Presumptive Service Connection Benefits

3 Elements of Direct Service Connection

Generally, when we talk about service connected disability compensation, we’re referring to the 3 elements of direct service connection. To establish entitlement to service connection on a direct basis (i.e., the condition is directly related to service) for a particular disability, a veteran must show (1) an in-service event (including an in-service illness or diagnosis), (2) a current diagnosed condition, and (3) a “nexus” between the current condition and the veteran’s service. That nexus is typically shown through medical evidence and a health care professional concluding the current diagnosed condition is at least as likely as not related to the veteran’s in-service event.

Presumptive Service Connection Claim

In a presumptive service connection claim, Congress and/or the VA has presumed the nexus requirement. This is usually due to the prevalence of certain conditions following exposure to a known toxic substance. The most famous (or perhaps, infamous) presumption is for conditions related to exposure to herbicides, like Agent Orange, that were widely used during the Vietnam War.

At work inside every claim for presumptive service connection are two smaller presumptions. First, the presumption of exposure to a toxic substance, which is based on the veteran’s service at a particular location during a particular time. The second is that the disability has been deemed presumptively related to the toxic exposure. For example, in a claim related to herbicides, such as Agent Orange, the two presumptions are: (1) The veteran has service in a particular location during the established time period -- such as in the Republic of Vietnam between January 1962 and May 1975 -- therefore, they are presumed to be exposed Agent Orange, and (2) That veteran has a current diagnosis of a condition that is presumptively related to exposure to Agent Orange (for example, ischemic heart disease).

So if you have a presumptive disability, you need only show evidence of the disability, and that you served on active duty in the location during the timeframe set by law or regulation to be compensated for that disability.

It is important to keep in mind that a claim is always for a current condition and not for the exposure itself. Thus, your claim would not be for “agent orange,” but rather for “ischemic heart disease” (or another presumptive condition). The same is true for presumptions under the PACT Act related to Gulf War service; the claim is for the condition, such as “asthma” or “kidney cancer,” and not for “PACT Act” or “burn pits,” etc.

Here are some common presumptions that VA currently recognizes based on toxic or hazardous exposures in service:

1. Agent Orange – Agent Orange is an herbicide and defoliant chemical that was used during the Vietnam War. Congress and VA continue to examine and add locations where herbicides were used, as well as conditions that are presumptively related to herbicides. Currently, the list of known locations for exposure to herbicides include Vietnam and its territorial waters, Thailand, Laos, Cambodia, Guam or American Samoa, Johnston Atoll, Korean DMZ, some storage facilities, or service aboard a contaminated C-123 following the Vietnam War. Each service location has specific dates that apply. For more information to see if your service qualifies, visit VA’s Agent Orange Exposure website. There are current 19 conditions that are presumptively related to exposure to Agent Orange. You can view those on VA’s website as well, but they include illnesses such as diabetes, ischemic heart disease, hypothyroidism, hypertension, Parkinsons, and others, as well as cancers including prostate cancer, bladder cancer, non-hodgkin’s lymphoma, respiratory cancers, and others.

2. Camp Lejeune Water Contamination – contaminated water at military installations continue to be an ongoing problem, but the water contamination at Camp Lejeune spanned a time period of over 30 years. If you had service for at least 30 days (does not need to be consecutive service) at Camp Lejeune from August 1, 1953 through December 31, 1987 you are presumed to have been exposed to the known toxins within water supply. These toxins included industrial solvents, such as trichloroethylene (TCE) and perchloroethylene (PCE), as well as benzene from underground fuel tanks. VA has established 8 illnesses and cancers related to this exposure, including adult leukemia, aplastic anemia, bladder, kidney and liver cancer, multiple myeloma, non-hodgkins lymphoma, and parkison’s disease. You can read more about the water contamination at Camp Lejeune, as well as the presumptive conditions, and eligibility for health care for the veteran and family members on VA’s website.

3. Gulf War Service – there are actually two different set of presumptions for Gulf War veterans. The first (and the original presumptive regulation) is what is commonly referred to as Gulf War Illnesses. The second set of presumptions were established in the PACT Act and is based on exposure to burn pits and other toxic exposure.

a. Gulf War Illness – “Gulf War Illness” refers to a “medically unexplained chronic multi-symptom illnesses,” or other symptoms that are persistent but have not resulted in a confirmed diagnosed condition. A qualifying chronic multisymptom illness includes conditions such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. Signs and symptoms of an undiagnosed illness include fatigue, headaches, joint and muscle pain, respiratory symptoms, gastrointestinal symptoms and others. If you have a chronic multi-symptom illness, or signs and symptoms of an undiagnosed illness, and you had service in the Southwest Asia Theatre of Operations (or other qualifying locations) on or after August 2, 1990, these conditions are presumptively related to your service. The Gulf War Illness presumptions also include certain infectious diseases diagnosed after service.

b. Burn pits and other toxic exposures (PACT Act) - While burn pits, and the toxins produced by the burn pits, was one of the biggest considerations for Congress when drafting the PACT Act, the Act does not elaborate on the details of the exposure (i.e., what specific substances were being produced by the burn pits, or other known toxic substances that a service member would have had routine contact with during service). However, the PACT Act did establish 13 diseases and 12 broad categories of cancers that are presumed to be related to service in one of the covered locations. Diseases include: Asthma, chronic bronchitis, COPD, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease, pleuritic, pulmonary fibrosis, sarcoidosis, chronic sinusitis, chronic rhinitis. Cancers include: Head, neck, respiratory, gastrointestinal, reproductive, lymphoma, glioblastoma, kidney cancer, brain cancer, melanoma, pancreatic cancer. To establish entitlement to a presumptive condition, a veteran must have served in one of the locations identified by Congress on or after August 2, 1990 and/or on or after September 11, 2001.

4. Atomic Veterans exposed to Ionizing Radiation – Generally, VA recognizes 7 distinct radiation exposure events and will presume exposure to excessive amounts of radiation if a veteran was involved in one of these events. VA also maintains a list of radiogenic diseases that are presumed to be related to excess exposure to radiation. These radiogenic diseases include all forms of leukemia, cancers of the thyroid, breast, pancreas, lung, bone, colon, and others, as well as multiple myeloma, and lymphomas. The distinct radiation events include: participation in an atmospheric nuclear testing, occupied or was a prisoner of war in Hiroshima or Nagasaki, participation in cleanup activities of Enewetak Atoll from January 1977 through December 1980, cleanup of the Air Force B-52 bomber carrying nuclear weapons off the coast of Palomares, Spain from January 1966 through March 1967, participated in the response to the fire onboard an Air Force B-52 bomber carrying nuclear weapons near Thule Air Force Base in Greenland from January 1968 through September 1985, other service at particular locations including at Amchitka Island, Alaska, or the gaseous diffusion plants in Paducah, Kentucky, Portsmouth, Ohio, or Oak Ridge (Area K-25), Tennessee (all have particular dates of service).

5. Prisoner of War: Given the conditions that a POW must endure, VA has also created presumptions related to such captivity. VA acknowledges conditions for those that were a POW less than 30 days, and greater than 30 days. For those held captive for less than 30 days, presumptive conditions include osteoporosis and post-traumatic osteoarthritis, damage from frost bite, stroke and hypertensive heart disease (and related conditions), as well as psychiatric disabilities. For those held captive in excess of 30 days, the VA also acknowledges helminthiasis, peripheral neuropathy, peptic ulcer disease, chronic dysentery, irritable bowel syndrome, cirrhosis of the liver, avitaminosis, beriberi, malnutrition, and pellagra.

In addition to claims that are related to toxic exposures in service, there are other conditions as well that may be deemed presumptively related to your service depending on how soon the condition manifested after active duty service:

1. Within one year after discharge: If a chronic condition manifests within one year after discharge, VA will presume that it is related to your active duty service. There is a list of chronic conditions that VA accepts based on regulation, and conditions include, for example, arthritis, diabetes, cardiovascular disease, sarcoidosis, tumors and some types of cancers, and many other conditions.

2. Within three years after discharge: VA will presume that Hansen’s disease and tuberculosis are related to a veteran’s active duty service if the condition manifests within 3 years of discharge.

3. Anytime: VA will always presume that Amyotrophic Lateral Sclerosis (ALS, also known as Loud Gehrig’s disease) is related to a veteran’s active duty service, regardless of when the condition manifested after service.

In sum, it is important to be familiar with presumptive service connection claims because it is one of the easiest and most straightforward ways to obtain service connection disability compensation. While you may not have a condition right now, it is important to be aware that benefits do exist should the condition manifest in the future. Presumptions may also change, so stay up to date with the VA and your accredited representative. If you currently have a condition that is not on the presumptive list, but you believe may be related to your service, talk to any accredited representative about filing a claim.