### Section C. Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311

#### Overview

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

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

  7            General Information on Claims for Service      1-C-2
               Connection for Disabilities Resulting From     
               Ionizing Radiation Exposure Under 38 CFR 3.311 

  8            Requesting Information and Evidence From the   1-C-6
               Claimant                                       

  9            Verification of Exposure to Ionizing Radiation 1-C-9
               Under 38 CFR 3.311                             

  10           Obtaining Dosimetry Information                1-C-18

  11           Referring Claims to Compensation and Pension   1-C-23
               (C&P) Service, Policy Staff (211)              

  12           Exhibit 1: Exposure to Nuclear Radiation and   1-C-26
               Department of Defense (DoD) Secrecy Agreement  
  ------------ ---------------------------------------------- ------------

#### 7. General Information on Claims for Service Connection for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains general information on claims for |
| troduction | > disabilities resulting from ionizing radiation        |
|            | > exposure under 38 CFR 3.311. It includes information  |
|            | > on                                                    |
|            |                                                         |
|            | -   the centralized processing of claims based on       |
|            |     radiation exposure                                  |
|            |                                                         |
|            | -   the provisions of 38 CFR 3.311                      |
|            |                                                         |
|            | -   considering presumptive versus direct service       |
|            |     connection                                          |
|            |                                                         |
|            | -   handling                                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   claims that require a subsequent review, and        |
|            |                                                         |
|            | -   the classified information needed to validate       |
|            |     exposure to nuclear radiation, and                  |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Department of Veterans Affairs (VA) responsibility  |
|            |     in expunging classified military data.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > September 5, 2008                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### a.   | > In October 2006, the processing of all claims for     |
| Centralize | > service connection based on radiation exposure was    |
| d Processi | > centralized at the Jackson Regional Office (RO).      |
| ng of Clai | >                                                       |
| ms Based o | > The Jackson RO is responsible for developing and      |
| n Radiatio | > resolving                                             |
| n Exposure |                                                         |
|            | -   all claims for service connection for disabilities  |
|            |     resulting from exposure to ionizing radiation under |
|            |     [38 CFR                                             |
|            |     3.311](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   all non radiation-related claims received while the |
|            |     radiation issue is pending.                         |
|            |                                                         |
|            | > ***Note***: Following resolution of all pending       |
|            | > issues, the Jackson RO will transfer the claims       |
|            | > folder back to the RO of original jurisdiction.       |
+------------+---------------------------------------------------------+

Continued on next page

7\. General Information on Claims for Service Connection for
Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR
3.311, Continued

+------------+---------------------------------------------------------+
| #####      | > The specific requirements for the adjudication of     |
|  b. Provis | > claims for service connection for disabilities        |
| ions of 38 | > resulting from exposure to ionizing radiation claims  |
|  CFR 3.311 | > are found in [38 CFR                                  |
|            | > 3.311](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC). |
|            | >                                                       |
|            | > The provisions of [38 CFR                             |
|            | > 3.311(b)(1)](http://                                  |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|            | > require that the                                      |
|            |                                                         |
|            | -   veteran must have been exposed to ionizing          |
|            |     radiation as a result of participation in           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   atmospheric testing of nuclear weapons              |
|            |                                                         |
|            | -   the occupation of Hiroshima or Nagasaki, Japan from |
|            |     September 1945 until July 1946, or                  |
|            |                                                         |
|            | -   other radiation-risk activities as claimed          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   veteran must have subsequently developed a          |
|            |     radiogenic disease listed in [38 CFR                |
|            |     3.311(b)(2)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   disease first manifested itself within the period   |
|            |     specified in [38 CFR                                |
|            |     3.311(b)(5)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > A claim for service connection under the provisions   |
| ## c. Pres | > of [38 CFR                                            |
| umptive Ve | > 3.311](http://                                        |
| rsus Direc | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
| t Service  | > is also a claim for service connection under the      |
| Connection | > provisions of [38 CFR                                 |
|            | > 3.303](http://w                                       |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_303.DOC). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > A claim for service connection for a disability       |
| ## d. Hand | > resulting from exposure to radiation as an            |
| ling Claim | > atmospheric test participant or a member of the       |
| s That Req | > Hiroshima/Nagasaki occupation forces that was denied  |
| uire a Sub | > prior to enactment of *Public Law (PL) 98-542*, "*The |
| sequent Re | > Veterans' Dioxin and Radiation Exposure Compensation  |
| view Under | > Standards Act*," on October 24, 1984, *must* receive  |
|  PL 98-542 | > a complete, new and complete review of the evidence   |
|            | > (*de novo* review) if the claim is subsequently       |
|            | > reopened.                                             |
|            | >                                                       |
|            | > ***Note***: It is not necessary for the claimant to   |
|            | > submit new and material evidence to reopen these      |
|            | > claims.                                               |
|            | >                                                       |
|            | > ***Reference***: For more information on the initial  |
|            | > review of reopened claims for compensation based on   |
|            | > radiation exposure, see                               |
|            |                                                         |
|            | -   [M21-1MR, Part IV, Subpart ii,                      |
|            |     1.B.5](../pt04_sp02_ch01_secB.xml#IV.ii.1.B.5), and |
|            |                                                         |
|            | -   [M21-1MR, Part IV, Subpart ii,                      |
|            |     1.C.8](http://vbaw.vba.va.gov/bl/21/M21-1           |
|            | MR/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.8). |
+------------+---------------------------------------------------------+

Continued on next page

7\. General Information on Claims for Service Connection for
Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR
3.311, Continued

+------------+---------------------------------------------------------+
| #####      | > On May 8, 2003, the National Research Council, an     |
| e. Handlin | > independent agency contracted to review the Defense   |
| g Claims T | > Threat Reduction Agency's (DTRA) radiation dose       |
| hat Requir | > estimates, reported that DTRA had underestimated      |
| e a Subseq | > upper bound radiation doses for atmospheric test      |
| uent Revie | > participants and Hiroshima/Nagasaki occupation        |
| w Based on | > forces.                                               |
|  Dose Esti | >                                                       |
| mates Made | > When a case is encountered in which a denial was      |
|  Before Ma | > based on a dose estimate provided by DTRA before May  |
| y 8, 2003  | > 8, 2003, obtain a new dose estimate from DTRA and     |
|            | > readjudicate the claim.                               |
|            | >                                                       |
|            | > ***Note***: It is not necessary for the claimant to   |
|            | > submit new and material evidence to reopen these      |
|            | > claims.                                               |
|            | >                                                       |
|            | > ***Reference***: For more information on developing   |
|            | > dose estimates, see [M21-1MR, Part IV, Subpart ii,    |
|            | > 1.C.10](http://vbaw.vba.va.gov/bl/21/M21-1M           |
|            | R/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.10). |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### f. H | > Veterans seeking benefits in connection with exposure |
| andling Cl | > to nuclear radiation are authorized by the *Exposure  |
| assified I | > to Nuclear Radiation and DoD Secrecy Agreement* to    |
| nformation | > divulge to VA the name, location of their command,    |
|  Needed to | > duties performed, dates of service, and related       |
|  Validate  | > information necessary to validate exposure to nuclear |
| Exposure t | > radiation.                                            |
| o Nuclear  | >                                                       |
| Radiation  | > This authorization does *not* relieve veterans of     |
|            | > responsibility for continuing to protect specific     |
|            | > technical information that could contribute to the    |
|            | > development of a weapon of mass destruction or the    |
|            | > application of nuclear technology.                    |
|            | >                                                       |
|            | > ***Important***: Information relative to military     |
|            | > bases where nuclear weapons                           |
|            |                                                         |
|            | -   may be located within the continental U.S. is       |
|            |     classified as "Confidential," and                   |
|            |                                                         |
|            | -   were or are located outside the continental U.S. is |
|            |     classified as "Secret" or "Top Secret."             |
|            |                                                         |
|            | > ***References***: For more information on             |
|            |                                                         |
|            | -   the *Exposure to Nuclear Radiation and DoD Secrecy  |
|            |     Agreement*, see [M21-1MR, Part IV, Subpart ii,      |
|            |     1.C.12](http://vbaw.vba.va.gov/bl/21/M21-1M         |
|            | R/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.12), |
|            |     and                                                 |
|            |                                                         |
|            | -   claims for radiogenic diseases under [38 CFR        |
|            |     3.309(d)](http://w                                  |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC), |
|            |     see [M21-1MR, Part IV, Subpart ii,                  |
|            |     1.B](../pt04_sp02_ch01_secB.xml#IV.ii.1.B).         |
+------------+---------------------------------------------------------+

Continued on next page

7\. General Information on Claims for Service Connection for
Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR
3.311, Continued

+------------+---------------------------------------------------------+
| #####      | > The fact that a veteran inadvertently reveals         |
|  g. VA Res | > classified military information during the course of  |
| ponsibilit | > applying for benefits should not be compounded        |
| y for Expu | > further by releasing this information within or       |
| nging Clas | > outside VA in any manner. Cut out (rather than        |
| sified Mil | > obliterate) any classified information from related   |
| itary Data | > documents or statements.                              |
|            | >                                                       |
|            | > When expungement is necessary, prepare a *VA Form     |
|            | > 119*, *Report of Contact*, for the claims folder and  |
|            | > have the form signed by the Veterans Service Center   |
|            | > Manager (VSCM) or supervisory designee, not lower     |
|            | > than the Assistant VSCM. On the *VA Form 119*         |
|            |                                                         |
|            | -   cite the                                            |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   kind of evidence removed, and                       |
|            |                                                         |
|            | -   reason for the record expungement, and              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   summarize or restate any other expunged facts or    |
|            |     statements not referring to specific military bases |
|            |     where radiation exposure allegedly occurred.        |
+------------+---------------------------------------------------------+

#### 8. Requesting Information and Evidence From the Claimant 

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on requesting         |
| troduction | > information and evidence from the claimant. It        |
|            | > includes information on                               |
|            |                                                         |
|            | -   the minimum evidence required from the claimant for |
|            |     development of exposure to ionizing radiation       |
|            |                                                         |
|            | -   the initial review of claims                        |
|            |                                                         |
|            | -   when to obtain information                          |
|            |                                                         |
|            | -   requesting a diagnosis of the veteran's disease     |
|            |                                                         |
|            | -   requesting a history of the veteran's exposure to   |
|            |     known carcinogens, and                              |
|            |                                                         |
|            | -   requesting a history of cancer in the veteran's     |
|            |     family, and                                         |
|            |                                                         |
|            | -   other information to obtain.                        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > September 5, 2008                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #          | > Do not initiate development of a claim for service    |
| #### a. Ev | > connection for a disability resulting from exposure   |
| idence Req | > to ionizing radiation unless                          |
| uired for  |                                                         |
| Initial De | -   the dates, places, and circumstances of exposure to |
| velopment  |     ionizing radiation are                              |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   contained in the claims folder, or                  |
|            |                                                         |
|            | -   provided by the claimant, and                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   diagnosis of a radiogenic disease is claimed.       |
|            |                                                         |
|            | > ***Note***: Ask the claimant to provide this          |
|            | > information, if it is not of record.                  |
+------------+---------------------------------------------------------+

Continued on next page

8\. Requesting Information and Evidence From the Claimant, Continued

+------------+---------------------------------------------------------+
| ###        | > If a claim is received for service connection for a   |
| ## b. Init | > disability caused by exposure to ionizing radiation   |
| ial Review | > *and* the claim is substantially complete, the        |
|  of Claims | > pre-determination activity reviews the claim to       |
|            |                                                         |
|            | -   direct development to determine whether service     |
|            |     connection may be established under [38 CFR         |
|            |     3.303](http://w                                     |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_303.DOC), |
|            |     and                                                 |
|            |                                                         |
|            | -   determine whether the requirements for              |
|            |     consideration of service connection under [38 CFR   |
|            |     3.311](http://                                      |
|            | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|            |     are satisfied.                                      |
|            |                                                         |
|            | > Under [38 CFR                                         |
|            | > 3.311(b)](http://w                                    |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|            | > the submitted or acquired evidence must show that the |
|            | > veteran                                               |
|            |                                                         |
|            | -   has either                                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   one of the radiogenic diseases listed in [38 CFR    |
|            |     3.311(b)(2)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|            |     or                                                  |
|            |                                                         |
|            | -   an unlisted disease for which a medical opinion or  |
|            |     medical treatise has been submitted showing a       |
|            |     causal relationship between the disease and         |
|            |     exposure to radiation, and                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   was exposed to ionizing radiation                   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   while a participant in atmospheric nuclear weapons  |
|            |     testing                                             |
|            |                                                         |
|            | -   during the post-war occupation of Hiroshima or      |
|            |     Nagasaki from September 1945 until July 1, 1946     |
|            |                                                         |
|            | -   as a prisoner of war (POW) in Japan, or             |
|            |                                                         |
|            | -   while performing other service activities, such as  |
|            |     work as an x-ray technician, in a reactor plant, or |
|            |     in nuclear medicine or radiography.                 |
+------------+---------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Note***: A veteran will be considered involved in a              |
| > radiation-risk activity if he/she performed tasks similar to work   |
| > engaged in by a Department of Energy employee that qualifies the    |
| > Department of Energy employee as a member of the Special Exposure   |
| > Cohort under [42 USC                                                |
| > 7384L(14)](http://assembler.la                                      |
| w.cornell.edu/uscode/html/uscode42/usc_sec_42_00007384---l000-.html). |
+-----------------------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > In all cases, *if* a substantially complete claim     |
|  c. When t | > under [38 CFR                                         |
| o Obtain I | > 3.311](http://                                        |
| nformation | www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|            | > exists, obtain the information listed in [M21-1MR,    |
|            | > Part IV, Subpart ii, 1.C.8.d through M21-1MR, Part    |
|            | > IV, Subpart ii,                                       |
|            | > 1.C.8.g](http://vbaw.vba.va.gov/bl/21/M21-1MR         |
|            | /pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.8.d). |
+------------+---------------------------------------------------------+

Continued on next page

8\. Requesting Information and Evidence From the Claimant, Continued

+------------+---------------------------------------------------------+
| #####      | > Obtain information on the diagnosis of the veteran's  |
| d. Request | > disease and, if known, the specific cell type and     |
| ing a Diag | > stage.                                                |
| nosis of t | >                                                       |
| he Disease | > ***Example***: If the disease is skin cancer, ask the |
|            | > claimant to provide the                               |
|            |                                                         |
|            | -   type of cancer diagnosed                            |
|            |                                                         |
|            | -   specific site of each lesion                        |
|            |                                                         |
|            | -   date that the disease was first diagnosed or        |
|            |     treated, and                                        |
|            |                                                         |
|            | -   name and address of the physician or facility who   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   made the diagnosis, or                              |
|            |                                                         |
|            | -   first treated the claimed disease.                  |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Obtain information on the veteran's history of        |
| e. Request | > exposure to known carcinogens, including a            |
| ing a Hist | > post-service occupational history. Ask whether,       |
| ory of the | > either before or after service, the veteran was       |
|  Veteran's | > exposed to a cancer-causing substance.                |
|  Exposure  | >                                                       |
| to Known C | > ***Examples***:                                       |
| arcinogens |                                                         |
|            | -   If the claim is for skin cancer, ask the claimant   |
|            |     to provide the                                      |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   extent of exposure to the sun (such as sun bathing  |
|            |     or occupations requiring the veteran to work        |
|            |     outdoors, and so forth) and                         |
|            |                                                         |
|            | -   specific site of each lesion.                       |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   Request the veteran's smoking history.              |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ###        | > Obtain information on the history of members of the   |
| ## f. Requ | > veteran's family who have been diagnosed as having    |
| esting a H | > cancer.                                               |
| istory of  | >                                                       |
| Cancer in  | > ***Example***: Ask whether members of the veteran's   |
| the Vetera | > immediate family, such as parents or siblings, have   |
| n's Family | > been diagnosed with diseases such as cancer or        |
|            | > leukemia, birth defects, or genetic disorders.        |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| #####      | > Obtain                                                |
| g. Other I |                                                         |
| nformation | -   the names and addresses of any physicians and       |
|  to Obtain |     facilities who have made subsequent diagnoses or    |
|            |     have provided treatment for the claimed disease     |
|            |                                                         |
|            | -   the complete clinical records (not summaries) for   |
|            |     all medical care relating to the claimed disease,   |
|            |     and                                                 |
|            |                                                         |
|            | -   all tissue blocks, slides or other pathology        |
|            |     samples, if available.                              |
+------------+---------------------------------------------------------+

#### 9. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311

+------------+---------------------------------------------------------+
| ##### In   | > This topic contains information on the process of     |
| troduction | > verifying exposure to ionizing radiation under 38 CFR |
|            | > 3.311. It includes information on                     |
|            |                                                         |
|            | -   requesting verification from DTRA for the veteran's |
|            |     participation in, and exposure to radiation as a    |
|            |     result of                                           |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   atmospheric nuclear weapons tests, 1945 to 1962,    |
|            |     and                                                 |
|            |                                                         |
|            | -   American occupation of Hiroshima or Nagasaki,       |
|            |     Japan, prior to July 1, 1946                        |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   requesting verification of                          |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   involvement in non-U.S. nuclear bomb tests, and     |
|            |                                                         |
|            | -   exposure to ionizing radiation by reason of         |
|            |     military duties                                     |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   obtaining records of occupational exposure to       |
|            |     radiation from the veteran's service department     |
|            |                                                         |
|            | -   obtaining records of occupational exposure to       |
|            |     radiation from the Atomic Energy Commission (AEC),  |
|            |     and                                                 |
|            |                                                         |
|            | -   developing claims for service connection based on   |
|            |     nasopharyngeal radium irradiation therapy (NRI).    |
+------------+---------------------------------------------------------+

+------------+---------------------------------------------------------+
| ##### C    | > September 5, 2008                                     |
| hange Date |                                                         |
+------------+---------------------------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+------------+---------------------------------------------------------+
| #####      | > When requesting verification from DTRA of exposure to |
| a. Request | > ionizing radiation due to the veteran's participation |
| ing Verifi | > in an atmospheric nuclear weapons test, use the       |
| cation of  | > Modern Award Processing-Development (MAP-D) system or |
| Participat | > Personal Computer-Generated Letters (PCGL) to send a  |
| ion in Atm | > letter to DTRA that                                   |
| ospheric N |                                                         |
| uclear Wea | -   specifies the                                       |
| pons Tests |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   disease being claimed (***Note***: If skin cancer   |
|            |     is claimed, specify the site of each lesion, type   |
|            |     of cancer, and date of diagnosis.)                  |
|            |                                                         |
|            | -   veteran's organization or unit of assignment at the |
|            |     time of exposure, and                               |
|            |                                                         |
|            | -   dates of assignment to the nuclear test site, and   |
|            |                                                         |
|            | ```{=html}                                              |
|            | <!-- -->                                                |
|            | ```                                                     |
|            | -   provides a full description of the veteran's duties |
|            |     and activities while participating in a             |
|            |     radiation-risk activity.                            |
|            |                                                         |
|            | > The letter to DTRA should also include a copy of      |
|            |                                                         |
|            | -   all available pathology reports that identify the   |
|            |     type of cancer and the organ involved, if the       |
|            |     disease claimed is a listed radiogenic disease,     |
|            |     and/or                                              |
|            |                                                         |
|            | -   the medical or scientific evidence showing a causal |
|            |     relationship between the claimed disease and        |
|            |     exposure to radiation, if the disease claimed is    |
|            |     not among those listed in [38 CFR                   |
|            |     3.311(b)(2)](http://w                               |
|            | ww.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC). |
+------------+---------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #####    | > When requesting verification from DTRA of exposure to   |
|  b. Requ | > ionizing radiation as a result of participation in the  |
| esting V | > American occupation of Hiroshima or Nagasaki, Japan,    |
| erificat | > prior to July 1, 1946, send a letter to DTRA that       |
| ion of P | > provides the following information:                     |
| articipa |                                                           |
| tion in  | -   the organization or unit (ship, task group, company   |
| the Amer |     or squadron) and rank at the time of exposure         |
| ican Occ |                                                           |
| upation  | -   the duty place and organizational unit from which the |
| of Hiros |     veteran may have been detailed, and                   |
| hima or  |                                                           |
| Nagasaki | -   the activities and length of time at ground zero      |
|          |     (hypocenter).                                         |
|          |                                                           |
|          | > The letter to DTRA should include a description from    |
|          | > the claimant and from the service records of activities |
|          | > performed during the entire period of exposure          |
|          | > including                                               |
|          |                                                           |
|          | -   whether or not the veteran went ashore                |
|          |                                                           |
|          | -   the length of time spent ashore, and                  |
|          |                                                           |
|          | -   the activities performed while ashore.                |
+----------+-----------------------------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| b\.      | > For former POWs, also provide DTRA with the following   |
| Re       | > information:                                            |
| questing |                                                           |
| Veri     | -   the dates of confinement                              |
| fication |                                                           |
| of       | -   the places of confinement                             |
| Parti    |                                                           |
| cipation | -   the date and place of liberation                      |
| in the   |                                                           |
| American | -   the date and method of departure from Japan, and      |
| Oc       |                                                           |
| cupation | -   the method of travel within Japan, since the method   |
| of       |     of travel, such as a specific train over a specific   |
| H        |     route, can provide critical information in confirming |
| iroshima |     participation.                                        |
| or       |                                                           |
| Nagasaki | > The letter to DTRA should also                          |
| (co      |                                                           |
| ntinued) | -   specify the disease being claimed (***Note***: If     |
|          |     skin cancer is claimed, specify the site of each      |
|          |     lesion, type of cancer, and date of diagnosis.), and  |
|          |                                                           |
|          | -   include                                               |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   available pathology reports that identify the type of |
|          |     cancer and the organ involved, if the disease claimed |
|          |     is a listed radiogenic disease, and/or                |
|          |                                                           |
|          | -   the medical or scientific evidence showing a causal   |
|          |     relationship between the claimed disease and exposure |
|          |     to radiation, if the disease is not among those       |
|          |     listed under [38 CFR                                  |
|          |     3.311(b)(2)](http:/                                   |
|          | /www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC). |
+----------+-----------------------------------------------------------+

+-----------------------------------------------------------------------+
| > ***Important***: Information on the activities performed and the    |
| > amount of time spent at ground zero is critical in obtaining an     |
| > accurate dose estimate. Recognition of an area can be critical in   |
| > determining and verifying participation.                            |
+-----------------------------------------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| #####    | > *PL 103-446* allows for a presumption of service        |
| c. Reque | > connection for the same radiogenic diseases, regardless |
| sting Ve | > of whether the veteran participated in U.S or non-U.S.  |
| rificati | > nuclear tests.                                          |
| on of In | >                                                         |
| volvemen | > Use the table below to obtain verification of a         |
| t in Non | > veteran's involvement in non-U.S. nuclear bomb tests.   |
| -U.S. Nu |                                                           |
| clear Bo |                                                           |
| mb Tests |                                                           |
+----------+-----------------------------------------------------------+

+------------------------------------------+---------------------------+
| If requesting radiation dose information | Then contact ...          |
| for ...                                  |                           |
+------------------------------------------+---------------------------+
| non-U.S. test participants involved in   | > ***Address***:          |
| flight missions                          | >                         |
|                                          | > HQAFTAC                 |
|                                          | >                         |
|                                          | > ATTN: IGO               |
|                                          | >                         |
|                                          | > 1030 South Highway A1A  |
|                                          | >                         |
|                                          | > Patrick AFB, FL         |
|                                          | > 32925-3002              |
|                                          | >                         |
|                                          | > ***Telephone***: (321)  |
|                                          | > 494-6867                |
|                                          |                           |
|                                          | ***Fax***: (407) 494-2319 |
+------------------------------------------+---------------------------+
| all other non-U.S. test participants     | > the appropriate Service |
|                                          | > points of contact       |
|                                          | > identified in [M21-1MR, |
|                                          | > Part IV, Subpart ii,    |
|                                          | >                         |
|                                          | 1.C.9.e](http://vbaw.vba. |
|                                          | va.gov/bl/21/M21-1MR/pt04 |
|                                          | /sp02/ch01/pt04_sp02_ch01 |
|                                          | _secC.xml#IV.ii.1.C.9.e). |
+------------------------------------------+---------------------------+

  -----------------------------------------------------------------------
  ***Important***: DTRA is *not* responsible responding to requests
  involving non-U.S. test participants and will return these requests to
  the RO.

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

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| ##### d  | > For a claim based on exposure to ionizing radiation by  |
| . Reques | > reason of the nature of military duties, such as a      |
| ting Ver | > radiologist or an x-ray technician, prepare a separate  |
| ificatio | > Personnel Information Exchange System (PIES) request to |
| n of Exp | > obtain a copy of the record of occupational exposure to |
| osure to | > ionizing radiation from the                             |
|  Ionizin |                                                           |
| g Radiat | -   Military Personnel Record Jacket (MPRJ)               |
| ion by R |                                                           |
| eason of | -   service treatment records (STRs), or                  |
|  Militar |                                                           |
| y Duties | -   any other record that contains radiation exposure     |
|          |     information.                                          |
|          |                                                           |
|          | > ***Notes***:                                            |
|          |                                                           |
|          | -   The record of occupational exposure to ionizing       |
|          |     radiation used by the service departments include     |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   DD Form 1141, Record of Occupational Exposure to      |
|          |     Ionizing Radiation                                    |
|          |                                                           |
|          | -   NAVMED 6470/10 and NAVMED 6470/11 for the Navy, and   |
|          |                                                           |
|          | -   the equivalent *NRC Form 5*.                          |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   Refer a request for information on human radiation    |
|          |     experiments to the appropriate Service point of       |
|          |     contact identified in [M21-1MR, Part IV, Subpart ii,  |
|          |     1.C.9.e](../pt04_sp02_ch01_secC.xml#IV.ii.1.C.9.e).   |
+----------+-----------------------------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| #####    | > Each branch of service maintains a record of its        |
| e. Obtai | > service members' occupational exposure to radiation. If |
| ning Rec | > evidence of occupational radiation exposure, such as a  |
| ords of  | > *DD Form 1141, NAVMED 6470/10*, *NAVMED 6470/11,* or    |
| Occupati | > *NRC Form 5,* cannot be found in the veteran's records  |
| onal Exp | > or obtained through PIES, prepare a written request for |
| osure to | > the record. Include the identifying data as required by |
|  Radiati | > [M21-1MR, Part IV, Subpart ii,                          |
| on From  | > 1.C.10.b](http://vbaw.vba.va.gov/bl/21/M21-1            |
| the Vete | MR/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.10.b) |
| ran's Se | > in the request and send it to the appropriate service   |
| rvice De | > department.                                             |
| partment | >                                                         |
|          | > The table below lists the addresses and telephone       |
| #####    | > numbers to use to obtain records of occupational        |
|          | > exposure to radiation from each branch of service.      |
+----------+-----------------------------------------------------------+

+------------------------------+---------------------------------------+
| Branch of Service            | Address and Telephone Number          |
+------------------------------+---------------------------------------+
| Air Force                    | ***Address***:                        |
|                              |                                       |
|                              | AFMOA/SGPR\                           |
|                              | Radiation Protection Division\        |
|                              | 110 Luke Avenue, Room 405\            |
|                              | Bolling Air Force Base\               |
|                              | Washington, DC   20032-7050           |
|                              |                                       |
|                              | ***Telephone***: (202) 767-4308       |
+------------------------------+---------------------------------------+
| Army                         | ***Address***:                        |
|                              |                                       |
|                              | Director                              |
|                              |                                       |
|                              | Proponency Office for Preventive      |
|                              | Medicine - San Antonio                |
|                              |                                       |
|                              | 2050 Worth Road, Suite 25             |
|                              |                                       |
|                              | Ft. Sam Houston, Texas 78234-6025     |
|                              |                                       |
|                              | ***Telephone***:                      |
|                              |                                       |
|                              | -   \(210\) 221-6612, and             |
|                              |                                       |
|                              | -   \(210\) 221-6613.                 |
+------------------------------+---------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

  -----------------------------------------------------------------------
  e\. Obtaining Records of Occupational Exposure to Radiation From the
  Veteran's Service Department (continued)

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

+------------------------------+---------------------------------------+
| Branch of Service            | Address and Telephone Number          |
+------------------------------+---------------------------------------+
| Navy and Marine Corps        | ***Address***:                        |
|                              |                                       |
|                              | Officer in Charge                     |
|                              |                                       |
|                              | Navy Environmental Health Center      |
|                              | Detachment                            |
|                              |                                       |
|                              | Naval Dosimetry Center                |
|                              |                                       |
|                              | Bethesda, MD 20889-5614               |
|                              |                                       |
|                              | ***Telephone***: (301) 295-5426       |
+------------------------------+---------------------------------------+
| Coast Guard                  | ***Address***:                        |
|                              |                                       |
|                              | Commandant                            |
|                              |                                       |
|                              | U.S. Coast Guard (CG-1133)            |
|                              |                                       |
|                              | ATTN: Occupational Health Physician   |
|                              |                                       |
|                              | 2100 Second Street, SW                |
|                              |                                       |
|                              | Washington, DC 20593-0001             |
|                              |                                       |
|                              | ***Telephone***: (202) 267-1883       |
+------------------------------+---------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| #####    | There are instances where military personnel were         |
|  f. Obta | assigned to the Atomic Energy Commission (AEC)            |
| ining Re | laboratories during the testing period and badged by the  |
| cords of | AEC facility.                                             |
|  Occupat |                                                           |
| ional Ex | > Include a search of the Department of Energy central    |
| posure t | > records repository as a part of a comprehensive search  |
| o Radiat | > for records of occupational exposure to radiation. Send |
| ion From | > requests for such a search to the following address:    |
|  the AEC | >                                                         |
|          | > ***Address for records from 1945 through present        |
|          | > only***:                                                |
|          | >                                                         |
|          | > U.S. Department of Energy                               |
|          | >                                                         |
|          | > c/o Bechtel Nevada                                      |
|          | >                                                         |
|          | > Coordination and Information Center                     |
|          | >                                                         |
|          | > 2621 Losee Road                                         |
|          | >                                                         |
|          | > North Las Vegas, NV 89030-4134                          |
|          | >                                                         |
|          | > ***Telephone***: (702) 295-0748/0714                    |
|          | >                                                         |
|          | > ***Address for records from 1987 to present***:         |
|          | >                                                         |
|          | > U.S. Department of Energy                               |
|          | >                                                         |
|          | > EH-32                                                   |
|          | >                                                         |
|          | > ATTN: Nimi Rao                                          |
|          | >                                                         |
|          | > 19901 Germantown Road                                   |
|          | >                                                         |
|          | > Germantown, MD 20874                                    |
|          | >                                                         |
|          | > ***Telephone***: (301) 903-2297                         |
+----------+-----------------------------------------------------------+

Continued on next page

9\. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311,
Continued

+----------+-----------------------------------------------------------+
| ##### g  | > Adjudicate claims for service connection based on       |
| . Develo | > in-service treatment involving nasopharyngeal radium    |
| ping Cla | > irradiation therapy (NRI) under the provisions of [38   |
| ims for  | > CFR                                                     |
| Service  | > 3.311](http:                                            |
| Connecti | //www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
| on Based | > with dose estimates prepared by the Under Secretary for |
|  on NRI  | > Health.                                                 |
|          | >                                                         |
|          | > Review STRs, clinical records, and dental records for   |
|          | > any annotation of radium therapy.                       |
|          | >                                                         |
|          | > Request STRs that are not already on file. In addition, |
|          | > request information concerning radiation exposure from  |
|          | > standard sources, and the following data from the       |
|          | > veteran:                                                |
|          |                                                           |
|          | -   the date the NRI treatment was administered, and      |
|          |                                                           |
|          | -   the place where the NRI treatment was administered,   |
|          |     including the specific base and medical facility.     |
|          |                                                           |
|          | > ***Note***: Even when STRs do verify NRI treatments,    |
|          | > they may not contain detailed records of radiation      |
|          | > doses during treatment. Forward the claim to            |
|          | > Compensation and Pension (C&P) Service, Policy Staff    |
|          | > (211) if NRI treatment is verified but dose information |
|          | > is not present. C&P Service will determine whether a    |
|          | > dose estimate may be provided by the Veterans Health    |
|          | > Administration (VHA).                                   |
|          | >                                                         |
|          | > ***Reference***: For more information on NRI therapy,   |
|          | > see the VA Fact Sheet, *[Nasopharyngeal Radium          |
|          | > Therapy](                                               |
|          | http://vbaw.vba.va.gov/bl/21/Rating/Medical/RADIUM.HTM),* |
|          | > dated September 1997.                                   |
+----------+-----------------------------------------------------------+

#### 10. Obtaining Dosimetry Information

+----------+-----------------------------------------------------------+
| ##       | > This topic contains information on obtaining dosimetry  |
| ### Intr | > information. It includes information on                 |
| oduction |                                                           |
|          | -   the initial notification of C&P service               |
|          |                                                           |
|          | -   the information to include in the initial request to  |
|          |     C&P Service                                           |
|          |                                                           |
|          | -   obtaining dosimetry information from DTRA             |
|          |                                                           |
|          | -   obtaining dosimetry information for individuals       |
|          |     outside the scope of DTRA's Nuclear Test Personnel    |
|          |     Review (NTPR) program                                 |
|          |                                                           |
|          | -   the information to include in the letter to the       |
|          |     Service Department requesting dosimetry information   |
|          |                                                           |
|          | -   handling claims based on radiation exposure in or     |
|          |     around Camp Hanford, Washington                       |
|          |                                                           |
|          | -   the definitions of ***not exposed*** and ***zero      |
|          |     dose***, and                                          |
|          |                                                           |
|          | -   handling dose estimates                               |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   submitted on behalf of the claimant, and              |
|          |                                                           |
|          | -   of "not exposed" or "zero."                           |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #        | > September 5, 2008                                       |
| #### Cha |                                                           |
| nge Date |                                                           |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| ####     | > Call C&P Service, Policy Staff (211), at (202) 273-7210 |
| # a. Ini | > if                                                      |
| tial Not |                                                           |
| ificatio | -   the requirements under [38 CFR                        |
| n of C&P |     3.311(b)](http:                                       |
|  Service | //www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|          |     have been met, and                                    |
|          |                                                           |
|          | -   either                                                |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   the development specified in [M21-1MR, Part IV,       |
|          |     Subpart ii,                                           |
|          |     1.C.8](http://vbaw.vba.va.gov/bl/21/M2                |
|          | 1-1MR/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.8) |
|          |     has been completed, or                                |
|          |                                                           |
|          | -   there is evidence sufficient to establish the veteran |
|          |     was exposed to radiation during service.              |
|          |                                                           |
|          | > ***Note***: After receiving C&P Service approval,       |
|          | > request a reconstructed radiation dose from DTRA.       |
|          | >                                                         |
|          | > ***Reference***: For information on obtaining dosimetry |
|          | > estimates from DTRA, see [M21-1MR, Part IV, Subpart ii, |
|          | > 1.C.10.c](http://vbaw.vba.va.gov/bl/21/M21-1M           |
|          | R/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.10.c). |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #####    | > Include the following information in the initial        |
|  b. Info | > request to C&P Service:                                 |
| rmation  |                                                           |
| to Inclu | -   the veteran's name and VA claim number                |
| de in th |                                                           |
| e Initia | -   the nature of the disability, and                     |
| l Reques |                                                           |
| t to C&P | -   the location of radiation exposure, such as           |
|  Service |     atmospheric nuclear weapons test, Hiroshima/Nagasaki, |
|          |     and so forth.                                         |
+----------+-----------------------------------------------------------+

Continued on next page

10\. Obtaining Dosimetry Information, Continued

+----------+-----------------------------------------------------------+
| #####    | > For claims involving U.S. atmospheric nuclear weapons   |
|  c. Obta | > tests, occupation of Hiroshima or Nagasaki, or POW      |
| ining Do | > interment in Japan, send a request for dosimetry        |
| simetry  | > information to the                                      |
| Informat | >                                                         |
| ion From | > Defense Threat Reduction Agency (DTRA)                  |
|  DTRA fo | >                                                         |
| r Atmosp | > Attn: TDND/NTPR                                         |
| heric Te | >                                                         |
| sts, Hir | > 8725 John J. Kingman Rd., Mail Stop 6201                |
| oshima o | >                                                         |
| r Nagasa | > Ft. Belvoir, VA 22060-6201                              |
| ki Occup | >                                                         |
| ation, o | > The letter to DTRA must contain the following           |
| r POW In | > information:                                            |
| terment  |                                                           |
| in Japan | -   the applicable regulation ([38 CFR                    |
|          |     3.309(d)](http:                                       |
|          | //www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC) |
|          |     or [38 CFR                                            |
|          |     3.311](http:/                                         |
|          | /www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC)) |
|          |                                                           |
|          | -   VA claim number                                       |
|          |                                                           |
|          | -   veteran's and claimant's names, addresses, and        |
|          |     telephone numbers                                     |
|          |                                                           |
|          | -   veteran's branch of service, service number, and      |
|          |     Social Security number                                |
|          |                                                           |
|          | -   specific organization or unit of assignment at the    |
|          |     time of exposure                                      |
|          |                                                           |
|          | -   dates of assignment to nuclear test site or           |
|          |     Hiroshima/Nagasaki                                    |
|          |                                                           |
|          | -   full description of duties and activities while a     |
|          |     participant in a radiation-risk activity, and         |
|          |                                                           |
|          | -   specific disease being claimed (***Note***: Specify   |
|          |     the type of cancer and the organ involved. If skin    |
|          |     cancer is claimed, also specify the site of each      |
|          |     lesion and date of diagnosis.)                        |
|          |                                                           |
|          | > The letter must include a copy of                       |
|          |                                                           |
|          | -   the claimant's response to the request for            |
|          |     information about the veteran's exposure to ionizing  |
|          |     radiation                                             |
|          |                                                           |
|          | -   the veteran's statement(s) about the nature of        |
|          |     his/her exposure to radiation                         |
|          |                                                           |
|          | -   any military documents supporting participation in a  |
|          |     radiation-risk activity, such as a *DD Form 214* or   |
|          |     military orders                                       |
|          |                                                           |
|          | -   the medical or scientific evidence showing a causal   |
|          |     relationship between the claimed disease and exposure |
|          |     to radiation, if the disease is not among those       |
|          |     listed under [38 CFR                                  |
|          |     3.311(b)(2)](http:/                                   |
|          | /www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|          |     and                                                   |
|          |                                                           |
|          | -   the Board of Veterans' Appeals (BVA) remand, if       |
|          |     applicable.                                           |
|          |                                                           |
|          | > ***Note***: DTRA only provides confirmation of          |
|          | > participation and radiation doses for individuals       |
|          | > involved in U.S. atmospheric nuclear testing (1945 to   |
|          | > 1960) and the occupation forces of Hiroshima/Nagasaki.  |
|          | >                                                         |
|          | > ***Reference***: For information on obtaining dosimetry |
|          | > information in cases not handled by DTRA, see [M21-1MR, |
|          | > Part IV, Subpart ii,                                    |
|          | > 1.C.10.d](http://vbaw.vba.va.gov/bl/21/M21-1M           |
|          | R/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.10.d). |
+----------+-----------------------------------------------------------+

Continued on next page

10\. Obtaining Dosimetry Information, Continued

+----------+-----------------------------------------------------------+
| #        | > For individuals outside the scope of DTRA's NTPR        |
| #### d.  | > program, such as x-ray technicians, reactor plant       |
| Obtainin | > workers, and workers in nuclear medicine, radar, and    |
| g Dosime | > radiography                                             |
| try Info |                                                           |
| rmation  | -   send a letter requesting dosimetry information to the |
| for Indi |     appropriate Service Department point of contact       |
| viduals  |     listed in [M21-1MR, Part IV, Subpart ii,              |
| Outside  |     1.C.9.e](http://vbaw.vba.va.gov/bl/21/M21-1           |
| the Scop | MR/pt04/sp02/ch01/pt04_sp02_ch01_secC.xml#IV.ii.1.C.9.e), |
| e of DTR |     and                                                   |
| A's NTPR |                                                           |
|  Program | -   forward all dosimetry records to C&P Service, Policy  |
|          |     Staff (211), for referral to the Under Secretary for  |
|          |     Health, who is responsible for preparation of a dose  |
|          |     estimate, to the extent feasible, based on available  |
|          |     methodologies.                                        |
|          |                                                           |
|          | > ***Note***: The claims folder should be forwarded to    |
|          | > C&P Service, Policy Staff (211), for review if          |
|          |                                                           |
|          | -   the claim alleges exposure to radiation from medical  |
|          |     diagnostic procedures or during medical treatment,    |
|          |     and                                                   |
|          |                                                           |
|          | -   the veteran's STRs support this exposure.             |
|          |                                                           |
|          | > ***Reference***: For information on what to include in  |
|          | > the letter to the Service point of contact, see         |
|          | > [M21-1MR, Part IV, Subpart ii,                          |
|          | > 1.C.10.e](../pt04_sp02_ch01_secC.xml#IV.ii.1.C.10.e).   |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #        | > The letter to the Service Department point of contact   |
| #### e.  | > requesting dosimetry information should include the     |
| Informat | > following:                                              |
| ion to I |                                                           |
| nclude i | -   the location and dates of the veteran's service       |
| n the Le |                                                           |
| tter to  | -   the veteran's military unit                           |
| the Serv |                                                           |
| ice Depa | -   the veteran's Military Occupational Specialty (MOS)   |
| rtment R |                                                           |
| equestin | -   the place(s) where the veteran worked                 |
| g Dosime |                                                           |
| try Info | -   a list of radioactive materials the veteran worked    |
| rmation  |     with (source, strength, and type)                     |
|          |                                                           |
|          | -   the number of hours per day the veteran spent working |
|          |     with radioactive materials and the number of days,    |
|          |     weeks, or months of the assignment the veteran worked |
|          |     with radioactive sources, and                         |
|          |                                                           |
|          | -   the number of hours per day the veteran spent working |
|          |     with radiation-producing devices and the number days, |
|          |     weeks, or months of the assignment the veteran worked |
|          |     with radiation-producing devices.                     |
|          |                                                           |
|          | > The letter should also enclose a copy of any available  |
|          |                                                           |
|          | -   training records associated with radiation training   |
|          |                                                           |
|          | -   radiation dose records provided by the veteran, and   |
|          |                                                           |
|          | -   medical records showing treatment for any             |
|          |     occupational radiation injuries or other records      |
|          |     documenting radiation exposure.                       |
+----------+-----------------------------------------------------------+

Continued on next page

10\. Obtaining Dosimetry Information, Continued

+----------+-----------------------------------------------------------+
| ##       | > Use the table below to determine how to handle claims   |
| ### f. H | > based on radiation exposure in or around Camp Hanford,  |
| andling  | > Washington.                                             |
| Claims B |                                                           |
| ased on  |                                                           |
| Radiatio |                                                           |
| n Exposu |                                                           |
| re in or |                                                           |
|  Around  |                                                           |
| Camp Han |                                                           |
| ford, Wa |                                                           |
| shington |                                                           |
+----------+-----------------------------------------------------------+

+------------------+---------------------------------------------------+
| Step             | Action                                            |
+------------------+---------------------------------------------------+
| 1                | Obtain the veteran's STRs and service personnel   |
|                  | records.                                          |
+------------------+---------------------------------------------------+
| 2                | Review the service records to                     |
|                  |                                                   |
|                  | -   confirm the veteran's presence in or around   |
|                  |     Camp Hanford                                  |
|                  |                                                   |
|                  | -   determine the duration of this duty           |
|                  |     assignment, and                               |
|                  |                                                   |
|                  | -   ascertain whether a *DD Form 1141* or other   |
|                  |     official record of radiation exposure is      |
|                  |     available.                                    |
+------------------+---------------------------------------------------+
| 3                | Forward the claims folder to C&P Service, Policy  |
|                  | Staff (211), for review when                      |
|                  |                                                   |
|                  | -   the veteran's presence in or around Camp      |
|                  |     Hanford is confirmed, and                     |
|                  |                                                   |
|                  | -   attempts to obtain information about the      |
|                  |     veteran's exposure to radiation, whether      |
|                  |     successful or unsuccessful, have been made    |
|                  |     and documented in the claims folder.          |
+------------------+---------------------------------------------------+

Continued on next page

10\. Obtaining Dosimetry Information, Continued

+----------+-----------------------------------------------------------+
| ##### g. | > ***Not*** ***exposed*** means                           |
|  Definit |                                                           |
| ion: Not | -   there was no potential for exposure to radiation, and |
|  Exposed |                                                           |
|          | -   the veteran did not enter a radiological environment. |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #####    | > ***Zero*** ***dose*** means there was *potential* for   |
| h. Defin | > exposure to radiation, but the dose received was zero.  |
| ition: Z |                                                           |
| ero Dose |                                                           |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| ##### i  | > If the dose estimate received from DTRA is "not         |
| . Handli | > exposed" or "zero," then do *not* submit the case to    |
| ng Dose  | > C&P Service.                                            |
| Estimate | >                                                         |
| s of Not | > Refer these claims to the RO rating activity for a      |
|  Exposed | > decision on the issue of service connection for         |
|  or Zero | > residuals of radiation exposure.                        |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| ####     | > Under [38 CFR                                           |
| # j. Han | > 3.311(a)(3)](http:/                                     |
| dling Do | /www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
| se Estim | > if a dose estimate is submitted on behalf of the        |
| ates Sub | > claimant, the rating activity must review the estimate  |
| mitted o | > to determine whether it is                              |
| n Behalf |                                                           |
|  of the  | -   from a credible source, and                           |
| Claimant |                                                           |
|          | -   at least double the dose provided by official         |
|          |     military records.                                     |
|          |                                                           |
|          | > If both these criteria are met, the claims folder       |
|          | > should be submitted to C&P Service, Policy Staff (211), |
|          | > for review.                                             |
+----------+-----------------------------------------------------------+

#### 11. Referring Claims to Compensation and Pension (C&P) Service, Policy Staff (211)

+----------+-----------------------------------------------------------+
| ##       | > This topic contains information on referring claims to  |
| ### Intr | > Compensation and Pension (C&P) Service, Policy Staff    |
| oduction | > (211). It includes information on                       |
|          |                                                           |
|          | -   consideration of the claim by the rating activity     |
|          |                                                           |
|          | -   the process for referring claims to C&P Service, and  |
|          |                                                           |
|          | -   the information to include in the cover letter of a   |
|          |     referral to C&P Service.                              |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| #        | > September 5, 2008                                       |
| #### Cha |                                                           |
| nge Date |                                                           |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| ##       | > If the rating activity determines that at least one of  |
| ### a. C | > the requirements of [38 CFR                             |
| onsidera | > 3.311(b)(1)](http:                                      |
| tion of  | //www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
| the Clai | > is *not* met, deny the claim by a formal rating         |
| m by the | > decision on the grounds that the disease did not result |
|  Rating  | > from exposure to ionizing radiation. Do *not* refer     |
| Activity | > such cases to C&P Service unless all of the             |
|          | > requirements are met.                                   |
|          | >                                                         |
|          | > The rating activity sends claims to C&P Service, Policy |
|          | > Staff (211), for additional development *if* the        |
|          |                                                           |
|          | -   three requirements under [38 CFR                      |
|          |     3.311(b)(1)](http:                                    |
|          | //www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC) |
|          |     are met, and                                          |
|          |                                                           |
|          | -   development under this section, M21-1MR, Part IV,     |
|          |     Subpart ii, 1.C, is complete.                         |
+----------+-----------------------------------------------------------+

Continued on next page

11\. Referring Claims to Compensation and Pension (C&P) Service, Policy
Staff (211), Continued

+----------+-----------------------------------------------------------+
| ####     | > The table below describes the process for referring a   |
| # b. Pro | > claim based on exposure to ionizing radiation to C&P    |
| cess for | > Service, Policy Staff (211).                            |
|  Referri |                                                           |
| ng Claim |                                                           |
| s to C&P |                                                           |
|  Service |                                                           |
+----------+-----------------------------------------------------------+

+----+-----------+--------------------------------+-------------------+
| S  | Who Is    | Description                    | References        |
| ta | Re        |                                |                   |
| ge | sponsible |                                |                   |
+----+-----------+--------------------------------+-------------------+
| 1  | RO        | -   Refers the claim to C&P    | For information   |
|    |           |     Service, Policy Staff      | on what to        |
|    |           |     (211), for review once     | include in the    |
|    |           |                                | cover letter for  |
|    |           | ```{=html}                     | a referral, see   |
|    |           | <!-- -->                       | [M21-1MR, Part    |
|    |           | ```                            | IV, Subpart ii,   |
|    |           | -   the three requirements of  | 1.C.11.c](http:// |
|    |           |     the initial review have    | vbaw.vba.va.gov/b |
|    |           |     been satisfied, and        | l/21/M21-1MR/pt04 |
|    |           |                                | /sp02/ch01/pt04_s |
|    |           | -   development has been       | p02_ch01_secC.xml |
|    |           |     completed, including       | #IV.ii.1.C.11.c). |
|    |           |     receipt of a response from |                   |
|    |           |     the Department of Defense  |                   |
|    |           |     (DoD) regarding exposure   |                   |
|    |           |     to radiation, and          |                   |
|    |           |                                |                   |
|    |           | ```{=html}                     |                   |
|    |           | <!-- -->                       |                   |
|    |           | ```                            |                   |
|    |           | -   notifies the claimant of   |                   |
|    |           |     the referral to Central    |                   |
|    |           |     Office (CO).               |                   |
+----+-----------+--------------------------------+-------------------+
| 2  | C&P       | -   Reviews the claim          | For more          |
|    | Service   |                                | information on    |
|    |           | -   requests a medical opinion | referrals by the  |
|    |           |     from the Under Secretary   | C&P Service,      |
|    |           |     for Health, and/or refers  | Policy Staff      |
|    |           |     the claim to an outside    | (211), to         |
|    |           |     consultant if necessary,   |                   |
|    |           |     and                        | -   the Under     |
|    |           |                                |     Secretary for |
|    |           | -   notifies the RO and the    |     Health, see   |
|    |           |     claimant if a referral is  |     [38 CFR       |
|    |           |     made to the Under          |     3.311         |
|    |           |     Secretary for Health.      | (c)](http://www.w |
|    |           |                                | arms.vba.va.gov/r |
|    |           |                                | egs/38CFR/BOOKB/P |
|    |           |                                | ART3/S3_311.DOC), |
|    |           |                                |     and           |
|    |           |                                |                   |
|    |           |                                | -   an outside    |
|    |           |                                |     consultant,   |
|    |           |                                |     see [38 CFR   |
|    |           |                                |     3.311         |
|    |           |                                | (d)](http://www.w |
|    |           |                                | arms.vba.va.gov/r |
|    |           |                                | egs/38CFR/BOOKB/P |
|    |           |                                | ART3/S3_311.DOC). |
+----+-----------+--------------------------------+-------------------+
| 3  | C&P       | Provides the RO with           | \-\--             |
|    | Service   |                                |                   |
|    |           | -   an opinion recommending    |                   |
|    |           |     either a grant or denial   |                   |
|    |           |     of the claim, and          |                   |
|    |           |                                |                   |
|    |           | -   the written response of    |                   |
|    |           |     both the VHA and/or        |                   |
|    |           |     outside consultant (if     |                   |
|    |           |     solicited).                |                   |
+----+-----------+--------------------------------+-------------------+

Continued on next page

11\. Referring Claims to Compensation and Pension (C&P) Service, Policy
Staff (211), Continued

+----------+-----------------------------------------------------------+
| ##### c. | > Include a cover letter briefly summarizing the          |
|  Informa | > following information when referring a claim based on   |
| tion to  | > exposure to ionizing radiation to C&P Service, Policy   |
| Include  | > Staff (211):                                            |
| in the C |                                                           |
| over Let | -   pertinent service information                         |
| ter of a |                                                           |
|  Referra | -   circumstances surrounding the exposure, including     |
| l to C&P |     dates of the exposure                                 |
|  Service |                                                           |
|          | -   a description of the claimed disease, including the   |
|          |     specific cell type and stage, if known                |
|          |                                                           |
|          | -   the date the claimed disease first manifested and the |
|          |     time lapse between exposure and the onset of the      |
|          |     disease                                               |
|          |                                                           |
|          | -   the veteran's                                         |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   age at the time of exposure                           |
|          |                                                           |
|          | -   gender                                                |
|          |                                                           |
|          | -   relevant family medical history, and                  |
|          |                                                           |
|          | -   employment history                                    |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   the dose assessment, as specified in [38 CFR          |
|          |     3.311(a)(2)(iii)](http:/                              |
|          | /www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC), |
|          |     given by                                              |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   DTRA, or                                              |
|          |                                                           |
|          | -   the applicable service department                     |
|          |                                                           |
|          | ```{=html}                                                |
|          | <!-- -->                                                  |
|          | ```                                                       |
|          | -   the veteran's history of exposure to known            |
|          |     carcinogens or radiation before and after service,    |
|          |     including smoking history and, if claiming skin       |
|          |     cancer, exposure to the sun, and                      |
|          |                                                           |
|          | -   any other information relevant to determining the     |
|          |     cause of the disease.                                 |
|          |                                                           |
|          | > ***Note***: The letter should include a copy of all     |
|          | > available pathology reports that identify the type of   |
|          | > cancer and the organ involved.                          |
+----------+-----------------------------------------------------------+

#### 12. Exhibit 1: Exposure to Nuclear Radiation and Department of Defense (DoD) Secrecy Agreement

+----------+-----------------------------------------------------------+
| #        | > September 5, 2008                                       |
| #### Cha |                                                           |
| nge Date |                                                           |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| ##### a. | > The *Exposure to Nuclear Radiation and DoD Secrecy      |
|  Exposur | > Agreement* is below.                                    |
| e to Nuc |                                                           |
| lear Rad |                                                           |
| iation a |                                                           |
| nd DoD S |                                                           |
| ecrecy A |                                                           |
| greement |                                                           |
+----------+-----------------------------------------------------------+

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