Introduction This topic contains information on developing claims for SC for positive tuberculin reactions, including the action to take when a positive tuberculin reaction only is claimed action to take when a positive tuberculin reaction and other disabilities are claimed, and reporting responsibilities of the Department of Veterans Affairs (VA) outpatient clinics and VA medical centers (VAMCs). Change Date October 23, 2015 a. Action to Take When a Positive Tuberculin Reaction Only Is Claimed If a claim is submitted for only a positive tuberculin reaction, refer the claim to the rating activity for a determination as to whether or not a disability is present. Reference: For more information on medical treatment for a positive tuberculin reaction, see M21-1, Part III, Subpart v, 7.A.10. b. Action to Take When a Positive Tuberculin Reaction and Other Disabilities Are Claimed If a positive tuberculin reaction is claimed together with other disabilities complete any appropriate development required for the other disabilities, and refer the claims folder to the rating activity for rating of all the claimed disabilities. c. Reporting Responsibilities of VA Outpatient Clinics and VAMCs As provided in M21-1, Part III, Subpart v, 7.A.10.c, a Department of Veterans Affairs (VA) outpatient clinic or VA medical center (VAMC) will furnish a report of the follow-up examination made at the expiration of the 12-month period of chemotherapy for discharged personnel who have had a tuberculin test conversion from negative to positive during service. If a VA outpatient clinic or VAMC report or any other evidence indicates the presence of tuberculous disease, solicit a claim for service connection (SC). Reference: For more information on soliciting claims for chronic, unclaimed disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.f. 2. Developing Claims for SC for Chronic or Tropical Diseases
j. Verification of Camp Lejeune Service If the Veteran is claiming Camp Lejeune service between 1953 and 1987, but military personnel and/or medical records or information obtained from the Veteran does not show it, request records as provided in M21-1, Part III, Subpart iii, 2.E.7.c. These records may verify Camp Lejeune service through temporary duty (TDY) orders or performance evaluations. Note: It is important to verify that the Veteran’s service at Camp Lejeune occurred during the period of water contamination, 1953 to 1987. 7. Developing Claims Based on Participation in the SHAD Project Introduction This topic contains information on developing claims based on participation in the SHAD project, including background on the SHAD Project identifying a SHAD Claim EP control of SHAD claims requesting access to the U.S. DoD and VA Chemical Biological Warfare Exposure System (Chem-Bio) Database verification of participation and SHAD Manager notification action to take upon receipt of final negative response from DOD regarding SHAD participation, and procedure when receiving confirmation of SHAD participation. Change Date August 7, 2015 a. Background on the SHAD Project From 1962 to 1974, the DoD conducted the Shipboard Hazards and Defense (SHAD) Project to identify the vulnerabilities of U.S. warships to chemical and biological warfare agents. Project SHAD encompassed tests designed to identify U.S. warships’ vulnerabilities to attacks with chemical or biological warfare agents and to develop procedures to respond to such attacks while maintaining a capability. Reference: For more information on Project SHAD, see the . b. Identifying a SHAD Claim Consider a claim to be a SHAD claim if the Veteran claims disease or injury as a result of participation in the SHAD Project. SHAD involved service members from the Navy and Marine Corps as well as a small number of
personnel from the Army and Air Force. Notes: The SHAD Project was part of a larger effort called Project 112, with tests being both ship and land-based. For VA purposes, all claims resulting from participation in ship-based or land-based chemical or biological testing under these projects are considered SHAD claims. A claim in which the Veteran clearly served outside of the dates SHAD was conducted would not be considered a SHAD claim but could be considered a Chemical-Biological (Chem-Bio) exposure claim and should be clarified with the claimant. c. EP Control of SHAD Claims In addition to the traditional rating EPs (for example, 010, 110, 020), establish an EP 683 to control SHAD claims for tracking purposes. Reference: For more information on EP control, see M21-4, Appendix B, Section II. d. Requesting Access to the U.S. DoD and VA Chem-Bio Database The U.S. DoD and VA Chemical Biological Warfare Exposure System (Chem-Bio) is a consolidated database for mustard gas, Shipboard Hazard and Defense (SHAD), and Chem-Bio participants. All ROs must maintain primary and alternate points of contact who are authorized access to DoD’s database. These POCs are responsible for conducting preliminary research regarding claimed in-service chemical and biological agent testing-related exposures. Access should be requested in advance of receipt of a claim based on exposure in order to ensure that claims processing is not unnecessarily delayed. Important: To request access to the Chem-Bio Database, send a completed DD Form 2875, System Authorization Access Request (SAAR), to the SHAD Mailbox at VAVBAWAS/CO/SHAD. e. Verification of Participation and SHAD Manager Notification Follow the steps in the table below to verify the Veteran’s participation in Project SHAD at the RO-level based on review of the exposure database for the Veteran’s name. If … Then ... the Veteran’s name appears in the Chem-Bio Database determine whether an examination and/or medical opinion is/are required to decide the claim. the Veteran’s name does not appear in the Chem-Bio Database it will be necessary to request a thorough search by DoD. To do so, a memorandum must be prepared
VAMC for Individuals Claiming Exposure as a Test Participant exposures you might have experienced more than 30 years ago, VA is offering a clinical examination to Veterans who receive this notification letter. If you have health concerns and wish to be medically evaluated, PLEASE BRING THIS LETTER WITH YOU TO THE NEAREST VA HEALTH CARE FACILITY. This letter will help you apply for the examination by providing needed documentation. Additional medical information about potential exposures is available through ‘environmental health coordinators’ located in every VA medical center. Note: The examination itself does not constitute, or provide eligibility for, enrollment in the VA health care system. If you are not already enrolled, you are encouraged to apply for VA health care benefits at the time you apply for the examination. Include notification to the Veteran to contact DoD at (800) 497-6261 for questions about chemical or biological tests conducted during military service to include concerns about releasing classified information. e. Use of the Chem-Bio Database The U.S. DoD and VA Chemical Biological Warfare Exposure System (Chem-Bio) is a consolidated database for mustard gas, SHAD, and participants. All ROs must maintain primary and alternate points of contact who are authorized access to DoD’s database. These POCs are responsible for conducting preliminary research regarding claimed in-service chemical and biological agent testing-related exposures. Access should be requested in advance of receipt of a claim based on exposure in order to ensure that claims processing is not unnecessarily delayed. Important: To request access to the Chem-Bio Database, send a completed DD Form 2875 to the CBRNE Mailbox at VAVBAWAS/CO/CBRNE. f. Procedure to Follow After Attempting to Verify Participation in CBRNE Testing Follow the steps in the table below after attempting to verify participation in CBRNE testing. Step Action 1 Veterans Service Representative (VSR) directly consults DoD’s online Chem-Bio Database (if he/she has access) or submits an inquiry through Compensation Service. The minimum information that should be provided with an inquiry to Compensation Service is listed in M21-1 Part IV, Subpart ii, 1.I.8.g.
2 Can participation be verified by CO or the VSR? If yes, order disability benefits questionnaire(s) (DBQ(s)) and medical opinions, as appropriate. If no, DoD needs to conduct a more thorough search of their records. Send copies of the Veteran’s personnel records, to include DD Form 214, to: Department of Veterans Affairs Compensation Service (211B) ATTN: Chem-Bio Manager 810 Vermont Ave, NW Washington, DC 20420 Note: If a DBQ is not available, or information is required beyond that provided in the DBQ, continue to use the traditional examination worksheets as a supplement to, or instead of, a DBQ. g. Completing the Request to Compensation Service to Verify Participation in CBRNE Testing E-mail requests for verification of participation in CBRNE testing to the CBRNE mailbox at VAVBAWAS/CO/CBRNE. In the subject heading of the e-mail, type CBRNE Test. In the body of the include Veteran’s full name VA claims folder number branch of military service SSN service number, if applicable (older DoD records contain only the eight digit service number of test participants) available test information (for example, test location, description of the test, or how exposure occurred), and the nature of the disability(ies) claimed as due to exposure to chemical or biological test agents during service. Important: Even if the claim seems implausible based on evidence in the claims folder (for example, Veteran claims exposure before or after the period of 1955 to 1975), it is DoD’s sole authority to validate whether an individual participated in any chemical or biological test. h. Where to Schedule an Examination for Claims Based on CBRNE Testing If an RO determines that an examination is needed in order to decide a CBRNE claim, the RO must submit the examination request to a VA medical facility and not to a contract examiner.
i. Information to Include in Examination or Medical Opinion Requests for Claims Based on CBRNE Testing The Veterans Health Administration (VHA) has prepared Under Secretary for Health Information Letter, 10-2006-010, Potential Health Effects Among Veterans Involved in Military Chemical Agent Experiments Conducted from 1955 to 1975, to address questions about the potential health effects to Veterans involved in the testing of warfare agents. The letter should be brought to the examiner’s attention either on the examination request or in information placed in the claims folder. When requesting an examination, also include a list of the agents, simulants, tracers, antidotes and other forms of exposure, as applicable, to which Compensation Service has verified exposure for the Veteran in the Remarks section of the examination request. When requesting a medical opinion as to whether there is a relationship between a disease or disability and participation in CBRNE testing during service, include the exposure information provided in response to the request under M21-1, Part IV, Subpart ii, 1.I.8.g on the medical opinion request. Important: When requesting an examination and/or medical opinion for claims based on CBRNE testing, ensure that the examiner is provided with the claims folder for consideration. j. Actions to Take on EP When a Response From DoD Is Received Use the table below to determine the action to take on the EP when a response from DoD is received. If ... Then ... DoD is unable to verify the Veteran’s participation in a CBRNE test cancel (PCAN) the EP 683. DoD confirms the Veteran’s participation in a CBRNE test leave the EP 683 pending until all CBRNE issues are resolved by rating decision and the Veteran is notified. 9. Exhibit 1: Fact Sheet Burn Pits in Iraq, Afghanistan, and the Horn of Africa Change Date October 23, 2015