h. Considering SC for Disabilities Claimed to Result From Exposure to Asbestos During Service When deciding a claim for SC for a disability claimed to result from exposure to asbestos during service, the rating activity should determine whether or not service records demonstrate the Veteran was exposed to asbestos during service ensure that development is accomplished to determine whether or not the Veteran was exposed to asbestos either before or after service, and determine whether or not a relationship exists between exposure to asbestos and the claimed disease, keeping in mind latency and exposure factors. Notes: As always, resolve reasonable doubt in the claimant’s favor. If assistance in deciding a case is needed, contact the Compensation Service Policy Staff (211). References: For more information on development procedures to be performed in claims based on asbestos exposure, see M21-1, Part IV, Subpart ii, 1.I.3, and need for a medical nexus to service in asbestos-related claims, see , and requesting assistance from Compensation Service, see M21-1, Part III, Subpart vi, 1.A. i. Determining the DC When Rating Disabilities Caused by Exposure to Asbestos Use the information to determine the diagnostic code (DC) to assign when rating disabilities caused by exposure to asbestos. If the condition is … Then rate … asbestosis under DC 6833. pleural effusions fibrosis, or pleural plaques analogous to asbestosis DC 6833. cancer under the DC for the appropriate body system. mesothelioma of pleura analogous to DC 6819. mesothelioma of peritoneum analogous to DC 7343. 3. SC for Disabilities Resulting From Exposure to Certain Herbicide Agents or Based on Service in the RVN
g. Determining the Last Date of Herbicide Exposure Under , the last date of herbicide exposure is the last date on which the Veteran served in the RVN during the Vietnam Era. h. Considering Direct SC When Entitlement to Presumption Does Not Exist If entitlement to presumptive SC on herbicide exposure does not exist, consider entitlement to SC on a direct, facts-found basis. Under , the presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations that allow for another basis of SC. Therefore, these provisions do not preclude direct SC, where appropriate. i. Date Disabilities Became Subject to Presumptive SC Under 38 CFR 3.309(e) The below shows the dates on which the diseases listed in became subject to presumptive SC. Disability Effective Date Chloracne or other acne-form disease consistent with chloracne, and soft-tissue sarcoma, than osteosarcoma chondrosarcoma Kaposi’s sarcoma, or mesothelioma February 6, 1991 Note: Originally, September 25, 1985, under 38 CFR 3.311a. Non-Hodgkin’s lymphoma (NHL) February 6, 1991 Note: Originally, August 5, 1964, under 38 CFR 3.313. Porphyria cutanea and Hodgkin’s disease February 3, 1994 Respiratory cancers of the lung bronchus larynx, or trachea, and multiple myeloma June 9, 1994 Prostate cancer, and acute and subacute PN November 7, 1996 Type 2 diabetes mellitus (DM) May 8, 2001 CLL October 16, 2003 AL amyloidosis May 7, 2009 Ischemic heart disease (IHD) August 31, 2010
Navy vessels that docked to the shore or pier of the RVN, traveled on inland waterways, or operated on close coastal waters for extended periods, see the Compensation Service presumption of exposure to herbicides with verified service on inland waterways, see M21-1, Part IV, Subpart ii, 1.H.2.c, and claims based on herbicide exposure due to transport, storage or use of herbicide agents on board the ship, see M21-1, Part IV, Subpart ii, 1.H.2.g-h. n. SC for NHL Under 38 CFR 3.313 Based on Service in RVN During the Vietnam Era VA regulations at provide for a presumption of SC for NHL based on service in the RVN during the Vietnam Era. Important: Exposure to herbicides is not a prerequisite for entitlement under . The claimant needs only to show service in the RVN, which includes the waters offshore. o. Subcategories of NHL Qualifying for Presumptive SC When was promulgated, the U.S. Center for Disease Control identified a number of subcategories that are manifestations of NHL. Extend the presumption of SC to a Veteran who claims SC for NHL if the Veteran had service in the RVN during the Vietnam Era, including naval service in the offshore waters of the RVN, and the medical evidence shows a diagnosis of any of the subcategories of low, intermediate, or high-grade lymphoma listed in the table below. Low Grade Lymphoma Intermediate Grade Lymphoma High Grade Lymphoma Small lymphocytic with plasmacytoid features Diffuse, small and large Diffuse, and large Small lymphocytic lymphoma and B-cell CLL Note: Small lymphocytic lymphoma and B-cell CLL are considered slightly different forms of the same disease. Diffuse, small cleaved Lymphoblastic Intermediate cell Diffuse, large cleaved Immunoblastic Follicular, mixed small and large Diffuse, large Burkitt’s Mantle zone Diffuse, --- Follicular, small cleaved Follicular, large ---
Alternate evidence includes personal statements buddy statements unit histories news articles, and other lay evidence. Concede exposure to the claimed environmental hazard if the statements provided by the Veteran and/or others are consistent with the facts, places, and circumstances of the Veteran’s service. Reference: For more information on considering evidence in claims for disability compensation, see , and . m. Considering Lay Statements in Verifying Exposure to Environmental Hazards The Veteran’s lay statement of exposure to an environmental hazard or statements provided by others can be used to verify exposure to the claimed environmental hazard if the statements provided by the Veteran and/or others are consistent with the facts, places, and circumstances of the Veteran’s service. Example: A Veteran’s lay statement of burn pit exposure, together with evidence verifying that the Veteran served in Iraq, Afghanistan, or Djibouti, generally will be sufficient to establish the occurrence of such exposure. Reference: For more information on considering lay statements, see M21-1, Part III, Subpart iv, 5.6.a. n. What to Include in VA Examination and/or Medical Opinion Requests in Environmental Hazard Claims When requesting a medical examination and/or medical opinion for a claim based on exposure to an environmental hazard listed in M21-1, Part IV, Subpart ii, 2.C.5.a, review M21-1, Part IV, Subpart ii, 1.I for guidance on what to include in the VA examination and/or medical opinion request. o. Applying the Provisions of 38 CFR 3.317 in Claims Based on Exposure to Environmental Hazards in Southwest Asia Apply the provisions of when rating claims for disabilities resulting from exposure to environmental hazards during service in Southwest Asia if the medical evidence reveals the presence of an undiagnosed illness, or a medically unexplained chronic multisymptom illness, and the medical evidence does not provide a sufficient link between this illness and the Veteran’s military service.