ࡱ> CG>?@AB 9bjbjVV :<<1$$$$$$$$8%'$]* 5:55567,7Py$z]66z]z]$$554uuuz]2$5$5 uz]uu4X5^$e (-0]hlzP$7 DP u%NtU7772uR777]z]z]z]z]777777777 #: Section C. Service Connection for Disabilities Resulting From Exposure to Environmental Hazards or Service in the Republic of Vietnam (RVN)  PRIVATE INFOTYPE="OTHER" Overview In this SectionThis section contains the following topics: TopicTopic NameSee Page8Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation2-C-29Service Connection for Disabilities Resulting From Exposure to Asbestos2-C-510Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN)2-C-1011Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides2-C-3312Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards2-C-41 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation  PRIVATE INFOTYPE="OTHER"  IntroductionThis topic contains information on service connection for disabilities resulting from exposure to ionizing radiation, including the provisions of Public Law (PL) 98-542, and PL 102-86, and history of time limits for disease manifestation, and list of presumptive disabilities under 38 CFR 3.309(d). Change DateDecember 13, 2005 PRIVATE INFOTYPE="PRINCIPLE"  a. Provisions of PL 98-542 Under Public Law (PL) 98-542, the Veterans Dioxin and Radiation Exposure Compensation Standards Act, which was enacted on October 24, 1984, the following claims that were denied prior to October 24, 1984, are entitled to a de novo review: claims for service connection based upon exposure to ionizing radiation as a consequence of service with the occupation forces of Hiroshima or Nagasaki, Japan, or claims for service connection based upon exposure to ionizing radiation in connection with nuclear testing. Notes: A de novo review is a new and complete review of an issue with no deference given to the previous decision. It is not necessary for the claimant to submit new and material evidence to reopen these claims. PRIVATE INFOTYPE="PRINCIPLE"  b. Provisions of PL 102-86PL 102-86, effective August 14, 1991, extended eligibility to presumptive service connection to individuals engaged in a radiation-risk activity during active duty for training, or inactive duty training.Continued on next page  STYLEREF "Map Title" 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation, Continued  PRIVATE INFOTYPE="PRINCIPLE"  c. History of Time Limits for Disease ManifestationOriginally, in order to establish presumptive service connection, the time limit for a disease listed under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(d) to become manifest to a degree of 10 percent or more was 30 years for leukemia, and 40 years for all other diseases. Then, the presumptive period was extended to 40 years for leukemia effective August 14, 1991. Effective October 1, 1992, a time limit for manifestation is not specified or required for any disease under listed  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(d). PRIVATE INFOTYPE="PRINCIPLE"  d. List of Disabilities Under 38 CFR 3.309(d) for Which Service Connection Is PresumedThe table below lists the disabilities for which service connection is presumed based on a Veterans exposure to ionizing radiation under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(d). Public Law or Federal Register CitationPresumptive Disabilities Under 38 CFR 3.309(d) PL 100-321 effective May 1, 1988Cancer of the bile ducts breast esophagus gall bladder pancreas pharynx small intestine stomach, and thyroid leukemia, other than chronic lymphocytic leukemia lymphomas, except Hodgkins disease multiple myeloma, and primary liver cancer, except if cirrhosis or hepatitis B is indicated.Continued on next page  STYLEREF "Map Title" 8. Service Connection for Disabilities Resulting From Exposure to Ionizing Radiation, Continued  STYLEREF "Block Label" d. List of Disabilities Under 38 CFR 3.309(d) for Which Service Connection Is Presumed (continued) Public Law or Federal Register CitationPresumptive Disabilities Under 38 CFR 3.309(d)PL 102-578 effective October 1, 1992Cancer of the salivary gland, and urinary tract. Note: The term urinary tract refers to the kidneys renal pelves ureters urinary bladder, and urethra.67 FR 3612-3616 effective March 26, 2002Bronchiolo-alveolar carcinoma, and cancer of the bone brain colon lung, and ovary. 9. Service Connection for Disabilities Resulting From Exposure to Asbestos  PRIVATE INFOTYPE="OTHER"  IntroductionThis topic contains information on service connection for disabilities resulting from exposure to asbestos, including the definition of asbestos the general effects of asbestos exposure specific details on disease resulting from exposure to asbestos occupational exposure and exposure during World War II (WWII) the latent period for development of disease the diagnostic indicators of asbestosis considering service connection for exposure to asbestos during service, and rating disabilities caused by exposure to asbestos. Change DateDecember 13, 2005 PRIVATE INFOTYPE="CONCEPT"  a. Definition: Asbestos Asbestos is a fibrous form of silicate mineral of varied chemical composition and physical configuration, derived from serpentine and amphibole ore bodies. Common materials that may contain asbestos include steam pipes for heating units and boilers ceiling tiles roofing shingles wallboard fire-proofing materials, and thermal insulation. Note: Due to concerns about the safety of asbestos, the use of materials containing asbestos has declined in the United States since the 1970s.Continued on next page  STYLEREF "Map Title" 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued  PRIVATE INFOTYPE="FACT"  b. General Effects of Asbestos ExposureAsbestos fiber masses have a tendency to break easily into tiny dust particles that can float in the air, stick to clothes, and may be inhaled or swallowed. Inhalation of asbestos fibers can produce fibrosis, the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis tumors pleural effusions and fibrosis pleural plaques mesotheliomas of pleura and peritoneum cancers of the lung bronchus gastrointestinal tract larynx pharynx, and urogenital system, except the prostate. Notes: The biological actions of the various fibers differ in some respects, in that chrysotile products have their initial effects on the small airways of the lung cause asbestosis more slowly, and result in lung cancer more often, and crocidolite and amosite have more initial effects on the small blood vessels of the lung, alveolar walls, and pleura, and result more often in mesothelioma. Continued on next page  STYLEREF "Map Title" 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued  PRIVATE INFOTYPE="FACT"  c. Specific Details on Diseases Resulting From Exposure to AsbestosSpecific effects of exposure to asbestos include lung cancer that originates in the lung parenchyma rather than the bronchi, and eventually develops in about 50 percent of persons with asbestosis gastrointestinal cancer that develops in 10 percent of persons with asbestosis urogenital cancer that develops in 10 percent of persons with asbestosis, and mesothelioma that develops in 17 percent of persons with asbestosis. Important: All persons with significant asbestosis develop cor pulmonale, heart disease secondary to disease of the lung or its blood vessels, and those who do not die from cancer often die from heart failure secondary to cor pulmonale. Disease-causing exposure to asbestos may be brief, and/or indirect. Notes: Current smokers who have been exposed to asbestos exposure face an increased risk of developing bronchial cancer. Mesotheliomas are not associated with cigarette smoking. PRIVATE INFOTYPE="FACT"  d. Latent Period for Development of DiseaseThe latent period for development of disease due to exposure to asbestos ranges from 10 to 45 or more years between first exposure and development of disease. PRIVATE INFOTYPE="FACT"  e. Diagnostic Indicators of AsbestosisA clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Symptoms and signs include dyspnea on exertion end-respiratory rales over the lower lobes compensatory emphysema clubbing of the fingers at late stages, and pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods.Continued on next page  STYLEREF "Map Title" 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued  PRIVATE INFOTYPE="FACT"  f. Occupational Exposures to AsbestosSome of the major occupations involving exposure to asbestos include mining milling work in shipyards insulation work demolition of old buildings carpentry and construction manufacture and servicing of friction products, such as clutch facings and brake linings, and manufacture and installation of products, such as roofing and flooring materials asbestos cement sheet and pipe products, and military equipment. Note: Exposure to any simple type of asbestos is unusual except in mines and mills where the raw materials are produced. PRIVATE INFOTYPE="FACT"  g. Exposure to Asbestos During WWIIHigh exposure to asbestos and a high prevalence of disease have been noted in insulation and shipyard workers. During World War II (WWII), several million people employed in U.S. shipyards and U.S. Navy Veterans were exposed to chrysotile products as well as amosite and crocidolite since these varieties were used extensively in military ship construction. Important: Many of these people have only recently come to medical attention because of the potentially long latent period between first exposure and development of disease.Continued on next page  STYLEREF "Map Title" 9. Service Connection for Disabilities Resulting From Exposure to Asbestos, Continued  PRIVATE INFOTYPE="PRINCIPLE"  h. Considering Service Connection for Disabilities Resulting From Exposure to Asbestos During ServiceWhen deciding a claim for service connection for a disability resulting from exposure to asbestos 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 claimants favor. If assistance in deciding a case is needed, contact the Compensation Service Policy Staff (211). PRIVATE INFOTYPE="PRINCIPLE"  i. Rating Disabilities Caused by Exposure to AsbestosUse the information below 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 plaquesanalogous to asbestosis under DC 6833.cancerunder the DC for the appropriate body system.mesothelioma of pleuraanalogous to DC 6819.mesothelioma of peritoneumanalogous to DC 7343. 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN)  PRIVATE INFOTYPE="OTHER"  IntroductionThis topic contains information on service connection for disabilities resulting from exposure to herbicides or based on service in the Republic of Vietnam (RVN), including the definitions of a herbicide agent and service in the Republic of Vietnam (RVN) presuming exposure to a herbicide agent determining the last date of herbicide exposure the time limits for disease manifestation when to consider direct service connection the definition of acute and subacute peripheral neuropathy handling claims based on acute and subacute peripheral neuropathy and later-occurring peripheral neuropathy the date of presumptive service connection under 38 CFR 3.309(e) conditions determined to have no positive association with herbicide exposure considering claims based on service aboard ships offshore the RVN use of the U.S. Army and Joint Services Records Research Center (JSRRC) memorandum in claims of exposure from herbicides being stored or transported on the Veterans ship JSRRC memorandum Herbicide Exposure During Naval Service exposure to herbicides during service aboard the USS Ingersoll verifying herbicide exposure on a factual basis in locations other than in RVN exposure to herbicides along the demilitarized zone in Korea exposure to herbicides in Thailand during the Vietnam Era use of JSRRCs memorandum in claims based on exposure to herbicides in Thailand memorandum for the record on herbicide use Thailand storage of herbicides on Johnston Island Fact Sheet: Storage of Agent Orange on Johnston Island, and service connection for non-Hodgkins lymphoma (NHL) under 38 CFR 3.313 based on service in the RVN. subcategories of NHL qualifying for presumptive service connection. Change DateDecember 16, 2011Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  a. Definition: Herbicide AgentUnder  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307(a)(6)(i), a herbicide agent is a chemical used in support of the U.S. and allied military operations in the Republic of Vietnam (RVN) during the Vietnam Era, specifically 2,4-D 2,4,5-T and its contaminant, TCDD (dioxin) cacodylic acid, and picloram.  b. Definition: Service in the RVNFor the purposes of establishing service connection under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307(a)(6) and HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC"38 CFR 3.309(e), service in the Republic of Vietnam (RVN) means service in the RVN or its inland waterways, or service in other locations if the conditions of service involved duty or visitation in the RVN. Reference: For more information on the definition of service in the RVN, see HYPERLINK "http://www.va.gov/ogc/docs/1997/Prc27-97.doc"VAOPGCPREC 27-97. c. Presuming Exposure to a Herbicide Agent Presume that a Veteran who served on active duty in the RVN during the Vietnam Era was exposed to a herbicide agent unless there is affirmative evidence to the contrary. Note: Any exposure to herbicide agents during service in locations other than the RVN must be established on a factual basis. Reference: For more information on verifying exposure to herbicides in locations other than the RVN, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.o"M21-1MR, Part IV, Subpart ii, 2.C.10.o through r. d. Determining the Last Date of Herbicide ExposureUnder  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307(a)(6)(iii), the last date of exposure is the last date on which the Veteran served in the RVN during the Vietnam Era.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  e. Time Limits for Disease ManifestationIn order to establish presumptive service connection, the following diseases listed in  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(e) must become manifest to a degree of 10 percent or more within one year of the last date of exposure to herbicides: chloracne or other acne-form disease consistent with chloracne porphyria cutanea tarda, and acute and subacute peripheral neuropathy. Notes: There is no time limit for the other listed diseases. Previously, respiratory cancers, cancers of the lung, bronchus, larynx, and trachea had to become manifest within 30 years of last exposure. PL 107-103 eliminated this requirement effective January 1, 2002. Reference: For more information on time limits for manifestation of diseases subject to presumptive service connection, see  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307(a)(6)(ii). PRIVATE INFOTYPE="CONCEPT"  f. When to Consider Direct Service ConnectionUnder  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_303.DOC" 38 CFR 3.303(d) the requirements for presumptive service connection do not preclude consideration of direct service connection when a medical nexus (link, relationship, or association) has been provided. g. Definition: Acute and Subacute Peripheral NeuropathyAcute peripheral neuropathy and subacute peripheral neuropathy are transient peripheral neuropathies that appeared within one year of last exposure to an herbicide agent resolved within two years of the date of onset, and do not include chronic peripheral neuropathy. Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  h. Handling Claims Based on a History of Acute and Subacute Peripheral Neuropathy and Later-Occurring Peripheral NeuropathyDo not assign a zero percent evaluation based on a history of acute and subacute peripheral neuropathy that manifested within one year of the date of last exposure, and resolved within two years of the date of onset. Rationale: There can be no valid claim without proof of a present disability. Reference: For more information on what constitutes a valid claim for service connection, see HYPERLINK "http://vbaw.vba.va.gov/bl/21/Advisory/CAVCDAD.htm" \l "bmb"Brammer v. Derwinski, 3 Vet.App. 223 (1992). Claims of service connection for later occurring peripheral neuropathy should be evaluated under the ordinary standards governing direct service connection. Note: Because any acute or subacute peripheral neuropathy will, by definition, resolve within a short time after exposure do not presume any later occurring peripheral neuropathy, whether transient or chronic, to be related to the prior herbicide exposure, or previously-resolved acute or subacute peripheral neuropathy.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="FACT"  i. Date Disabilities Became Subject to Presumptive Service ConnectionThe table below shows the dates on which the diseases listed in  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(e) became subject to presumptive service connection. DisabilityEffective DateChloracne or other acne-form disease consistent with chloracne, and soft-tissue sarcoma, other than osteosarcoma chondrosarcoma Kaposis sarcoma, or mesotheliomaFebruary 6, 1991 Note: Originally, September 25, 1985, under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC" 38 CFR 3.311a.Non-Hodgkins lymphoma February 6, 1991 Note: Originally, August 5, 1964, under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_313.DOC" 38 CFR 3.313.Porphyria cutanea tarda, and Hodgkins diseaseFebruary 3, 1994Respiratory cancers, such as cancer of the lung bronchus larynx, or trachea, and multiple myelomaJune 9, 1994Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" i. Date Disabilities Became Subject to Presumptive Service Connection (continued) DisabilityEffective DateProstate cancer, and acute and subacute peripheral neuropathyNovember 7, 1996Type 2 diabetes mellitusMay 8, 2001Chronic lymphocytic leukemiaOctober 16, 2003AL amyloidosisMay 7, 2009Ischemic heart disease chronic B-cell leukemia, and Parkinsons disease.August 31, 2010 Note: Unless an earlier effective date is determined pursuant to the Nehmer stipulation, the provisions pertaining to retroactive payment under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC" 38 CFR 3.114(a) apply. Reference: For more information on the Nehmer stipulation, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.11"M21-1MR, Part IV, Subpart ii, 2.C.11.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="FACT"  j. Conditions Determined to Have No Positive Association With Herbicide ExposureUnder the Agent Orange Act of 1991, the Secretary receives from the National Academy of Science (NAS) periodic reviews and summaries of the scientific evidence concerning the association between exposure to herbicides and diseases suspected to be associated with those exposures. Based on cumulative scientific data reported by the NAS since 1993, the Secretary has determined that there is no positive association between herbicide exposure and the following conditions: bone cancers brain tumors breast cancer circulatory disorders cognitive and neuropsychiatric effects female reproductive system cancers gastrointestinal and digestive disease, other than Type 2 diabetes mellitus gastrointestinal tract tumors hepatobiliary cancers immune system disorders lipid and lipoprotein disorders nasal and nasopharyngeal cancer chronic persistent peripheral neuropathy renal cancer reproductive effects, such as abnormal sperm parameters and infertility respiratory disorders, other than certain respiratory cancers skin cancer testicular cancer, and urinary bladder cancer. Note: No positive association means that the evidence for an association does not equal or outweigh the evidence against association.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  k. Considering Claims Based on Service Aboard Ships Offshore the RVNWhen a Veteran claims exposure to herbicides during service aboard a Navy or Coast Guard ship that operated on the offshore waters of the RVN, establish exposure on a presumptive basis if evidence shows the ship docked on the shores or piers of the RVN operated temporarily on the RVN inland waterways, or operated on close coastal waters for extended periods, with evidence that crew members went ashore, or smaller vessels from the ship went ashore regularly with supplies or personnel evidence places the Veteran onboard the ship at the time the ship docked to the shore or pier or operated in inland waterways or on close coastal waters for extended periods, and the Veteran has stated that he/she went ashore when the ship docked or operated on close coastal waters for extended periods, if the evidence shows the ship docked to the shore or pier or that crew members were sent ashore when the ship operated on close coastal waters. Notes: Service aboard a ship that anchored in an open deep-water harbor, such as Da Nang, Vung Tau, or Cam Ranh Bay, along the RVN coast does not constitute inland waterway service or qualify as docking to the shore and is not sufficient to establish presumptive exposure to herbicides, unless the Veteran served as a coxswain aboard ship and reports going ashore during anchorage. Veterans who served aboard large ocean-going ships that operated on the offshore waters of the RVN are often referred to as blue water Veterans because of the blue color of the deep offshore waters. They are distinguished from brown water Veterans who served aboard smaller patrol vessels or their supply vessels that operated on the brown-colored rivers, canals, estuaries, and delta areas making up the inland waterways of the RVN. Brown water Navy and Coast Guard Veterans receive the same presumption of herbicide exposure as Veterans who served on the ground in the RVN. Reference: For more information on Navy vessels that docked to the shore or pier of the RVN or traveled on inland waterways, or operated on close coastal waters for extended periods, see the Compensation Service Intranet at  HYPERLINK "http://vbaw.vba.va.gov/bl/21/rating/VENavyShip.htm" http://vbaw.vba.va.gov/bl/21/rating/VENavyShip.htm.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  l. Use of JSRRCs Memorandum in Claims of Exposure From Herbicides Being Stored or Transported on Veterans ShipIn all cases where a Veteran claims that he/she served on a ship that stored or transported herbicides, regional offices should place a copy of the U.S. Army and Joint Services Records Research Centers (JSRRCs) memorandum shown in HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.m"M21-1MR, Part IV, Subpart ii, 2.C.10.m in the Veterans claim folder. This document will substitute for individual inquiries to the Compensation Services Agent Orange mailbox and to the JSRRC, and establish that the JSRRC has no evidence to support a claim of herbicide exposure based solely on shipboard service.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="STRUCTURE"  m. JSRRC Memorandum Herbicide Exposure During Naval ServiceBelow is the JSRRCs memorandum confirming it has no evidence to support a Veterans claim of herbicide exposure during naval service offshore the RVN. DEPARTMENT OF THE ARMY U.S. ARMY & JOINT SERVICES RECORDS RESEARCH CENTER 7701 TELEGRAPH ROAD KINGMAN BUILDING, ROOM 2C08 ALEXANDRIA, VA 22315-3828 AAHS-RDC 01 May 09 MEMORANDUM FOR RECORD SUBJECT: Joint Services Records Research Center Statement on Research Findings Regarding Navy and Coast Guard Ships During the Vietnam Era 1. In the course of its research efforts, the JSRRC has reviewed numerous official military documents, ships histories, deck logs, and other sources of information related to Navy and Coast Guard ships and the use of tactical herbicide agents, such as Agent Orange, during the Vietnam Era. 2. To date, the JSRRC has found no evidence that indicates Navy or Coast Guard ships transported tactical herbicides from the United States to the Republic of Vietnam or that ships operating off the coast of Vietnam used, stored, tested, or transported tactical herbicides. Additionally, the JSRRC cannot document or verify that a shipboard Veteran was exposed to tactical herbicides based on contact with aircraft that flew over Vietnam or equipment that was used in Vietnam. 3. Therefore, the JSRRC can provide no evidence to support a Veterans claim of exposure to tactical herbicide agents while serving aboard a Navy or Coast Guard ship during the Vietnam era. /s/ Domenic A. Baldini DirectorContinued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  n. Exposure to Herbicides During Service Aboard the USS IngersollThe National Archives and Records Administration (NARA) has confirmed that the Navy destroyer USS Ingersoll (DD 652) traveled into the inland waterways of RVN on October 24 and 25, 1965. Therefore, according to  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307, concede exposure to herbicides for crewmembers that served aboard the USS Ingersoll on these dates. If a Veteran alleges herbicide exposure based on duty aboard the USS Ingersoll, request Navy personnel records via the Personnel Information Exchange System (PIES) (request code O19). If personnel records are unavailable, or do not confirm a specific shipboard assignment during this timeframe, send a request for a review of NARA records to Compensation Service via e-mail at VAVBAWAS/CO/211/AGENTORANGE. This request should include the Veterans name date of birth VA claim number Social Security number (SSN), and service number, if different than SSN. Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PROCEDURE"  o. Verifying Herbicide Exposure on a Factual Basis in Locations Other Than in RVN or Korean DMZThe table below shows how to verify herbicide exposure on a factual basis in locations other than in the RVN during the Vietnam Era, or Korea at or near the demilitarized zone (DMZ) between April 1, 1968, and August 31, 1971. Reference: For more information on exposure to herbicides along the Korean DMZ, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.p"M21-1MR, Part IV, Subpart ii, 2.C.10.p, and  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC" 38 CFR 3.307(a)(6)(iv). Step Action1 If the Veteran alleges exposure Then in Thailand see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.q"M21-1MR, Part IV, Subpart ii, 2.C.10.q. in other locations go to Step 2. 2Ask the Veteran for the approximate dates, location, and nature of the alleged exposure.3After waiting 30 days, did VA receive this information? If yes, go to Step 4. If no refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. (Note: For a sample of a formal finding, see HYPERLINK "imi-internal:M21-1MRIV.ii.1.D.16.c"M21-1MR, Part IV, Subpart ii, 1.D.16.c.), and decide the claim based on the evidence of record.4Furnish the Veterans detailed description of exposure to Compensation Service via e-mail at VAVBAWAS/CO/211/AGENTORANGE, and request a review of DoDs inventory of herbicide operations to determine whether herbicides were used as alleged.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" o. Verifying Herbicide Exposure on a Factual Basis in Locations Other Than in RVN or Korean DMZ (continued) StepAction5Did Compensation Services review confirm that herbicides were used as alleged? If yes, determine whether service connection is otherwise in order. If no, go to Step 6.6Has the Veteran provided sufficient information to permit a search by the JSRRC? If yes, send a request to the JSRRC for verification of exposure to herbicides. If no refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. (Note: For a sample of a formal finding, see HYPERLINK "imi-internal:M21-1MRIV.ii.1.D.16.c"M21-1MR, Part IV, Subpart ii, 1.D.16.c.), decide the claim based on the evidence of record.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  p. Exposure to Herbicides Along the Korean DMZUnder HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC"38 CFR 3.307(a)(6)(iv), effective February 24, 2011, extend the presumption of herbicide exposure to any Veteran who served between April 1, 1968, and August 31, 1971, and in a unit that VA or the Department of Defense (DoD) has determined to have operated in an area in or near the Korean DMZ. The table below shows the units or other military entities that DoD has identified as operating in or near the Korean DMZ during the qualifying time period. Note: Before the amendment of HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_307.DOC"38 CFR 3.307(a)(6)(iv), effective February 24, 2011, VA conceded exposure to herbicides on a direct basis for Veterans who served between April 1968 and July 1969 in one of the groups listed below. Combat Brigade of the 2nd Infantry DivisionDivision Reaction Force3rd Brigade of the 7th Infantry Division1st Battalion, 38th Infantry4th Squadron, 7th Cavalry, Counter Agent Company1st Battalion, 17th Infantry2nd Battalion, 38th Infantry1st Battalion, 31st Infantry1st Battalion, 23rd Infantry1st Battalion, 32nd Infantry2nd Battalion, 23rd Infantry2nd Squadron, 10th Cavalry3rd Battalion, 23rd Infantry2nd Battalion, 17th Infantry2nd Battalion, 31st Infantry Note: Service records may show assignment to either the 2nd or the 7th Infantry Division.2nd Battalion, 31st Infantry Note: Service records may show assignment to either the 2nd or the 7th Infantry Division.2nd Battalion, 32nd Infantry3rd Battalion, 32nd Infantry Note: Service records may show assignment to either the 2nd or the 7th Infantry.3rd Battalion, 32nd Infantry Note: Service records may show assignment to either the 2nd or the 7th Infantry.1st Battalion, 9th Infantry1st Battalion, 73rd Armor2nd Battalion, 9th Infantry1st Battalion, 72nd Armor2nd Battalion, 72nd ArmorContinued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" p. Exposure to Herbicides Along the Korean DMZ (continued) Combat Brigade of the 2nd Infantry DivisionDivision Reaction Force3rd Brigade of the 7th Infantry Division1st Battalion, 12th Artillery1st Battalion, 15th Artillery7th Battalion, 17th Artillery5th Battalion, 38th Artillery6th Battalion, 37th ArtilleryOther Qualifying Assignments2nd Military Police Company, 2nd Infantry Division13th Engineer Combat BattalionUnited Nations Command Security Battalion-Joint Security Area (UNCSB-JSA)Crew of the USS Pueblo Important: Send a request to the JSRRC for verification of exposure to herbicides when a Veteran claims exposure in Korea, and his/her service was not between April 1, 1968, and August 31, 1971, and in a unit or entity listed in the table above.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PROCEDURE"  q. Herbicide Exposure in Thailand During the Vietnam EraThe Compensation Service has determined that a special consideration of herbicide exposure on a factual basis should be extended to Veterans whose duties placed them on or near the perimeters of Thailand military bases. Follow the steps in the table below to verify exposure to herbicides when a Veteran with service in Thailand during the Vietnam Era claims a disability based on herbicide exposure. StepAction1Did the Veteran serve in the U.S. Air Force in Thailand during the Vietnam Era at one of the Royal Thai Air Force Bases (RTAFBs) at U-Tapao Ubon Nakhon Phanom Udorn Takhli Korat, or Don Muang, and as an Air Force security policeman security patrol dog handler member of the security police squadron, or otherwise near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence? If yes, concede herbicide exposure on a direct/facts-found basis. If no, go to Step 2. Notes: Also concede herbicide exposure on a direct or facts-found basis for Veterans who served on RTAFBs in Thailand, while a member of the U.S. Army, if the claimant provides a statement that he was involved with perimeter security duty, and there is additional credible evidence supporting this statement. U.S. Army personnel may have provided RTAFB security early in the war before the base was fully operational.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" q. Herbicide Exposure in Thailand During the Vietnam Era (continued) StepAction2Did the Veteran serve at a U.S. Army Base in Thailand during the Vietnam Era as a member of a military police (MP) unit, or with a military police occupational specialty? If yes, concede exposure to herbicides on a facts-found or direct basis if the Veteran states his duty placed him at or near the base perimeter. If no, go to Step 3.3Place in the Veterans claims file a copy of the Compensation Services Memorandum for the Record shown in HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.r"M21-1MR, Part IV, Subpart ii, 2.C.10.r.4Ask the Veteran for the approximate dates, location, and nature of the alleged exposure.5Did the Veteran furnish this information within 30 days? If yes, go to Step 4. If no refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. (Note: For a sample of a formal finding, see HYPERLINK "imi-internal:M21-1MRIV.ii.1.D.16.c"M21-1MR, Part IV, Subpart ii, 1.D.16.c.), and decide the claim based on the evidence of record. 6Review the information provided by the Veteran together with the Memorandum for the Record.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" q. Herbicide Exposure in Thailand During the Vietnam Era (continued) StepAction7Can exposure to herbicides be acknowledged on a direct or facts-found basis as a result of this review? If yes, proceed with any other necessary development, such as scheduling a VA medical examination, before referring the claim to the rating activity. If no, go to Step 8.8Has the Veteran provided sufficient information to permit a search by the JSRRC? If yes, send a request to the JSRRC for verification of exposure to herbicides. If no refer the case to the JSRRC coordinator to make a formal finding that sufficient information required to verify herbicide exposure does not exist. (Note: For a sample of a formal finding, see HYPERLINK "imi-internal:M21-1MRIV.ii.1.D.16.c"M21-1MR, Part IV, Subpart ii, 1.D.16.c.), decide the claim based on the evidence of record. Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="STRUCTURE"  r. Memorandum for Record Herbicide Use in ThailandShown below is the Compensation Services Memorandum for the Record on herbicide use in Thailand during the Vietnam Era. Memorandum for the Record Subject: Herbicide use in Thailand during the Vietnam Era The Compensation Service has reviewed a listing of herbicide use and test sites outside Vietnam provided to our office by the Department of Defense (DoD). This list contains 71 sites within the U.S. and in foreign countries where tactical herbicides, such as Agent Orange, were used, tested, or stored. Testing and evaluations of these tactical herbicides were conducted by or under the direction of the U.S. Army Chemical Corps, Fort Detrick, Maryland. The list does not contain names of individuals. Additionally, it does not contain any references to routine base maintenance activities such as range management, brush clearing, weed killing, etc., because these vegetation control activities were conducted by the Base Civil Engineer and involved the use of commercial herbicides approved by the Armed Forces Pest Control Board. The application of commercial herbicides on military installations was conducted by certified applicators. DoD has advised us that commercial herbicides were routinely purchased by the Base Civil Engineer under federal guidelines and that records of these procurements were generally kept no longer than two years. We have also reviewed a series of official DoD monographs describing in detail the use, testing, and storage of herbicides at various foreign and domestic locations. In addition, the Project CHECO Southeast Asia Report: Base Defense in Thailand, produced during the Vietnam era, has been reviewed. Regarding your Veteran claimant with Thailand service, the DoD list indicates only that limited testing of tactical herbicides was conducted in Thailand from 2 April through 8 September 1964. Specifically, the location identified was the Pranburi Military Reservation associated with the Replacement Training Center of the Royal Thai Army, near Pranburi, Thailand. The Report of these tests noted that 5 civilian and 5 military personnel from Fort Detrick, Maryland conducted the spray operations and subsequent research. This location was not near any U.S. military installation or Royal Thai Air Force Base. Tactical herbicides, such as Agent Orange, were used and stored in Vietnam, not Thailand. We received a letter from the Department of the Air Force stating that, other than the 1964 tests on the Pranburi Military Reservation, there are no records of tactical herbicide storage or use in Thailand. There are records indicating that commercial herbicides were frequently used for vegetation control within the perimeters of air bases during the Vietnam era, but all such use required approval of both the Armed Forces Pest Control Board and the Base Civil Engineer. In Vietnam, tactical herbicides were aerially applied by UC-123 aircraft in Operation RANCH HAND or by helicopters under the control of the U.S. Army Chemical Corps. Base Civil Engineers were not permitted to purchase or apply tactical herbicides. Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  STYLEREF "Block Label" r. Memorandum for Record Herbicide Use in Thailand (continued)There are no records of tactical herbicide spraying by RANCH HAND or Army Chemical Corps aircraft in Thailand after 1964, and RANCH HAND aircraft that sprayed herbicides in Vietnam were stationed in Vietnam, not in Thailand. However, there are records indicating that modified RANCH HAND aircraft flew 17 insecticide missions in Thailand from 30 August through 16 September 1963 and from 14 17 October 1966. The 1966 missions involved the spraying of malathion insecticide for the control of malaria carrying mosquitoes. These facts are not sufficient to establish tactical herbicide exposure for any Veteran based solely on service in Thailand. While the Thailand CHECO Report does not report the use of tactical herbicides on allied bases in Thailand, it does indicate sporadic use of non-tactical (commercial) herbicides within fenced perimeters. Therefore, if a Veterans MOS (military occupational specialty) or unit is one that regularly had contact with the base perimeter, there was a greater likelihood of exposure to commercial pesticides, including herbicides. Security police units were known to have walked the perimeters, especially dog handlers. However, as noted above, there are no records to show that the same tactical herbicides used in Vietnam were used in Thailand. Please consider this information when you evaluate the Veterans claim. If the Veterans claim is based on servicing or working on aircraft that flew bombing missions over Vietnam, please be advised that there is no presumption of secondary exposure based on being near or working on aircraft that flew over Vietnam or handling equipment once used in Vietnam. Aerial spraying of tactical herbicides in Vietnam did not occur everywhere, and it is inaccurate to think that herbicides covered every aircraft and piece of equipment associated with Vietnam. Additionally, the high altitude jet aircraft stationed in Thailand generally flew far above the low and slow flying UC-123 aircraft that sprayed tactical herbicides over Vietnam during Operation RANCH HAND. Also, there are no studies that we are aware of showing harmful health effects for any such secondary or remote herbicide contact that may have occurred. If the Veterans claim is based on general herbicide use within the base, such as small-scale brush or weed clearing activity along the flight line or around living quarters, there are no records of such activity involving tactical herbicides, only the commercial herbicides that would have been approved by the Armed Forces Pest Control Board and sprayed under the control of the Base Civil Engineer. Since 1957, the Armed Forces Pest Control Board (now the Armed Forces Pest Management Board) has routinely provided listings of all approved herbicides and other pesticides used on U.S. Military Installations worldwide. The Compensation Service cannot provide any additional evidence beyond that described above to support the Veterans claim. Therefore, unless the claim is inherently incredible, clearly lacks merit, or there is no reasonable possibility that further VA assistance would substantiate the claim [see 38 CFR 3.159(d)], regional offices should send a request to JSRRC for any information that this organization can provide to corroborate the Veterans claimed exposure. Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  s. Herbicide Storage on Johnston IslandHerbicides were stored in drums on Johnston Island in the north Pacific between April 1972 and September 1977. Because military contractors were responsible for the inventory, few military personnel who served on Johnston Island had duties involving the direct handling of herbicides. If a Veteran alleges exposure to herbicides during service on Johnston Island, obtain verification of exposure on a factual basis. References: For more information on verifying exposure to herbicides on a factual basis, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.o"M21-1MR, Part IV, Subpart ii, 2.C.10.o, and storage of herbicides on Johnston Island, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.10.t"M21-1MR, Part IV, Subpart ii, 2.C.10.t.Continued on next page  STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="STRUCTURE"  t. Herbicide Storage on Johnston Island: Fact SheetBelow is a fact sheet on the storage of the herbicide Agent Orange on Johnston Island. FACT SHEET: STORAGE OF AGENT ORANGE ON JOHNSTON ISLAND Approximately 1.5 million gallons of Agent Orange (AO) were stored on Johnston Island (JI) between April 1972 and September 1977, when it was incinerated at sea. There were approximately 25 thousand 55-gallon drums stored in rows stacked three high on about 3.5 acres on the NW corner of the island. The storage location was selected because the east-to-west trade winds would rapidly disburse any airborne AO into the Pacific. Military contractors (and not U.S. military personnel) were solely responsible for site monitoring and redrumming and dedrumming activities. The storage area was fenced and off limits from a distance. The entire inventory of AO was screened for leaks daily. Leaking drums were re-drummed on a weekly basis. Fresh spillage was absorbed, and surface soil was scraped and sealed. Leakage of drums began in 1974. Between 1974 and 1977, the equivalent of the contents of 405 drums was leaked. The floor of the storage site was comprised of dense coral. Because of the composition and properties of coral, leaked AO was literally bound to the coral, providing little opportunity for AO to become airborne. A 1974 Air Force report found that the condition of the storage area provided evidence of the rapid identification of leaking drums, as few spill areas were observed. Soil samples in 1974 revealed that herbicide contamination was not detected outside of the storage yard except in close proximity to the redrumming operation. Water samples were collected and analyzed twice per month from 10 different locations. A 1978 Air Force Land Based Environmental Monitoring study concluded that no adverse consequences of the minimal release of AO into the JI environment during the dedrumming operation were observed. The report further stated that exposure to (land-based operations) workers to airborne 2,4-D and 2,4,5-T were well below permissible levels.   STYLEREF "Map Title" 10. Service Connection for Disabilities Resulting From Exposure to Herbicides or Based on Service in the Republic of Vietnam (RVN), Continued  PRIVATE INFOTYPE="PRINCIPLE"  u. Service Connection for NHL Under 38 CFR 3.313 Based on Service in RVN VA regulations at  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_313.DOC" 38 CFR 3.313 provide for a presumption of service connection for non-Hodgkins lymphoma (NHL) based on service in the RVN during the Vietnam Era. Important: Exposure to herbicides is not a prerequisite for entitlement under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_313.DOC" 38 CFR 3.313. The claimant needs only to show service in the RVN, which includes the waters offshore. PRIVATE INFOTYPE="PRINCIPLE"  v. Subcategories of NHL Qualifying for Presumptive Service Connection When  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_313.DOC" 38 CFR 3.313 was promulgated, the U.S. Center for Disease Control identified a number of subcategories that are manifestations of NHL. Extend the presumption of service connection to a Veteran who claims service connection 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 LymphomaIntermediate Grade LymphomaHigh Grade LymphomaSmall lymphocytic with plasmacytoid featuresDiffuse, small and largeDiffuse, small and largeSmall lymphocytic lymphoma and B-cell chronic lymphocytic leukemia*Diffuse, small cleavedLymphoblasticIntermediate cellDiffuse, large cleavedImmunoblasticFollicular, mixed small and largeDiffuse, large non-cleavedBurkittsMantle zoneDiffuse, largeFollicular, small cleavedFollicular, largeWaldenstroms macroglobulinemia *Note: Small lymphocytic lymphoma and B-cell chronic lymphocytic leukemia are considered slightly different forms of the same disease. 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides IntroductionThis topic contains information on the payment under the Nehmer stipulation, 38 CFR 3.816, for disabilities resulting from exposure to herbicides, including the Nehmer stipulation background the Nehmer class member categories the definition of a covered herbicide disease entitlement to benefits under 38 CFR 3.816 effective dates of awards under 38 CFR 3.816 examples of establishing a retroactive effective date handling claims that do not specifically mention herbicide exposure an example of a claim in which exposure to herbicides was not specifically mentioned handling claims for service connection for porphyria cutanea tarda (PCT), and Type 2 diabetes mellitus examples of claims for service connection for Type 2 diabetes mellitus identifying the appropriate survivor of a Nehmer class member the action when the appropriate survivor of a Nehmer class member cannot be located, and identifying other survivors of Nehmer class members. Change DateSeptember 15, 2011 PRIVATE INFOTYPE="FACT"  a. Nehmer Stipulation Background38 CFR 3.311a, which became effective on September 25, 1985, was the first VA regulation to provide guidance for the adjudication of claims based on exposure to dioxin. In February 1986, a class action suit entitled Nehmer v. United States Veterans Administration, No. C86-6160 THE (N.D. Cal.), was filed in the United States District Court for the Northern District of California. On May 3, 1989, the district court invalidated a portion of 38 CFR 3.311a. All denials after September 24, 1985, that were based on 38 CFR 3.311a were voided, and a moratorium was placed on further denials. The moratorium was lifted on February 15, 1994. On September 24, 2003, a new regulation,  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816, was added to provide guidance in the adjudication of claims under the Nehmer litigation.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued b. Nehmer Class Member CategoriesNehmer class members under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816 include a Veteran who served in the Republic of Vietnam during the Vietnam era, and has a covered herbicide disease, and surviving spouse, child, or parent of a deceased Veteran who served in the Republic of Vietnam during the Vietnam era, and died as the result of a covered herbicide disease. PRIVATE INFOTYPE="CONCEPT"  c. Covered Herbicide Disease DefinitionA covered herbicide disease under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816 means a disease for which VA has established a presumption of service connection before October 1, 2002, under the Agent Orange Act of 1991. Exception: Chloracne is not a covered herbicide disease under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816. The covered herbicide diseases under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816 are acute and subacute peripheral neuropathy Hodgkins disease multiple myeloma non-Hodgkins lymphoma porphyria cutanea tarda prostate cancer respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) soft-tissue sarcoma, as defined in  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(c), and Type 2 diabetes, also known as type II diabetes mellitus or adult-onset diabetes.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  d. Entitlement to Benefits Under 38 CFR 3.816A Nehmer class member is entitled to compensation under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816 if a claim for service connection for a covered herbicide disease, or DIC based on death caused by a covered herbicide disease, was denied in a decision issued between September 25, 1985, and May 3, 1989 pending on May 3, 1989, or received between May 3, 1989, and the effective date of the regulation establishing a presumption of service connection for the covered disease.  PRIVATE INFOTYPE="PRINCIPLE"  e. Effective Dates of Awards Under 38 CFR 3.816The effective date of disability compensation or DIC benefits under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816 is the date of receipt of the claim on which the prior denial was based or the date entitlement arose, whichever is later. Exceptions: If VA received the prior claim for compensation within one year after the Veterans separation from service, the effective date of compensation would be governed by  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC" 38 CFR 3.400(b)(2). If VA received the prior claim for DIC within one year after the Veterans death, the effective date of DIC would be governed by  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC" 38 CFR 3.400(c). Notes: The provisions of  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC" 38 CFR 3.114(a), which limit effective dates to no earlier than the date of a liberalizing law or issue, do not apply to benefits awarded under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816. Whatever the effective date, the actual payment of benefits commences on the first day of the following month in accordance with  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_31.DOC" 38 CFR 3.31.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  f. Example 1: Initial Claim Denied After September 25, 1985Situation: The Veterans initial claim for service connection for lung cancer was received on August 4, 1985, and denied on November 19, 1985. Medical evidence showed a diagnosis of lung cancer in July 1985. The Veteran reopened his claim in March 2001. Result: Establish service connection for lung cancer effective the date the initial claim was received, August 4, 1985. Rationale: Since the initial claim for service connection for a covered herbicide disease was denied after September 25, 1985, service connection may be established from the date the initial claim was received, per  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816. Note: If the claim had been denied, to include any appeals, before September 25, 1985, it would be unaffected by the Nehmer stipulation, and the effective date would be governed by  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_114.DOC" 38 CFR 3.114(a). PRIVATE INFOTYPE="PRINCIPLE"  g. Example 2: Initial Claim Received Prior to the Effective Date of the Law Establishing a Presumption of Service ConnectionSituation: The Veterans initial claim for service connection for lung cancer was received on October 14, 1992, and denied on December 23, 1992. Medical evidence showed a diagnosis of lung cancer in September 1992. The Veteran reopened his claim in March 2001. Result: Establish service connection for lung cancer effective the date the initial claim was received, October 14, 1992. Rationale: Since the claim was received prior to June 9, 1994, the effective date of the law establishing a presumption of service connection for lung cancer under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(e), service connection may be established from the date the initial claim was received, per  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816.  PRIVATE INFOTYPE="PRINCIPLE"  h. Example 3: Claim for DIC Benefits Received Within One Year of the Veterans DeathSituation: On November 3, 1986, a Veteran who served in the RVN during the Vietnam era died from Hodgkins disease. His surviving spouses claim for DIC benefits was received on December 10, 1986, and denied on February 12, 1987. The surviving spouse reopened her claim on March 15, 1993. Result: Establish entitlement to DIC benefits from November 1, 1986, the first day of the month in which the Veteran died. Rationale: Since the claim for DIC benefits was received within one year of the Veterans death, the effective date is governed by  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_400.DOC" 38 CFR 3.400(b)(2).Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  i. Handling Claims in Which Exposure to Herbicides Is Not Specifically MentionedIn its February 11, 1999, order, the district court held that a Nehmer class members claim for disability compensation or DIC need only include a request for service connection for a covered herbicide disease to qualify as a Nehmer claim. It is not necessary for the claimant to assert the condition was caused by exposure to herbicides. PRIVATE INFOTYPE="PRINCIPLE"  j. Example: Establishing an Effective Date When Exposure to Herbicides Is Not Specifically Mentioned in the ClaimSituation: A Veteran who served in the RVN during the Vietnam Era filed a claim in 1994, expressly alleging that his prostate cancer was caused by exposure to ionizing radiation before the Veterans service in Vietnam. VA denied the claim in 1995. The Veteran reopened the claim in 1997 and service connection was established. Result: Based on these facts, the effective date must relate back to the 1994 claim, even though the Veteran alleged a different basis for service connection. PRIVATE INFOTYPE="PROCEDURE"  k. Handling Claims for Service Connection for Porphyria Cutanea TardaUnder  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC" 38 CFR 3.311a(d), which was published on October 21, 1991, sound scientific and medical evidence did not establish a significant statistical association between exposure to herbicides and the development of porphyria cutanea tarda (PCT). When determining the effective date for the establishment of service connection for PCT do not assign an earlier effective date under the Nehmer stipulation, since a denial of service connection for PCT under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_311.DOC" 38 CFR 3.311a after October 20, 1991, is valid, and consider an earlier effective date under the Nehmer stipulation for a claim for service connection for PCT that was denied between September 24, 1985, and October 21, 1991.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  l. Handling Claims for Service Connection for Type 2 Diabetes MellitusEffective May 8, 2001, Type 2 diabetes mellitus became subject to presumptive service connection under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_309.DOC" 38 CFR 3.309(e). Retroactive benefits under the Nehmer review may be warranted for claims filed or denied during the period September 25, 1985, to May 7, 2001. If a prior claim did not involve service connection for Type 2 diabetes mellitus, there generally exists no basis for assigning an earlier effective date. However, a lack of specificity in the initial claim may be clarified by later submissions. PRIVATE INFOTYPE="PRINCIPLE"  m. Example 1: Claim for Service Connection for Type 2 Diabetes MellitusSituation: In January 1987, a Veteran filed a claim for service connection for hyperglycemia. In developing the claim, VA obtained medical records indicating that the Veteran was diagnosed with Type 2 diabetes mellitus in February 1987. Result: Based on these facts, it would be reasonable to treat the January 1987 claim as a claim for service connection for Type 2 diabetes mellitus. Rationale: Under Nehmer, benefits may be paid retroactive to the date the initial claim was received or the date the disability arose as determined by the facts of the case, whichever is later. PRIVATE INFOTYPE="PRINCIPLE"  n. Example 2: Claim for Service Connection for Type 2 Diabetes MellitusSituation: In 1995, a Veteran filed a claim for service connection for hyperglycemia. Medical records obtained by VA indicated that the Veteran did not have Type 2 diabetes mellitus. In 2001, the Veteran filed a second claim for service connection for Type 2 diabetes mellitus, submitting evidence showing that the condition was diagnosed in 1996. Result: Based on these facts, the 1995 claim is not considered a claim for service connection for Type 2 diabetes mellitus. Rationale: Neither the claim nor the evidence of record (when the 1995 claim was processed) indicated the Veteran had been diagnosed with Type 2 diabetes mellitus.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  o. Identifying Appropriate Survivor of a Nehmer Class Member If a Nehmer class member entitled under  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_816.DOC" 38 CFR 3.816(c) and (d) dies before receiving the payment of retroactive benefits, VA will award the unpaid benefits to the first individual or entity in existence in the following order: spouse child or children, divided into equal shares if more than one child exists, regardless of age or marital status parents, divided in half if both parents are alive, and estate. Note: The survivor or estate of a Nehmer class member is not required to file an application in order to receive unpaid benefits. PRIVATE INFOTYPE="PRINCIPLE"  p. Action When Appropriate Survivor of Nehmer Class Member Cannot Be LocatedUse all available information in the folder to determine an appropriate payee if a class member is deceased, and the claims folder does not contain sufficient information to identify an eligible survivor. Example: If an authorized representative or relative is identified in the claims folder, contact this person for information on the existence of a surviving spouse, children, parents, or estate. If this effort fails to identify an appropriate payee, annotate the rating decision, stating that it was not possible to locate any payee eligible for payment under Nehmer.Continued on next page  STYLEREF "Map Title" 11. Payment Under the Nehmer Stipulation for Disabilities Resulting From Exposure to Herbicides, Continued  PRIVATE INFOTYPE="PRINCIPLE"  q. Identifying Other Survivors of Nehmer Class MembersBefore awarding benefits to an identified payee, ask the payee to state whether or not there are any other survivors of the class member who may have an equal or greater entitlement to unpaid benefits. Once benefits have been awarded in full to a payee, do not pay any portion of the amount to any other individual, unless the payment previously released can be recovered.  12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards  PRIVATE INFOTYPE="OTHER"  IntroductionThis topic contains information on service connection for disabilities resulting from exposure to other specific environmental hazards, including locations of specific environmental hazards identified by the Department of Defense (DoD) using DoD records to verify exposure to environmental hazards using alternative records to establish exposure to environmental hazards what to include in VA examination and/or medical opinion requests in environmental hazard claims applying the provisions of 38 CFR 3.317 in claims based on exposure to environmental hazards in Southwest Asia, and diseases potentially associated with exposure to contaminants present in the Camp Lejeune water supply between 1957 and 1987. Change DateDecember 16, 2011 PRIVATE INFOTYPE="FACT"  a. Locations of Specific Environmental Hazards Identified by DoDThe Department of Dense (DoD) has identified a number of specific environmental hazards at military installations in Iraq, Afghanistan, and elsewhere that could present health risks. These hazards include large pit burns throughout Iraq, Afghanistan, and Djibouti on the Horn of Africa particulate matter in Iraq and Afghanistan a large sulfur fire at Mishraq State Sulphur Mine near Mosul, Iraq hexavalent chromium exposure at the Qarmat Ali Water Treatment Plant at Basrah, Iraq contaminated drinking water at Camp LeJeune, North Carolina, 1957 to 1987, and pollutants from a waste incinerator near the Naval Air Facility (NAF) at Atsugi, Japan. Reference: For more information on processing claims based on exposure to the environmental hazards listed above, see  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL10-03.doc" Training Letter 10-03, Environmental Hazards in Iraq, Afghanistan, and Other Military Installations, and  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL11-03.doc" Training Letter 11-03, Revised, Processing Disability Claims Based on Exposure to Contaminated Drinking Water at Camp Lejeune. Continued on next page  STYLEREF "Map Title" 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued  PRIVATE INFOTYPE="PROCEDURE"  b. Using DoD Records to Verify Exposure to Environmental Hazards DoD has provided VA a list of those who served at the Qarmat Ali Water Treatment Plant in Basrah, Iraq. If the Veteran is claiming exposure to an environmental hazard at this location, send an e-mail request for verification of service to the following Compensation Service mailbox: VAVBAWAS/CO/211/ENVIRO. If exposure cannot be verified through an official list provided by DoD, review STRs, military personnel records, and all other available for evidence that corroborates the Veterans statement of exposure. Important: Carefully review the Post-Deployment Health Assessment (PDHA) and Discharge Examination, generally located in the STRs, for exposure information. The PDHA includes specific questions relating to exposure incidents. Reference: For more information on using alternative evidence to establish exposure, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.H.32.e"M21-1MR, Part IV, Subpart ii, 1.H.32.e. c. Using Alternative Evidence to Establish Exposure to Environmental HazardsBecause military service records will not verify all incidents of exposure, it is important to consider alternative evidence in establishing whether the Veteran participated in or was affected by an in-service exposure incident. Alternative 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 Veterans service. Reference: For more information on considering evidence in claims for disability compensation, see HYPERLINK "http://www.law.cornell.edu/uscode/html/uscode38/usc_sec_38_00001154----000-.html"38 U.S.C. 1154(a), and  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_303.DOC" 38 CFR 3.303(a). Continued on next page  STYLEREF "Map Title" 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued d. What to Include in VA Examination and/or Medical Opinion Request 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 HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.13.a"M21-1MR, Part IV, Subpart ii, 2.C.13.a advise the examiner of the nature of the claimed environmental hazard and the location and timeframe of exposure attach the appropriate Fact Sheet from  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL10-03.doc" Training Letter 10-03 to the claims folder to explain the environmental hazard in detail (Exception: If the claim is based on exposure to contaminated drinking water at Camp Lejeune, attach the notice from Appendix D of  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL11-03.doc" Training Letter 11-03.) forward the claims folder to the examiner and ask him/her to review the medical and other evidence in the claims folder, including the Fact Sheet, and provide an opinion, and rationale for the opinion, as to the likelihood that the Veterans claimed disability is related to the hazardous environmental exposure. In some cases, an opinion based on a records review only may suffice, but other cases may require a current examination. When initially requesting an opinion only, ask the examiner to schedule an examination if he/she believes it is needed to render the requested medical opinion. Note: Do not request an examination or medical opinion until exposure has been established. For more information on establishing exposure to a claimed environmental hazard, see HYPERLINK "imi-internal:M21-1MRIV.ii.2.C.13.b"M21-1MR, Part IV, Subpart ii, 2.C.13.b and c. PRIVATE INFOTYPE="PROCEDURE"  e. Applying the Provisions of 38 CFR 3.317 in Claims Based on Exposure to Environmental Hazards in Southwest AsiaApply the provisions of  HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_317.DOC" 38 CFR 3.317 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 Veterans military service. If both criteria stated above are met, develop the claim under the Southwest Asia claim procedures shown in HYPERLINK "imi-internal:M21-1MRIV.ii.1.E"M21-1MR, Part IV, Subpart ii, 1.E, and HYPERLINK "imi-internal:M21-1MRIV.ii.2.D"M21-1MR, Part IV, Subpart ii, 2.D.Continued on next page  STYLEREF "Map Title" 12. Service Connection for Disabilities Resulting From Exposure to Other Specific Environmental Hazards, Continued  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  f. Diseases Potentially Associated With Contaminants Found in the Camp Lejeune Water Supply Between 1957 and 1987The following is a non-exclusive list of diseases potentially associated with contaminants present in the Camp Lejeune water supply between 1957 and 1987: esophageal cancer lung cancer breast cancer bladder cancer kidney cancer adult leukemia multiple myeloma myleodisplasic syndromes renal toxicity hepatic steatosis female infertility miscarriage, with exposure during pregnancy scleroderma neurobehavioral effects Notes: Manifestation of any of these diseases in a Veteran with verified Camp Lejeune service between 1957 and 1987 is sufficient to initiate a VA medical examination, and request an opinion regarding its relationship to Camp Lejeune service. Do not establish service connection for one of these diseases or disabilities unless a competent medical authority, based on the Veterans individual case, has determined that it is at least as likely as not that the claimed disease or disability has resulted from exposure to the contaminated water. References: For more information on the contaminants present in the Camp Lejeune water supply between 1957 and 1987, see Appendix B of  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL11-03.doc" Training Letter 11-03 more information on obtaining medical opinions, see HYPERLINK "http://www.warms.vba.va.gov/regs/38CFR/BOOKB/PART3/S3_159.DOC"38 CFR 3.159(c)(4), and HYPERLINK "imi-internal:M21-1MRIII.iv.3.A.9"M21-1MR, Part III, Subpart iv. 3.A.9, and a list of Internet websites describing potential health effects of exposure to chemical contaminants present in the Camp Lejeune water supply between 1957 and 1987, see Appendix C of  HYPERLINK "http://vbaw.vba.va.gov/bl/21/publicat/Letters/TrngLtrs/TL11-03.doc" Training Letter 11-03. ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT  ADDIN \* MERGEFORMAT      M21-1MR, Part IV, Subpart ii, Chapter 2, Section C M21-1MR, Part IV, Subpart ii, Chapter 2, Section C 2-C- PAGE 44 2-C- PAGE 43 11/26/02 M21-1MR, Part IV Unproofed CV Draft 2-K- PAGE 1       p q . 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