |
|            | -   presuming exposure to a herbicide agent             |
|            |                                                         |
|            | -   determining the last date of exposure               |
|            |                                                         |
|            | -   the time limits for disease manifestation           |
|            |                                                         |
|            | -   when to consider direct service connection          |
|            |                                                         |
|            | -   the definition of ***acute*** and ***subacute       |
|            |     peripheral neuropathy***                            |
|            |                                                         |
|            | -   handling claims based on acute and subacute         |
|            |     peripheral neuropathy and later-occurring           |
|            |     peripheral neuropathy                               |
|            |                                                         |
|            | -   the dates disabilities became subject to            |
|            |     presumptive service connection under 38 CFR         |
|            |     3.309(e)                                            |
|            |                                                         |
|            | -   conditions determined to have no positive           |
|            |     association with herbicide exposure                 |
|            |                                                         |
|            | -   exposure to herbicides during service aboard the    |
|            |     USS Ingersoll                                       |
|            |                                                         |
|            | -   exposure to herbicides along the demilitarized zone |
|            |     (DMZ) in Korea                                      |
|            |                                                         |
|            | -   storage of herbicide agents on Johnston Island, and |
|            |                                                         |
|            | -   Fact Sheet: Storage of Agent Orange on Johnston     |
|            |     Island.                                             |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > June 20, 2008                                         |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Under [38 CFR                                         |
| a. Definit | > 3.307(a)(6)(i)](http://w                              |
| ion: Herbi | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC), |
| cide Agent | > a ***herbicide agent*** is a chemical used in support |
|            | > of the U.S. and allied military operations in the     |
|            | > Republic of Vietnam (RVN) during the Vietnam Era,     |
|            | > specifically                                          |
|            |                                                         |
|            | -   2,4-D                                               |
|            |                                                         |
|            | -   2,4,5-T and its contaminant, TCDD (dioxin)          |
|            |                                                         |
|            | -   cacodylic acid, and                                 |
|            |                                                         |
|            | -   picloram.                                           |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ##### b.   | > For the purposes of establishing service connection   |
| Definition | > under [38 CFR                                         |
| : Service  | > 3.307(a)(6)](http://                                  |
| in the RVN | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC) |
|            | > and [38 CFR                                           |
|            | > 3.309(e)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC), |
|            | > ***service in the Republic of Vietnam*** (RVN) means  |
|            |                                                         |
|            | -   service in the RVN or its inland waterways, or      |
|            |                                                         |
|            | -   service in other locations if the conditions of     |
|            |     service involved duty or visitation in the RVN.     |
|            |                                                         |
|            | > ***Reference***: For more information on the          |
|            | > definition of service in the RVN, see [VAOPGCPREC     |
|            | > 27-97](http://www.va.gov/ogc/docs/1997/Prc27-97.doc). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### c.   | > Presume that a veteran who served on active duty in   |
| Presuming  | > the RVN during the Vietnam Era was exposed to a       |
| Exposure t | > herbicide agent *unless* there is affirmative         |
| o a Herbic | > evidence to the contrary.                             |
| ide Agent  | >                                                       |
|            | > ***Note***: Any exposure to herbicide agents during   |
|            | > service in locations other than Vietnam *must* be     |
|            | > established on a factual basis.                       |
|            | >                                                       |
|            | > ***Reference***: For more information on verifying    |
|            | > exposure to herbicides in locations other than        |
|            | > Vietnam, see M21-1MR, Part IV, Subpart ii, 2.C.10.l   |
|            | > through o.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Under [38 CFR                                         |
| d. Determi | > 3.307(a)(6)(iii)](http://w                            |
| ning the L | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC), |
| ast Date o | > the last date of exposure is the last date on which   |
| f Exposure | > the veteran served in the RVN during the Vietnam Era. |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > In order to establish presumptive service connection, |
| e. Time Li | > the following diseases listed in [38 CFR              |
| mits for D | > 3.309(e)](http://                                     |
| isease Man | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC) |
| ifestation | > must become manifest to a degree of 10 percent or     |
|            | > more within one year of the last date of exposure to  |
|            | > herbicides:                                           |
|            |                                                         |
|            | -   chloracne or other acne-form disease consistent     |
|            |     with chloracne                                      |
|            |                                                         |
|            | -   porphyria cutanea tarda, and                        |
|            |                                                         |
|            | -   acute and subacute peripheral neuropathy.           |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   There is no time limit for the other listed         |
|            |     diseases.                                           |
|            |                                                         |
|            | -   Previously, respiratory cancers, cancers of the     |
|            |     lung, bronchus, larynx, and trachea had to become   |
|            |     manifest within 30 years of last exposure. *PL      |
|            |     107-103* eliminated this requirement effective      |
|            |     January 1, 2002.                                    |
|            |                                                         |
|            | > ***Reference***: For more information on time limits  |
|            | > for manifestation of diseases subject to presumptive  |
|            | > service connection, see [38 CFR                       |
|            | > 3.307(a)(6)(ii)](http://w                             |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Under [38 CFR                                         |
| #### f. Wh | > 3.303(d)](http://                                     |
| en to Cons | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_303.DOC) |
| ider Direc | > the requirements for presumptive service connection   |
| t Service  | > do *not* preclude consideration of direct service     |
| Connection | > connection when a medical nexus (link, relationship,  |
|            | > or association) has been provided.                    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > ***Acute peripheral neuropathy*** and ***subacute     |
| #### g. De | > peripheral neuropathy*** are *transient* peripheral   |
| finition:  | > neuropathies that                                     |
| Acute and  |                                                         |
| Subacute P | -   appeared within one year of last exposure to an     |
| eripheral  |     herbicide agent                                     |
| Neuropathy |                                                         |
|            | -   resolved within two years of the date of onset, and |
|            |                                                         |
|            | -   do not include chronic peripheral neuropathy.       |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ##### h.   | > Do not assign a "0-percent" evaluation based on a     |
| Handling C | > history of acute and subacute peripheral neuropathy   |
| laims Base | > that                                                  |
| d on a His |                                                         |
| tory of Ac | -   manifested within one year of the date of last      |
| ute and Su |     exposure, and                                       |
| bacute Per |                                                         |
| ipheral Ne | -   resolved within two years of the date of onset.     |
| uropathy a |                                                         |
| nd Later-O | > ***Rationale***: There can be no valid claim without  |
| ccurring P | > proof of a present disability.                        |
| eripheral  | >                                                       |
| Neuropathy | > ***Reference***: For more information on what         |
|            | > constitutes a valid claim for service connection, see |
|            | > *[Brammer v.                                          |
|            | > Derwinski](http://vba                                 |
|            | w.vba.va.gov/bl/21/Advisory/CAVC/1992dec/Brammer.doc),* |
|            | > 3 Vet. App. 223 (1992).                               |
|            | >                                                       |
|            | > Claims of service connection for later occurring      |
|            | > peripheral neuropathy should be evaluated under the   |
|            | > ordinary standards governing direct service           |
|            | > connection.                                           |
|            | >                                                       |
|            | > ***Note***: Because any acute or subacute peripheral  |
|            | > neuropathy will, by definition, resolve within a      |
|            | > short time after exposure do *not* presume any later  |
|            | > occurring peripheral neuropathy, whether transient or |
|            | > chronic, to be related to the                         |
|            |                                                         |
|            | -   prior herbicide exposure, or                        |
|            |                                                         |
|            | -   previously-resolved acute or subacute peripheral    |
|            |     neuropathy.                                         |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > The table below shows the dates on which the diseases |
|  i. Date D | > listed in [38 CFR                                     |
| isabilitie | > 3.309(e)](http://                                     |
| s Became S | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC) |
| ubject to  | > became subject to presumptive service connection.     |
| Presumptiv |                                                         |
| e Service  |                                                         |
| Connection |                                                         |
+------------+---------------------------------------------------------+

+------------------------------------+---------------------------------+
| Disability                         | Effective Date                  |
+------------------------------------+---------------------------------+
| -   Chloracne or other acne-form   | February 6, 1991                |
|     disease consistent with        |                                 |
|     chloracne, and                 | ***Note***: Originally,         |
|                                    | September 25, 1985, under [38   |
| -   soft-tissue sarcoma, *other    | CFR                             |
|     than*                          | 3.311a](h                       |
|                                    | ttp://www.warms.vba.va.gov/regs |
| ```{=html}                         | /38CFR/BOOKB/PART3/S3_311.DOC). |
| <!-- -->                           |                                 |
| ```                                |                                 |
| -   osteosarcoma                   |                                 |
|                                    |                                 |
| -   chondrosarcoma                 |                                 |
|                                    |                                 |
| -   Kaposi's sarcoma, or           |                                 |
|                                    |                                 |
| -   mesothelioma                   |                                 |
+------------------------------------+---------------------------------+
| Non-Hodgkin's lymphoma             | February 6, 1991                |
|                                    |                                 |
|                                    | ***Note***: Originally, August  |
|                                    | 5, 1964, under [38 CFR          |
|                                    | 3.313](h                        |
|                                    | ttp://www.warms.vba.va.gov/regs |
|                                    | /38CFR/BOOKB/PART3/S3_313.DOC). |
+------------------------------------+---------------------------------+
| -   Porphyria cutanea tarda, and   | February 3, 1994                |
|                                    |                                 |
| -   Hodgkin's disease              |                                 |
+------------------------------------+---------------------------------+
| -   Respiratory cancers, such as   | June 9, 1994                    |
|     cancer of the                  |                                 |
|                                    |                                 |
| ```{=html}                         |                                 |
| <!-- -->                           |                                 |
| ```                                |                                 |
| -   lung                           |                                 |
|                                    |                                 |
| -   bronchus                       |                                 |
|                                    |                                 |
| -   larynx, or                     |                                 |
|                                    |                                 |
| -   trachea, and                   |                                 |
|                                    |                                 |
| ```{=html}                         |                                 |
| <!-- -->                           |                                 |
| ```                                |                                 |
| -   multiple myeloma               |                                 |
+------------------------------------+---------------------------------+
| -   Prostate cancer, and           | November 7, 1996                |
|                                    |                                 |
| -   acute and subacute peripheral  |                                 |
|     neuropathy                     |                                 |
+------------------------------------+---------------------------------+
| Type 2 diabetes mellitus           | May 8, 2001                     |
+------------------------------------+---------------------------------+
| Chronic lymphocytic leukemia       | October 16, 2003                |
+------------------------------------+---------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: Unless an earlier effective date is determined pursuant |
| > to the *Nehmer* stipulation, the provisions pertaining to           |
| > retroactive payment under [38 CFR                                   |
| > 3.1                                                                 |
| 14(a)](http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC) |
| > apply.                                                              |
| >                                                                     |
| > ***Reference***: For more information on the *Nehmer* stipulation,  |
| > see M21-1MR, Part IV, Subpart ii, 2.C.11.                           |
+-----------------------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > Under the Agent Orange Act of 1991, the Secretary     |
| j. Conditi | > receives from the National Academy of Science (NAS)   |
| ons Determ | > periodic reviews and summaries of the scientific      |
| ined to Ha | > evidence concerning the association between exposure  |
| ve No Posi | > to herbicides and diseases suspected to be associated |
| tive Assoc | > with those exposures.                                 |
| iation Wit | >                                                       |
| h Herbicid | > Based on cumulative scientific data reported by the   |
| e Exposure | > NAS since 1993, the Secretary has determined that     |
|            | > there is no positive association between herbicide    |
|            | > exposure and the following conditions:                |
|            |                                                         |
|            | -   amyloidosis                                         |
|            |                                                         |
|            | -   bone cancers                                        |
|            |                                                         |
|            | -   brain tumors                                        |
|            |                                                         |
|            | -   breast cancer                                       |
|            |                                                         |
|            | -   circulatory disorders                               |
|            |                                                         |
|            | -   cognitive and neuropsychiatric effects              |
|            |                                                         |
|            | -   female reproductive system cancers                  |
|            |                                                         |
|            | -   gastrointestinal and digestive disease, other than  |
|            |     Type 2 diabetes mellitus                            |
|            |                                                         |
|            | -   gastrointestinal tract tumors                       |
|            |                                                         |
|            | -   hepatobiliary cancers                               |
|            |                                                         |
|            | -   immune system disorders                             |
|            |                                                         |
|            | -   leukemia                                            |
|            |                                                         |
|            | -   lipid and lipoprotein disorders                     |
|            |                                                         |
|            | -   nasal and nasopharyngeal cancer                     |
|            |                                                         |
|            | -   Parkinson's disease                                 |
|            |                                                         |
|            | -   chronic persistent peripheral neuropathy            |
|            |                                                         |
|            | -   renal cancer                                        |
|            |                                                         |
|            | -   reproductive effects, such as abnormal sperm        |
|            |     parameters and infertility                          |
|            |                                                         |
|            | -   respiratory disorders, other than certain           |
|            |     respiratory cancers                                 |
|            |                                                         |
|            | -   skin cancer                                         |
|            |                                                         |
|            | -   testicular cancer, and                              |
|            |                                                         |
|            | -   urinary bladder cancer.                             |
|            |                                                         |
|            | > ***Note***: No positive association means that the    |
|            | > evidence for an association does not equal or         |
|            | > outweigh the evidence against association.            |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #          | > The National Archives and Records Administration      |
| #### k. Ex | > (NARA) has confirmed that the Navy destroyer USS      |
| posure to  | > Ingersoll (DD 652) traveled into the inland waterways |
| Herbicides | > of RVN on October 24 and 25, 1965. Therefore,         |
|  During Se | > according to [38 CFR                                  |
| rvice Aboa | > 3.307](http://w                                       |
| rd the USS | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC), |
|  Ingersoll | > concede exposure to herbicides for crewmembers that   |
|            | > served aboard the USS Ingersoll on these dates.       |
|            | >                                                       |
|            | > If a veteran alleges herbicide exposure based on duty |
|            | > aboard the USS Ingersoll, request Navy personnel      |
|            | > records via the Personnel Information Exchange System |
|            | > (PIES) (request code O19).                            |
|            | >                                                       |
|            | > If personnel records are unavailable or do not        |
|            | > confirm a specific shipboard assignment during this   |
|            | > timeframe, send a request for a review of NARA        |
|            | > records to C&P Service via e-mail at                  |
|            | > VAVBAWAS/CO/211/AGENTORANGE. This request should      |
|            | > include the veteran's                                 |
|            |                                                         |
|            | -   name                                                |
|            |                                                         |
|            | -   date of birth                                       |
|            |                                                         |
|            | -   VA claim number                                     |
|            |                                                         |
|            | -   Social Security number (SSN), and                   |
|            |                                                         |
|            | -   service number, if different than SSN.              |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ####       | > The Department of Defense (DoD) has identified        |
| # l. Expos | > specific units that served in areas along the         |
| ure to Her | > demilitarized zone (DMZ) in Korea where herbicides    |
| bicides Al | > were used between April 1968 and July 1969.           |
| ong the DM | >                                                       |
| Z in Korea | > Concede exposure to herbicides on a factual basis if  |
|            | > a veteran                                             |
|            |                                                         |
|            | -   alleges service along the DMZ in Korea, and         |
|            |                                                         |
|            | -   was assigned to one of the units shown in the table |
|            |     below between April 1968 and July 1969.             |
+------------+---------------------------------------------------------+

+----------------------+-----------------------+-----------------------+
| Combat Brigade of    | Division Reaction     | 3^rd^ Brigade of the  |
| the 2^nd^ Infantry   | Force                 | 7^th^ Infantry        |
| Division             |                       | Division              |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     | 4^th^ Squadron, 7^th^ | 1^st^ Battalion,      |
| 38^th^ Infantry      | Cavalry, Counter      | 17^th^ Infantry       |
|                      | Agent Company         |                       |
+----------------------+-----------------------+-----------------------+
| 2^nd^ Battalion,     |                       | 1^st^ Battalion,      |
| 38^th^ Infantry      |                       | 31^st^ Infantry       |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     |                       | 1^st^ Battalion,      |
| 23^rd^ Infantry      |                       | 32^nd^ Infantry       |
+----------------------+-----------------------+-----------------------+
| 2^nd^ Battalion,     |                       | 2^nd^ Battalion,      |
| 23^rd^ Infantry      |                       | 10^th^ Cavalry        |
+----------------------+-----------------------+-----------------------+
| 3^rd^ Battalion,     |                       | 2^nd^ Battalion,      |
| 23^rd^ Infantry      |                       | 17^th^ Infantry       |
+----------------------+-----------------------+-----------------------+
| 2^nd^ Battalion,     |                       | 2^nd^ Battalion,      |
| 31^st^ Infantry      |                       | 31^st^ Infantry       |
|                      |                       |                       |
| ***Note***: Service  |                       | ***Note***: Service   |
| records may show     |                       | records may show      |
| assignment to either |                       | assignment to either  |
| the 2^nd^ or the     |                       | the 2^nd^ or the      |
| 7^th^ Infantry       |                       | 7^th^ Infantry        |
| Division.            |                       | Division.             |
+----------------------+-----------------------+-----------------------+
|                      |                       | 2^nd^ Battalion,      |
|                      |                       | 32^nd^ Infantry       |
+----------------------+-----------------------+-----------------------+
| 3^rd^ Battalion,     |                       | 3^rd^ Battalion,      |
| 32^nd^ Infantry      |                       | 32^nd^ Infantry       |
|                      |                       |                       |
| ***Note***: Service  |                       | ***Note***: Service   |
| records may show     |                       | records may show      |
| assignment to either |                       | assignment to either  |
| the 2^nd^ or the     |                       | the 2^nd^ or the      |
| 7^th^ Infantry.      |                       | 7^th^ Infantry.       |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     |                       |                       |
| 9^th^ Infantry       |                       |                       |
+----------------------+-----------------------+-----------------------+
| 2^nd^ Battalion,     |                       |                       |
| 9^th^ Infantry       |                       |                       |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     |                       |                       |
| 72^nd^ Armor         |                       |                       |
+----------------------+-----------------------+-----------------------+
| 2^nd^ Battalion,     |                       |                       |
| 72^nd^ Armor         |                       |                       |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     |                       |                       |
| 12^th^ Artillery     |                       |                       |
+----------------------+-----------------------+-----------------------+
| 1^st^ Battalion,     |                       |                       |
| 15^th^ Artillery     |                       |                       |
+----------------------+-----------------------+-----------------------+
| 7^th^ Battalion,     |                       |                       |
| 17^th^ Artillery     |                       |                       |
+----------------------+-----------------------+-----------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

  -----------------------------------------------------------------------
  l\. Exposure to Herbicides Along the DMZ in Korea (continued)

  -----------------------------------------------------------------------

  ----------------------- ----------------------- -----------------------
  Combat Brigade of the   Division Reaction Force 3^rd^ Brigade of the
  2^nd^ Infantry Division                         7^th^ Infantry Division

  5^th^ Battalion, 38^th^                         
  Artillery                                       

  6^th^ Battalion, 37^th^                         
  Artillery                                       

  United Nations Command                          
  Security                                        
  Battalion-Joint                                 
  Security Area                                   
  (UNCSB-JSA)                                     

  Crew of the *USS                                
  Pueblo*                                         
  ----------------------- ----------------------- -----------------------

+-----------------------------------------------------------------------+
| > ***Note***: Submit a request to the U.S. Army and Joint Services    |
| > Records Research Center (JSRRC) for verification of the location of |
| > a veteran's unit if he/she                                          |
|                                                                       |
| -   alleges service along the DMZ between April 1968 and July 1969,   |
|     and                                                               |
|                                                                       |
| -   was assigned to a unit other than one listed in the table above.  |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Herbicide agents were stored in drums on Johnston     |
|  m. Storag | > Island in the north Pacific between April 1972 and    |
| e of Herbi | > September 1977. Because military contractors were     |
| cide Agent | > responsible for the inventory, few military personnel |
| s on Johns | > who served on Johnston Island had duties involving    |
| ton Island | > the direct handling of herbicides. If a veteran       |
|            | > alleges exposure to herbicides during service on      |
|            | > Johnston Island, obtain verification of exposure on a |
|            | > factual basis.                                        |
|            | >                                                       |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   verifying exposure to herbicides, see M21-1MR, Part |
|            |     IV, Subpart ii, 2.C.10.n, and                       |
|            |                                                         |
|            | -   storage of herbicides on Johnston Island, see       |
|            |     M21-1MR, Part IV, Subpart ii, 2.C.10.o.             |
+------------+---------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ##         | > Use the table below to verify that exposure to        |
| ### n. Ver | > herbicides occurred in locations *other than*         |
| ifying Exp |                                                         |
| osure in L | -   in RVN during the Vietnam Era, or                   |
| ocations O |                                                         |
| ther Than  | -   along the DMZ in Korea as specified in M21-1MR,     |
| RVN or Alo |     Part IV, Subpart ii, 2.C.10.l.                      |
| ng the DMZ |                                                         |
|  in Korea  |                                                         |
+------------+---------------------------------------------------------+

+-------+--------------------------------------------------------------+
| Step  | Action                                                       |
+-------+--------------------------------------------------------------+
| 1     | Ask the veteran for the approximate dates, location, and     |
|       | nature of the alleged exposure.                              |
+-------+--------------------------------------------------------------+
| 2     | Did the veteran furnish this information within 30 days?     |
|       |                                                              |
|       | -   If *yes,* go to Step 3.                                  |
|       |                                                              |
|       | -   If *no*, decide the claim based on the evidence of       |
|       |     record.                                                  |
+-------+--------------------------------------------------------------+
| 3     | -   Furnish the veteran's detailed description of exposure   |
|       |     to C&P Service via e-mail at                             |
|       |     VAVBAWAS/CO/211/AGENTORANGE, and                         |
|       |                                                              |
|       | -   request a review of DoD's inventory of herbicide         |
|       |     operations to determine whether herbicides were used as  |
|       |     alleged.                                                 |
+-------+--------------------------------------------------------------+
| 4     | Did C&P Service's review confirm that herbicides were used   |
|       | as alleged?                                                  |
|       |                                                              |
|       | -   If *yes*, determine whether service connection is        |
|       |     otherwise in order.                                      |
|       |                                                              |
|       | -   If *no*, submit a request to JSRRC for verification of   |
|       |     exposure to herbicides.                                  |
+-------+--------------------------------------------------------------+

Continued on next page

10\. General Information on Establishing Service Connection for
Disabilities Resulting From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ###        | > Below is a fact sheet on the storage of the herbicide |
| ## o. Fact | > Agent Orange on Johnston Island.                      |
|  Sheet: St |                                                         |
| orage of A |                                                         |
| gent Orang |                                                         |
| e on Johns |                                                         |
| ton Island |                                                         |
+------------+---------------------------------------------------------+

  -----------------------------------------------------------------------
  ![](media/image1.jpeg){width="6.278472222222222in"
  height="6.122222222222222in"}

  -----------------------------------------------------------------------

#### 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicide Agents

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on the payment under  |
| troduction | > the *Nehmer* stipulation, 38 CFR 3.816, for           |
|            | > disabilities resulting from exposure to herbicides,   |
|            | > including                                             |
|            |                                                         |
|            | -   the background of the *Nehmer* stipulation          |
|            |                                                         |
|            | -   categories of *Nehmer* class members                |
|            |                                                         |
|            | -   the definition of a ***covered herbicide disease*** |
|            |                                                         |
|            | -   entitlement to benefits under 38 CFR 3.816          |
|            |                                                         |
|            | -   effective dates of awards under 38 CFR 3.816        |
|            |                                                         |
|            | -   examples of establishing a retroactive effective    |
|            |     date                                                |
|            |                                                         |
|            | -   handling claims that do not specifically mention    |
|            |     herbicide exposure                                  |
|            |                                                         |
|            | -   an example of a claim in which exposure to          |
|            |     herbicides was not specifically mentioned           |
|            |                                                         |
|            | -   handling claims for service connection for          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   porphyria cutanea tarda (PCT), and                  |
|            |                                                         |
|            | -   Type 2 diabetes mellitus, and                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   examples of claims for service connection for Type  |
|            |     2 diabetes mellitus.                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > 38 CFR 3.311a, which became effective on September    |
|  a. Backgr | > 25, 1985, was the first VA regulation to provide      |
| ound of th | > guidance for the adjudication of claims based on      |
| e Nehmer S | > exposure to dioxin.                                   |
| tipulation | >                                                       |
|            | > In February 1986, a class action suit entitled        |
|            | > *Nehmer v. United States Veterans Administration*,    |
|            | > No*.* C86-6160 THE (N.D. Cal.), was filed in the      |
|            | > United States District Court for the Northern         |
|            | > District of California.                               |
|            | >                                                       |
|            | > On May 3, 1989, the district court invalidated a      |
|            | > portion of 38 CFR 3.311a. All denials after September |
|            | > 24, 1985, that were based on 38 CFR 3.311a were       |
|            | > voided, and a moratorium was placed on further        |
|            | > denials. The moratorium was lifted on February 15,    |
|            | > 1994.                                                 |
|            | >                                                       |
|            | > On September 24, 2003, a new regulation, [38 CFR      |
|            | > 3.816](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC), |
|            | > was added to provide guidance in the adjudication of  |
|            | > claims under the *Nehmer* litigation.                 |
+------------+---------------------------------------------------------+

Continued on next page

11\. Payment Under the Nehmer Stipulation for Disabilities Resulting
From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| ###        | > *Nehmer* class members under [38 CFR                  |
| ## b. Cate | > 3.816](http://                                        |
| gories of  | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
| Nehmer Cla | > include a                                             |
| ss Members |                                                         |
|            | -   veteran who                                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   served in the Republic of Vietnam during the        |
|            |     Vietnam era, and                                    |
|            |                                                         |
|            | -   has a covered herbicide disease, and                |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   surviving spouse, child, or parent of a deceased    |
|            |     veteran who                                         |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   served in the Republic of Vietnam during the        |
|            |     Vietnam era, and                                    |
|            |                                                         |
|            | -   died as the result of a covered herbicide disease.  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > A ***covered herbicide disease*** under [38 CFR       |
| c. Definit | > 3.816](http://                                        |
| ion: Cover | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
| ed Herbici | > means a disease for which VA has established a        |
| de Disease | > presumption of service connection before October 1,   |
|            | > 2002, under the "Agent Orange Act of 1991."           |
|            | >                                                       |
|            | > ***Exception***: Chloracne is *not* a covered         |
|            | > herbicide disease under [38 CFR                       |
|            | > 3.816](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC). |
|            | >                                                       |
|            | > The covered herbicide diseases under [38 CFR          |
|            | > 3.816](http://                                        |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
|            | > are                                                   |
|            |                                                         |
|            | -   acute and subacute peripheral neuropathy            |
|            |                                                         |
|            | -   Hodgkin's disease                                   |
|            |                                                         |
|            | -   multiple myeloma                                    |
|            |                                                         |
|            | -   non-Hodgkin's lymphoma                              |
|            |                                                         |
|            | -   porphyria cutanea tarda                             |
|            |                                                         |
|            | -   prostate cancer                                     |
|            |                                                         |
|            | -   respiratory cancers (cancer of the lung, bronchus,  |
|            |     larynx, or trachea)                                 |
|            |                                                         |
|            | -   soft-tissue sarcoma, as defined in [38 CFR          |
|            |     3.309(c)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   Type 2 diabetes, also known as type II diabetes     |
|            |     mellitus or adult-onset diabetes.                   |
+------------+---------------------------------------------------------+

Continued on next page

11\. Payment Under the Nehmer Stipulation for Disabilities Resulting
From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #          | > A *Nehmer* class member is entitled to compensation   |
| #### d. En | > under [38 CFR                                         |
| titlement  | > 3.816](http://                                        |
| to Benefit | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
| s under 38 | > if a claim for service connection for a covered       |
|  CFR 3.816 | > herbicide disease, or DIC based on death caused by a  |
|            | > covered herbicide disease, was                        |
|            |                                                         |
|            | -   denied in a decision issued between September 25,   |
|            |     1985, and May 3, 1989                               |
|            |                                                         |
|            | -   pending on May 3, 1989, or                          |
|            |                                                         |
|            | -   received between                                    |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   May 3, 1989, and                                    |
|            |                                                         |
|            | -   the effective date of the regulation establishing a |
|            |     presumption of service connection for the covered   |
|            |     disease.                                            |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > The effective date of disability compensation or DIC  |
| ## e. Effe | > benefits under [38 CFR                                |
| ctive Date | > 3.816](http://                                        |
| s of Award | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
| s under 38 | > is the date of receipt of the claim on which the      |
|  CFR 3.816 | > prior denial was based or the date entitlement arose, |
|            | > whichever is later.                                   |
|            | >                                                       |
|            | > ***Exceptions***:                                     |
|            |                                                         |
|            | -   If VA received the prior claim for compensation     |
|            |     within one year after the veteran's separation from |
|            |     service, the effective date of compensation would   |
|            |     be governed by [38 CFR                              |
|            |     3.400(b)(2)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC). |
|            |                                                         |
|            | -   If VA received the prior claim for DIC within one   |
|            |     year after the veteran's death, the effective date  |
|            |     of DIC would be governed by [38 CFR                 |
|            |     3.400(c)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC). |
|            |                                                         |
|            | > ***Notes***:                                          |
|            |                                                         |
|            | -   The provisions of [38 CFR                           |
|            |     3.114(a)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC), |
|            |     which limit effective dates to no earlier than the  |
|            |     date of a liberalizing law or issue, do not apply   |
|            |     to benefits awarded under [38 CFR                   |
|            |     3.816](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC). |
|            |                                                         |
|            | -   Whatever the effective date, the actual payment of  |
|            |     benefits commences on the first day of the          |
|            |     following month in accordance with [38 CFR          |
|            |     3.31](http://                                       |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_31.DOC). |
+------------+---------------------------------------------------------+

Continued on next page

11\. Payment Under the Nehmer Stipulation for Disabilities Resulting
From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > ***Situation***: The veteran's initial claim for      |
|  f. Exampl | > service connection for lung cancer was received on    |
| e 1: Initi | > August 4, 1985, and denied on November 19, 1985.      |
| al Claim D | > Medical evidence showed a diagnosis of lung cancer in |
| enied Afte | > July 1985. The veteran reopened his claim in March    |
| r Septembe | > 2001.                                                 |
| r 25, 1985 | >                                                       |
|            | > ***Result***: Establish service connection for lung   |
|            | > cancer effective the date the initial claim was       |
|            | > received, August 4, 1985.                             |
|            | >                                                       |
|            | > ***Rationale***: Since the initial claim for service  |
|            | > connection for a covered herbicide disease was denied |
|            | > after September 25, 1985, service connection may be   |
|            | > established from the date the initial claim was       |
|            | > received, per [38 CFR                                 |
|            | > 3.816](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC). |
|            | >                                                       |
|            | > ***Note***: If the claim had been denied, to include  |
|            | > any appeals, before September 25, 1985, it would be   |
|            | > unaffected by the *Nehmer* stipulation, and the       |
|            | > effective date would be governed by [38 CFR           |
|            | > 3.114(a)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### g. E | > ***Situation***: The veteran's initial claim for      |
| xample 2:  | > service connection for lung cancer was received on    |
| Initial Cl | > October 14, 1992, and denied on December 23, 1992.    |
| aim Receiv | > Medical evidence showed a diagnosis of lung cancer in |
| ed Prior t | > September 1992. The veteran reopened his claim in     |
| o the Effe | > March 2001.                                           |
| ctive Date | >                                                       |
|  of the La | > ***Result***: Establish service connection for lung   |
| w Establis | > cancer effective the date the initial claim was       |
| hing a Pre | > received, October 14, 1992.                           |
| sumption o | >                                                       |
| f Service  | > ***Rationale***: Since the claim was received prior   |
| Connection | > to June 9, 1994, the effective date of the law        |
|            | > establishing a presumption of service connection for  |
|            | > lung cancer under [38 CFR                             |
|            | > 3.309(e)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC), |
|            | > service connection may be established from the date   |
|            | > the initial claim was received, per [38 CFR           |
|            | > 3.816](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### h. E | > ***Situation***: On November 3, 1986, a veteran who   |
| xample 3:  | > served in the RVN during the Vietnam era died from    |
| Claim for  | > Hodgkin's disease. His surviving spouse's claim for   |
| DIC Benefi | > DIC benefits was received on December 10, 1986, and   |
| ts Receive | > denied on February 12, 1987. The surviving spouse     |
| d Within O | > reopened her claim on March 15, 1993.                 |
| ne Year of | >                                                       |
|  the Veter | > ***Result***: Establish entitlement to DIC benefits   |
| an's Death | > from November 1, 1986, the first day of the month in  |
|            | > which the veteran died.                               |
|            | >                                                       |
|            | > ***Rationale***: Since the claim for DIC benefits was |
|            | > received within one year of the veteran's death, the  |
|            | > effective date is governed by [38 CFR                 |
|            | > 3.400(b)(2)](http://w                                 |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC). |
+------------+---------------------------------------------------------+

Continued on next page

11\. Payment Under the Nehmer Stipulation for Disabilities Resulting
From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > In its February 11, 1999, order, the district court   |
| i. Handlin | > held that a *Nehmer* class member's claim for         |
| g Claims i | > disability compensation or DIC need only include a    |
| n Which Ex | > request for service connection for a covered          |
| posure to  | > herbicide disease to qualify as a *Nehmer* claim.     |
| Herbicides | >                                                       |
|  Is Not Sp | > It is not necessary for the claimant to assert the    |
| ecifically | > condition was caused by exposure to herbicides.       |
|  Mentioned |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### j.   | > ***Situation***: A veteran who served in the RVN      |
| Example: E | > during the Vietnam Era filed a claim in 1994,         |
| stablishin | > expressly alleging that his prostate cancer was       |
| g an Effec | > caused by exposure to ionizing radiation before the   |
| tive Date  | > veteran's service in Vietnam. VA denied the claim in  |
| When Expos | > 1995. The veteran reopened the claim in 1997 and      |
| ure to Her | > service connection was established.                   |
| bicides Is | >                                                       |
|  Not Speci | > ***Result***: Based on these facts, the effective     |
| fically Me | > date must relate back to the 1994 claim, even though  |
| ntioned in | > the veteran alleged a different basis for service     |
|  the Claim | > connection.                                           |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Under [38 CFR                                         |
|  k. Handli | > 3.311a(d)](http://w                                   |
| ng Claims  | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
| for Servic | > which was published on October 21, 1991, sound        |
| e Connecti | > scientific and medical evidence did *not* establish a |
| on for Por | > significant statistical association between exposure  |
| phyria Cut | > to herbicides and the development of porphyria        |
| anea Tarda | > cutanea tarda (PCT).                                  |
|            | >                                                       |
|            | > When determining the effective date for the           |
|            | > establishment of service connection for PCT           |
|            |                                                         |
|            | -   do not assign an earlier effective date under the   |
|            |     *Nehmer* stipulation, since a denial of service     |
|            |     connection for PCT under [38 CFR                    |
|            |     3.311a](http://                                     |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|            |     after October 20, 1991, is valid, and               |
|            |                                                         |
|            | -   consider an earlier effective date under the        |
|            |     *Nehmer* stipulation for a claim for service        |
|            |     connection for PCT that was denied between          |
|            |     September 24, 1985, and October 21, 1991.           |
+------------+---------------------------------------------------------+

Continued on next page

11\. Payment Under the Nehmer Stipulation for Disabilities Resulting
From Exposure to Herbicide Agents, Continued

+------------+---------------------------------------------------------+
| #####      | > Effective May 8, 2001, Type 2 diabetes mellitus       |
| l. Handlin | > became subject to presumptive service connection      |
| g Claims f | > under [38 CFR                                         |
| or Service | > 3.309(e)](http://w                                    |
|  Connectio | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC). |
| n for Type | > Retroactive benefits under the *Nehmer* review may be |
|  2 Diabete | > warranted for claims filed or denied during the       |
| s Mellitus | > period September 25, 1985, to May 7, 2001.            |
|            | >                                                       |
|            | > If a prior claim did not involve service connection   |
|            | > for Type 2 diabetes mellitus, there generally exists  |
|            | > no basis for assigning an earlier effective date.     |
|            | > However, a lack of specificity in the initial claim   |
|            | > may be clarified by later submissions.                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### m    | > ***Situation***: In January 1987, a veteran filed a   |
| . Example  | > claim for service connection for hyperglycemia. In    |
| 1: Claim f | > developing the claim, VA obtained medical records     |
| or Service | > indicating that the veteran was diagnosed with Type 2 |
|  Connectio | > diabetes mellitus in February 1987.                   |
| n for Type | >                                                       |
|  2 Diabete | > ***Result***: Based on these facts, it would be       |
| s Mellitus | > reasonable to treat the January 1987 claim as a claim |
|            | > for service connection for Type 2 diabetes mellitus.  |
|            | >                                                       |
|            | > ***Rationale***: Under *Nehmer*, benefits may be paid |
|            | > retroactive to the date the initial claim was         |
|            | > received or the date the disability arose as          |
|            | > determined by the facts of the case, whichever is     |
|            | > later.                                                |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### n    | > ***Situation***: In 1995, a veteran filed a claim for |
| . Example  | > service connection for hyperglycemia. Medical records |
| 2: Claim f | > obtained by VA indicated that the veteran did not     |
| or Service | > have Type 2 diabetes mellitus. In 2001, the veteran   |
|  Connectio | > filed a second claim for service connection for Type  |
| n for Type | > 2 diabetes mellitus, submitting evidence showing that |
|  2 Diabete | > the condition was diagnosed in 1996.                  |
| s Mellitus | >                                                       |
|            | > ***Result***: Based on these facts, the 1995 claim is |
|            | > not considered a claim for service connection for     |
|            | > Type 2 diabetes mellitus.                             |
|            | >                                                       |
|            | > ***Rationale***: Neither the claim nor the evidence   |
|            | > of record (when the 1995 claim was processed)         |
|            | > indicated the veteran had been diagnosed with Type 2  |
|            | > diabetes mellitus.                                    |
+------------+---------------------------------------------------------+

#### 12. Payment to the Survivors or Estate of a Nehmer Class Member

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on payment to the     |
| troduction | > survivors or estate of a *Nehmer* class member,       |
|            | > including                                             |
|            |                                                         |
|            | -   identifying the appropriate payee                   |
|            |                                                         |
|            | -   the action when an appropriate payee cannot be      |
|            |     located, and                                        |
|            |                                                         |
|            | -   identifying other survivors.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > December 13, 2005                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##         | > If a *Nehmer* class member entitled under [38 CFR     |
| ### a. Ide | > 3.816(c) and                                          |
| ntifying t | > (d)](http://                                          |
| he Appropr | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC) |
| iate Payee | > dies before receiving the payment of retroactive      |
|            | > benefits, VA will award the unpaid benefits to the    |
|            | > first individual or entity in existence in the        |
|            | > following order:                                      |
|            |                                                         |
|            | -   spouse                                              |
|            |                                                         |
|            | -   child or children, divided into equal shares if     |
|            |     more than one child exists, regardless of age or    |
|            |     marital status                                      |
|            |                                                         |
|            | -   parents, divided in half if both parents are alive, |
|            |     and                                                 |
|            |                                                         |
|            | -   estate.                                             |
|            |                                                         |
|            | > ***Note***: The survivor or estate of a *Nehmer*      |
|            | > class member is not required to file an application   |
|            | > in order to receive unpaid benefits.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Use all available information in the folder to        |
| b. Action  | > determine an appropriate payee if                     |
| When Appro |                                                         |
| priate Pay | -   a class member is deceased, and                     |
| ee Cannot  |                                                         |
| Be Located | -   the claims folder does not contain sufficient       |
|            |     information to identify an eligible survivor.       |
|            |                                                         |
|            | > ***Example***: If an authorized representative or     |
|            | > relative is identified in the claims folder, contact  |
|            | > this person for information on the existence of a     |
|            | > surviving spouse, children, parents, or estate. If    |
|            | > this effort fails to identify an appropriate payee,   |
|            | > annotate the rating decision, stating that it was not |
|            | > possible to locate any payee eligible for payment     |
|            | > under *Nehmer*.                                       |
+------------+---------------------------------------------------------+

Continued on next page

12\. Payment to the Survivors or Estate of a Nehmer Class Member,
Continued

+------------+---------------------------------------------------------+
| #####      | > Before awarding benefits to an identified payee, ask  |
| c. Identif | > the payee to state whether or not there are any other |
| ying Other | > survivors of the class member who may have an equal   |
|  Survivors | > or greater entitlement to unpaid benefits.            |
|            | >                                                       |
|            | > Once benefits have been awarded in full to a payee,   |
|            | > do not pay any portion of the amount to any other     |
|            | > individual, unless the payment previously released    |
|            | > can be recovered.                                     |
+------------+---------------------------------------------------------+