--- title: "Part VIII, Subpart iii, Chapter 4, Section B Developing Claims for Service Connection (SC) for Disabilities Resulting from Ionizing Radiation Exposure Under 38 CFR 3.311" document: "M-21-1" section: "Part VIII, Subpart iii, Chapter 4, Section B" canonical: "https://veteranai.co/va-regulations/m21-1/viii.iii.4.b-developing-claims-for-service-connection-sc-for-disabilities" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000177455/M21-1-Part-VIII-Subpart-iii-Chapter-4-Section-B-Developing-Claims-for-Service-Connection-SC-for-Disabilities-Resulting-from-Ionizing-Radiation-Exposure-Under-38-CFR-3311" updated: "2026-09-07T14:37:34.524411Z" --- June 3, 2015 ### VIII.iii.4.B.1.a. Provisions of 38 CFR 3.311 The specific requirements for the adjudication of claims for service connection (SC) for disabilities resulting from exposure to ionizing radiation claims are found in [38 CFR 3.311]().The provisions of [38 CFR 3.311(b)(1)]() require that the * Veteran must have been exposed to ionizing radiation as a result of participation in * atmospheric testing of nuclear weapons * the occupation of Hiroshima or Nagasaki, Japan, from September 1945 until July 1946, or * other radiation-risk activities as claimed * Veteran must have subsequently developed a radiogenic disease listed in [38 CFR 3.311(b)(2)](), and * disease first manifested itself within the period specified in [38 CFR 3.311(b)(5)](). **Important:** If a listed cancer is a metastasis of a primary cancer that has not been service-connected (SC) on the basis of exposure to ionizing radiation under the provisions of [38 CFR 3.309(d)]() or _[38 CFR 3.311]()_ , then SC cannot be awarded. ### VIII.iii.4.B.1.b. Presumptive Versus Direct SC If a claimant files a claim for SC under the provisions of [38 CFR 3.311](), the claims processor must also consider the claim for SC under the provisions of [38 CFR 3.303]().**Reference:** For more information on disabilities resulting from radiation exposure, see [M21-1, Part VIII, Subpart iii, 4.C](). ### VIII.iii.4.B.1.c. Handling Claims That Require a Subsequent Review Under PL 98-542 On October 24, 1984, _Public Law (PL) 98-542_ , _The Veterans’ Dioxin and Radiation Exposure Compensation Standards Act_ , was placed into law to address disabilities resulting from exposure to radiation as an atmospheric test participant or a member of the Hiroshima/Nagasaki occupation forces. If a claim was denied prior to the enactment of _PL 98-542_ , claims processors must complete a _de novo_ review of the evidence to determine if readjudication of the claim is warranted. **Note:** It is not necessary for the claimant to submit new and relevant evidence to justify readjudication of the previously denied claim.**References:** For more information on * developing claims for compensation based on radiation exposure, see * [M21-1, Part VIII, Subpart iii, 4.A.2](), and * M21-1, Part VIII, Subpart iii, 4.B.2, and * the provisions of _PL 98-542_ , see [M21-1, Part VIII, Subpart iii, 4.C.1.a](). ### VIII.iii.4.B.1.d. Handling Claims That Require a Subsequent Review Based on Dose Estimates Made Before May 8, 2003 On May 8, 2003, the National Research Council, an independent agency contracted to review the Defense Threat Reduction Agency’s (DTRA) radiation dose estimates, reported that DTRA had underestimated upper bound radiation doses for atmospheric test participants and Hiroshima/Nagasaki occupation forces.When a claim was previously denied based on a dose estimate provided by DTRA before May 8, 2003, obtain a new dose estimate from DTRA and readjudicate the claim.**Note:** It is not necessary for the claimant to submit new and relevant evidence to justify readjudication of the previously denied claim. **Reference:** For more information on obtaining dose estimates, see M21-1, Part VIII, Subpart iii, 4.B.4. ### VIII.iii.4.B.1.e. Handling Classified Information Needed to Validate Exposure to Nuclear Radiation Veterans seeking benefits in connection with exposure to nuclear radiation are authorized by the _Exposure to Nuclear Radiation and Department of Defense (DoD) Secrecy Agreement_ to divulge to the Department of Veterans Affairs (VA) the * name and location of their command * duties performed * dates of service, and * related information necessary to validate exposure to nuclear radiation. This authorization does _not_ relieve Veterans of responsibility for continuing to protect specific technical information that could contribute to the development of a weapon of mass destruction or the application of nuclear technology. **Important:** Veterans must refrain from divulging information relative to military bases where nuclear weapons * may be located within the continental U.S., which is classified as “Confidential,” and * were or are located outside the continental U.S., which is classified as “Secret” or “Top Secret.” ** _References_** : For more information on * the _Exposure to Nuclear Radiation and DoD Secrecy Agreement_ , see M21-1, Part VIII, Subpart iii, 4.B.6, and * claims for radiogenic diseases under [38 CFR 3.309(d)](), see [M21-1, Part VIII, Subpart iii, 4.A.2](). ### VIII.iii.4.B.1.f. VA Responsibility for Expunging Classified Military Data The fact that a Veteran inadvertently reveals classified military information during the course of applying for benefits should not be compounded further by releasing this information within or outside VA in any manner. Cut out (rather than obliterate) any classified information from related documents or statements.When expungement is necessary, follow the steps in the table below to properly remove the classified information.| **Step**| **Action** 1| Prepare a _[VA Form 27-0820, Report of General Information]()_, for the claims folder and have the form signed by the Veterans Service Center Manager (VSCM), Pension Management Center Manager (PMCM), or supervisory designee, not lower than the Assistant VSCM or PMCM. On the [_VA Form 27-0820_](), * cite the * kind of evidence removed, and * reason for the record expungement, and * summarize or restate any other expunged facts or statements not referring to specific military bases where radiation exposure allegedly occurred. 2| Once approved, redact the classified information.**Reference:** For more information on redacting adobe documents, see the _[Adobe Acrobat XI Pro Quick Start Guide]()_. 3| Place the redacted document(s) and [_VA Form 27-0820_]() in the claims folder. 4| Mark the document(s) containing classified information for deletion. ## 2. Developing Claims for SC for Disabilities Resulting From Ionizing Radiation Exposure Under 38 CFR 3.311 This topic contains information on developing claims for SC for disabilities resulting from ionizing radiation exposure under 38 CFR 3.311, including * centralized processing of claims based on radiation exposure * procedures for transferring radiation claims * criteria to consider before beginning development of a claim based on exposure to ionizing radiation * when to obtain information, and * requesting * a history of the Veteran’s exposure to known carcinogens, and * medical evidence of claimed disease. January 12, 2022 ### VIII.iii.4.B.2.a. Centralized Processing of Claims Based on Radiation Exposure In October 2006, VA centralized the processing of all claims for SC based on radiation exposure at the Jackson Regional Office (RO), to include all claims for SC for disabilities resulting from exposure to ionizing radiation under [38 CFR 3.311]().When ROs receives a claim identifying exposure to radiation, the existence of a radiogenic disease must be confirmed prior to transferring the claim to the Jackson RO. Confirmation of the existence of a presumptive disease under [38 CFR 3.309(d)]() in a “radiation-exposed veteran” or of a “radiogenic disease” as defined in [38 CFR 3.311]() is, generally, a medical diagnosis from a health care provider.All folders with pending radiation claims must be transferred to the Jackson RO after the radiogenic disease is confirmed. **Important:** * The station in receipt of a claim for SC based on radiation exposure is responsible for noting the following in the claims folder: * _no development accomplished_ * _partial/complete development – request not sent to DTRA_ * _development completed - request sent to DTRA, or_ * _pending opinion from Compensation Service_. * Legacy appeals of radiation determinations, including remanded legacy appeals, are processed by the Jackson RO. **References:** For more information on * the criteria to consider before beginning development of an ionizing radiation claim, see M21-1, Part VIII, Subpart iii, 4.B.2.c, and * jurisdiction over radiation claims and legacy appeals, see * [M21-1, Part II, Subpart ii, 3.1.b]() * [M21-1, Part VIII, Subpart iii, 4.A.2.a](), and * [M21-5, Chapter 7, Section G.3.b](). ### VIII.iii.4.B.2.b. Procedures for Transferring Radiation Claims After it has been determined that a radiation claim is ready to be transferred to the Jackson RO, the station in receipt of a claim for SC based on radiation exposure must add the _Radiation Radiogenic Disability Confirmed_ special issue indicator to the contention(s) before the claim can transferred to the Jackson RO for processing. The station must leave the rating end product (EP) pending, as well as all other EPs _not_ related to the radiation claim. The Jackson RO will have jurisdiction of all non-radiation-related claims while processing the radiation issues.Upon receipt of the claim, the Jackson RO will * accept the transfer, if a paper claims folder has been transferred, and * review the case to determine the status of the radiation claim and any other pending claim. **Note:** The National Work Queue (NWQ) will assign to the Jackson RO all radiation claim EPs established in the Veterans Benefits Management System (VBMS) once the _Radiation Radiogenic Disability Confirmed_ special issue indicator has been added to the contention(s). ### VIII.iii.4.B.2.c. Criteria to Consider Before Beginning Development of a Claim Based on Exposure to Ionizing Radiation If a claim is received for SC for a disability caused by exposure to ionizing radiation _and_ the claim is substantially complete, the development activity reviews the claim to * determine whether SC may be established under * [38 CFR 3.303](), or * [38 CFR 3.309(d)](), and * determine whether the requirements for consideration of SC under [38 CFR 3.311]() are satisfied. Under [38 CFR 3.311(b)](), the submitted or acquired evidence must show that the Veteran * has either * one of the radiogenic diseases listed in [38 CFR 3.311(b)(2)]() * a death certificate signed by a physician listing the cause of death as a disease specific to radiation exposure under [38 CFR 3.309(d)]() or radiogenic disease under [38 CFR 3.311](),or * an unlisted disease for which a medical opinion or medical treatise has been submitted showing a causal relationship between the disease and exposure to radiation, and * was exposed to ionizing radiation * while a participant in atmospheric nuclear weapons testing * during the post-war occupation of Hiroshima or Nagasaki from September 1945 until July 1946 * as a prisoner of war (POW) in Japan, or * while performing other service activities, such as work as an x-ray technician, in a reactor plant, or in nuclear medicine or radiography. **Note:** A Veteran will be considered involved in a radiation-risk activity if they performed tasks similar to work engaged in by a Department of Energy (DoE) employee that qualifies the DoE employee as a member of the Special Exposure Cohort under [42 U.S.C. 7384l(14)]().**Reference:** For more information on the diseases recognized under [38 CFR 3.311](), see [M21-1, Part VIII, Subpart iii, 4.C.1.e](). ### VIII.iii.4.B.2.d. When to Obtain Information In all cases, _if_ a substantially complete claim under [38 CFR 3.311]() exists, obtain the information listed in M21-1, Part VIII, Subpart iii, 4.B.2.e and f. ### VIII.iii.4.B.2.e. Requesting a History of the Veteran’s Exposure to Known Carcinogens VA may seek a referral from an outside consultant to ensure the Veteran’s disease(s) resulted from radiation exposure in service.Obtain information on the Veteran’s history of exposure to known carcinogens, to include asking the Veteran to identify * the circumstance and date of the Veteran’s exposure * post-service occupational history * pertinent family history * smoking history * evidence of any other effects radiation exposure may have had on the Veteran, and * any other information relevant to a determination of the cause of the Veteran’s disease. **Notes:** * If the claim is for skin cancer, ask the claimant to provide the * extent of exposure to the sun (such as sun bathing or occupations requiring the Veteran to work outdoors, and so forth), and * specific site of each lesion. * When obtaining family history, ask the Veteran whether his immediate family, such as parents or siblings, have been diagnosed with diseases such as cancer or leukemia, birth defects, or genetic disorders. * When requesting the information referenced above, send the claimant the _Radiation Risk Activity Information Sheet_ for completion. ### VIII.iii.4.B.2.f. Requesting Medical Evidence of Claimed Disease To obtain evidence that demonstrates continuity and symptomatology of the claimed disease(s), request the claimant provide * the names and addresses of any physicians and facilities who have made subsequent diagnoses or have provided treatment for the claimed disease * clinical records (not summaries) for all medical care relating to the claimed disease, and * all tissue blocks, slides or other pathology samples, if available. **Note:** If the claimant asks for VA’s assistance in obtaining private clinical records, VA must request the claimant to authorize the release of these records by completing and signing * [_VA Form 21-4142_ ,_Authorization to Disclose Information to the Department of Veterans Affairs (VA)_](), and/or * [_VA Form 21-4142a_ , _General Release for Medical Provider Information to the Department of Veterans Affairs (VA)_](). **Reference:** For more information on [_VA Forms 21-4142_]() and [_21-4142a_](), see [M21-1, Part III, Subpart ii, 3](). 3. Verification of Exposure to Ionizing Radiation Under 38 CFR 3.311 This topic contains information on the process of verifying exposure to ionizing radiation under 38 CFR 3.311, including * requesting verification of * participation in * atmospheric nuclear weapons tests, and * American occupation of Hiroshima or Nagasaki prior to July 1, 1946 * involvement in non-U.S. nuclear bomb tests * exposure to radiation in Japan following the March 2011 earthquake and tsunami, and * exposure to ionizing radiation by reason of military duties * obtaining records of occupational exposure to radiation from the * Veteran’s service department * Atomic Energy Commission (AEC), and * U.S. Army Public Health Command (USAPHC), and * developing claims for SC based on nasopharyngeal radium irradiation (NRI) therapy. December 18, 2019 ### VIII.iii.4.B.3.a. Requesting Verification of Participation in Atmospheric Nuclear Weapons Tests When requesting verification from DTRA of exposure to ionizing radiation due to the Veteran’s participation in an atmospheric nuclear weapons test, send a letter to DTRA that * specifies the * disease being claimed (If skin cancer is claimed, specify the site of each lesion, type of cancer, and date of diagnosis.) * Veteran’s organization or unit of assignment at the time of exposure, and * dates of assignment to the nuclear test site, and * provides a full description of the Veteran’s duties and activities while participating in a radiation-risk activity. The letter to DTRA should also include * a copy of all available pathology reports that identify the type of cancer and the organ involved, if the disease claimed is a listed radiogenic disease * a copy of the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease claimed is not among those listed in [38 CFR 3.311(b)(2)](), and * the Veteran’s current address and phone number. ### VIII.iii.4.B.3.b. Requesting Verification of Participation in the American Occupation of Hiroshima or Nagasaki Prior to July 1, 1946 When requesting verification from DTRA of exposure to ionizing radiation as a result of participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946, send a letter to DTRA that provides the following information: * the organization or unit (ship, task group, company, or squadron) and rank at the time of exposure * the duty place and organizational unit from which the Veteran may have been detailed, and * the activities and length of time at ground zero (hypocenter). The letter to DTRA should include a description from the claimant and from the service records of activities performed during the entire period of exposure, including * whether or not the Veteran went ashore * the length of time spent ashore, and * the activities performed while ashore. The letter to DTRA should also * specify the disease being claimed (If skin cancer is claimed, specify the site of each lesion, type of cancer, and date of diagnosis.), and * include * available pathology reports that identify the type of cancer and the organ involved, if the disease claimed is a listed radiogenic disease, and/or * the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease is not among those listed under [38 CFR 3.311(b)(2)](). For former POWs, also provide DTRA with the following information: * the dates of confinement * the places of confinement * the date and place of liberation * the date and method of departure from Japan, and * the method of travel within Japan, since the method of travel, such as a specific train over a specific route, can provide critical information in confirming exposure. **Important:** Information on the activities performed and the amount of time spent at ground zero is critical in obtaining an accurate dose estimate. Recognition of an area can be critical in determining and verifying participation. ### VIII.iii.4.B.3.c. Requesting Verification of Involvement in Non-U.S. Nuclear Bomb Tests _PL 103-446_ allows for a presumption of SC for the same radiogenic diseases, regardless of whether the Veteran participated in U.S or non-U.S. nuclear tests.Use the table below to obtain verification of a Veteran’s involvement in non-U.S. nuclear bomb tests.| **If requesting radiation dose information for …**| **Then contact …** non-U.S. test participants involved in flight missions| ** _Address_** :AFTAC/SE ATTN: Ms. Joy Morris 10989 S. Patrick Drive Patrick AFB, FL 32925-3002** _Telephone_** : (321) 494-3870 ** _Fax_** : (321) 494-2319 ** _E-mail_** : _[belinda.morris@us.af.mil]()_** _Important_** : The e-mail address is not encrypted. To prevent a security violation, do not send out any personally identifiable information (PII) to this e-mail address. all other non-U.S. test participants| the appropriate service department points of contact identified in M21-1, Part VIII, Subpart iii, 4.B.3.f. **Important:** DTRA is _not_ responsible for responding to requests that involve non-U.S. test participants. These requests will be returned to the RO without a response. ### VIII.iii.4.B.3.d. Requesting Verification of Exposure to Radiation in Japan Following the March 2011 Earthquake and Tsunami The Department of War (DOW) established the Operation Tomodachi Registry (OTR) following the March 11, 2011, earthquake and tsunami in Japan. These events caused severe damage to the Fukushima Daiichi Nuclear Power Station, which resulted in the release of radiation into the environment. To obtain information on who is included in the registry, contact the OTR staff through [DoD’s Environmental Health Surveillance Registries site](), under the OPERATION TOMODACHI tab. **Important:** * When completing the online form to contact the OTR staff, do not include any PII. * Radiation dosage evidence found in the on-line registry must be * filed in the claims folder, or * uploaded into the electronic claims folder (eFolder) and properly labeled as, for example, _RAD dose assessments for prostate cancer claim_. ### VIII.iii.4.B.3.e. Requesting Verification of Exposure to Ionizing Radiation by Reason of Military Duties For a claim based on exposure to ionizing radiation by reason of the nature of military duties, such as a radiologist or an x-ray technician, prepare a separate Personnel Information Exchange System (PIES) request to obtain a copy of the record of occupational exposure to ionizing radiation from the * Official Military Personnel File * service treatment records (STRs), or * any other record that contains radiation exposure information. **Notes:** * The record of occupational exposure to ionizing radiation used by the service departments include * _DD Form 1141, Record of Occupational Exposure to Ionizing Radiation_ * NAVMED 6470/10, _Record of Occupational Exposure to Ionizing Radiation_ , and NAVMED 6470/11, _Record of Occupational Exposure to Ionizing Radiation From Internally Deposited Radionuclides_ , for the Navy, and * the equivalent _NRC Form 5_. * Refer a request for information on human radiation experiments to the appropriate service department point of contact identified in M21-1, Part VIII, Subpart iii, 4.B.3.f. ### VIII.iii.4.B.3.f. Obtaining Records of Occupational Exposure to Radiation From the Veteran’s Service Department Each branch of service maintains a record of its service members’ occupational exposure to radiation. If evidence of occupational radiation exposure, such as a _DD Form 1141, NAVMED 6470/10_ , _NAVMED 6470/11,_ or _NRC Form 5,_ cannot be found in the Veteran’s records or obtained through PIES, prepare a written request for the record. Include the identifying data as required by M21-1, Part VIII, Subpart iii, 4.B.3.b in the request and send it to the appropriate service department. The table below lists the addresses and telephone numbers to use to obtain records of occupational exposure to radiation from each branch of service.| **Branch of Service**| **Address and Telephone Number** Air Force| ** _Address_** :Surgeon General of the Air Force Air Force Medical Support Agency (AFMSA) ATTN: SG3PB (Radiation Health) Scott A. Nemmers7700 Arlington Blvd Suite 5151 Falls Church, VA 22042-5151** _Telephone_** : (703) 681-7876** _E-mail_** : _[scott.a.nemmers.mil@mail.mil]()_ Army| ** _Address_** :US ARMY Dosimetry Center ATTN: AMSAM-TMD-SD (Courtney Smith) Building 5417 Redstone Arsenal, AL 35898** _Telephone_** : * (256) 876-2412, and * (210) 876-1786. **Fax:** (256) 876-3816** _E-mail_** :_[courtney.d.smith.civ@mail.mil]()_ Navy and Marine Corps| ** _Address_** :Naval Dosimetry Center ATTN: NARER Officer Building 4/6Bethesda, MD 20889-5603** _Telephone_** : (301) 319-4927 Coast Guard| ** _Address_** :CDR Gerald Taylor Commandant (CG-112), Occupational Medicine Physician 2703 Martin Luther King Jr Ave SE Washington, DC 20593-7902** _Telephone_** : (202) 475-5211** _E-mail_** : _[gerald.n.taylor@uscg.mil]()_ ** _Note_** : The e-mail addresses listed above are not encrypted. To prevent a security violation, do not send out any PII to the e-mail addresses. ### VIII.iii.4.B.3.g. Obtaining Records of Occupational Exposure to Radiation From the AEC There are instances where military personnel were assigned to the Atomic Energy Commission (AEC) laboratories during the testing period and badged by the AEC facility. Include a search of the DoE central records repository as a part of a comprehensive search for records of occupational exposure to radiation. Send requests for such a search to the following address:**Address for records from 1945 through present only:** U.S. Department of Energy National Nuclear Security Administration – Nevada Site Office P.O. Box 98518 Las Vegas, NV 89193-8518** _Telephone_** : (702) 295-3521** _Address for records from 1987 to present_** :U.S. Department of Energy Office of Health and Safety Stop AU-10/GTN ATTN: Dr. Patricia Worthington 1000 Independence Ave SW Washington, DC 20585** _Telephone_** : (301) 903-5926 ### VIII.iii.4.B.3.h. Obtaining Records of Occupational Exposure to Radiation From USAPHC The U.S. Army Public Health Command (USAPHC) military exposure surveillance library documents occupational and environmental exposures at military base camps through [Periodic Occupational Environmental Monitoring Summaries]() (POEMS).The summaries * describes the types of occupational and environmental health exposures identified during that time and provides a characterization of the base camp population’s exposures and potential associated health effects * are available as they are produced and document the exposure for many of the large troop locations in Iraq and Afghanistan * are not medical disability documents and _do not_ describe any specific person’s unique exposure experience, and * were not created prior to 1999. ### VIII.iii.4.B.3.i. Developing Claims for SC Based on NRI Therapy Adjudicate claims for SC based on in-service treatment involving nasopharyngeal radium irradiation (NRI) therapy under the provisions of [38 CFR 3.311]() with dose estimates prepared by the Under Secretary for Health (USH).Review STRs, clinical records, and dental records for any annotation of radium therapy. Request STRs that are not already on file. In addition, request * information concerning radiation exposure from standard sources, and * the following data from the Veteran: * the date the NRI treatment was administered, and * the place where the NRI treatment was administered, including the specific base and medical facility. **Note:** Even when STRs do verify NRI treatments, they may not contain detailed records of radiation doses during treatment. Refer the claim to Compensation Service if NRI treatment is verified but dose information is not present. Compensation Service will determine whether a dose estimate may be provided by the Veterans Health Administration.**References:** For more information on * referring claims to Compensation Service, see * M21-1, Part VIII, Subpart iii, 4.B.5, and * [M21-1, Part X, Subpart v, 1.A](), and * NRI therapy, see the VA Fact Sheet, [_Nasopharyngeal Radium Therapy_](), dated September 1997. ## 4. Obtaining Dosimetry Information This topic contains information on obtaining dosimetry information, including * obtaining dosimetry information * from DTRA for atmospheric tests, Hiroshima or Nagasaki occupation, or POW interment in Japan, and * for individuals outside the scope of DTRA’s Nuclear Test Personnel Review (NTPR) program * data to include in the letter to the service department requesting dosimetry information * handling claims based on radiation exposure in or around Camp Hanford, Washington * definitions of * not exposed, and * zero dose, and * handling dose estimates * of not exposed or zero, and * submitted on behalf of the claimant. December 4, 2015 ### VIII.iii.4.B.4.a. Obtaining Dosimetry Information From DTRA for Atmospheric Tests, Hiroshima or Nagasaki Occupation, or POW Interment in Japan For claims involving U.S. atmospheric nuclear weapons tests, occupation of Hiroshima or Nagasaki, or POW interment in Japan, send a request for dosimetry information to theDefense Threat Reduction Agency (DTRA) ATTN: RD-NTSD Stop 6201 8725 John J. Kingman Rd. Ft. Belvoir, VA 22060-6201The letter to DTRA must contain the following information: * the applicable regulation ([38 CFR 3.309(d)]() or [38 CFR 3.311]()) * VA claim number * Veteran’s and claimant’s names, addresses, and telephone numbers * Veteran’s branch of service, service number, and Social Security number * specific organization or unit of assignment at the time of exposure * dates of assignment to nuclear test site or Hiroshima/Nagasaki * full description of duties and activities while a participant in a radiation-risk activity, and * specific disease being claimed (Specify the type of cancer and the organ involved. If skin cancer is claimed, also specify the site of each lesion and date of diagnosis.) The letter must include a copy of * the claimant’s response to the request for information about the Veteran’s exposure to ionizing radiation * the Veteran’s statement(s) about the nature of their exposure to radiation * any military documents supporting participation in a radiation-risk activity, such as a _DD Form 214_ ,_Certificate of Release of Discharge from Active Duty_ , or military orders * the medical or scientific evidence showing a causal relationship between the claimed disease and exposure to radiation, if the disease is not among those listed under [38 CFR 3.311(b)(2),]() and * the Board of Veterans’ Appeals (BVA) remand, if applicable. **Note:** DTRA only provides confirmation of participation and radiation doses for individuals involved in U.S. atmospheric nuclear testing (1945 to 1960) and the occupation forces of Hiroshima/Nagasaki. **Reference:** For more information on obtaining dosimetry information in cases not handled by DTRA, see M21-1, Part VIII, Subpart iii, 4.B.4.b. ### VIII.iii.4.B.4.b. Obtaining Dosimetry Information for Individuals Outside the Scope of DTRA’s NTPR Program Use the table below to determine the appropriate action to take for individuals outside the scope of DTRA’s Nuclear Test Personnel Review (NTPR) program. | **If the claimant alleges exposure to radiation ...**| **Then ...** * through a military occupation, such as x-ray technicians, reactor plant workers, and workers in nuclear medicine, radar, and radiography, and * the Veteran’s military records document the military occupation * send a letter requesting dosimetry information to the appropriate service department point of contact listed in M21-1, Part VIII, Subpart iii, 4.B.3.f, and * once dosimetry information is received, refer the claim to Compensation Service for referral to the USH, who is responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. * from medical diagnostic procedures or during medical treatment, and * the Veteran’s STRs support this exposure | refer the claim to Compensation Service for assistance. **References:** For more information on * what to include in the letter to the service department point of contact, see M21-1, Part VIII, Subpart iii, 4.B.4.c, and * referring claims to Compensation Service, see M21-1, Part VIII, Subpart iii, 4.B.5. ### VIII.iii.4.B.4.c. Data to Include in the Letter to the Service Department Requesting Dosimetry Information The letter to the service department point of contact requesting dosimetry information should include the following: * the location and dates of the Veteran’s service * the Veteran’s military unit * the Veteran’s military occupational specialty (MOS) * the place(s) where the Veteran worked * a list of radioactive materials the Veteran worked with (source, strength, and type) * the number of hours per day the Veteran spent working with radioactive materials, and the number of days, weeks, or months of the assignment the Veteran worked with radioactive sources, and * the number of hours per day the Veteran spent working with radiation-producing devices, and the number of days, weeks, or months of the assignment the Veteran worked with radiation-producing devices. The letter should also enclose a copy of any available * training records associated with radiation training * radiation dose records provided by the Veteran, and * medical records showing treatment for any occupational radiation injuries or other records documenting radiation exposure. ### VIII.iii.4.B.4.d. Handling Claims Based on Radiation Exposure in or Around Camp Hanford, Washington Use the table below to determine how to handle claims based on radiation exposure in or around Camp Hanford, Washington.| **Step**| **Action** 1| Obtain the Veteran’s STRs and service personnel records. 2| Review the service records to * confirm the Veteran’s presence in or around Camp Hanford * determine the duration of this duty assignment, and * ascertain whether a _DD Form 1141_ or other official record of radiation exposure is available. 3| Refer the claim to Compensation Service for assistance when * the Veteran’s presence in or around Camp Hanford is confirmed, and * attempts to obtain information about the Veteran’s exposure to radiation, whether successful or unsuccessful, have been made and documented in the claims folder. **Reference:** For more information on referring claims to Compensation Service, see M21-1, Part VIII, Subpart iii, 4.B.5. ### VIII.iii.4.B.4.e. Definition: Not Exposed ** _Not_** **_exposed_** means * there was no potential for exposure to radiation, and * the Veteran did not enter a radiological environment. ### VIII.iii.4.B.4.f. Definition: Zero Dose ** _Zero_** **_dose_** means there was _potential_ for exposure to radiation, but the dose received was zero. ### VIII.iii.4.B.4.g. Handling Dose Estimates of Not Exposed or Zero If the dose estimate received from DTRA is not exposed or zero, then do _not_ submit the case to Compensation Service.Refer these claims to the rating activity for a decision on the issue of SC for residuals of radiation exposure. ### VIII.iii.4.B.4.h. Handling Dose Estimates Submitted on Behalf of the Claimant Under [38 CFR 3.311(a)(3)](), if a dose estimate is submitted on behalf of the claimant, the rating activity must review the estimate to determine whether it is * from a credible source and prepared by a person or persons who are certified in the field of health physics, nuclear medicine, or radiology * based on analysis of the facts and circumstances of the particular claim, and * at least double the dose provided by official military records. **Important:** If the above criteria are met, refer the claim to Compensation Service for assistance.**Reference:** For more information on referring claims to Compensation Service, see M21-1, Part VIII, Subpart iii, 4.B.5. ## 5. Referring Claims to Compensation Service This topic contains information on referring claims to Compensation Service, including * consideration of the claim by the rating activity * process for referring claims to Compensation Service * required memorandum for referral to Compensation Service of a 38 CFR 3.311 claim, and * procedures for referring claims to Compensation Service. October 6, 2021 ### VIII.iii.4.B.5.a. Consideration of the Claim by the Rating Activity If the rating activity determines that at least one of the requirements of [38 CFR 3.311(b)(1)]() is _not_ met, deny the claim by a formal rating decision on the grounds that the disease did not result from exposure to ionizing radiation. Do _not_ refer such cases to Compensation Service unless all of the requirements are met.The rating activity sends claims to Compensation Service for additional development _only if_ the * three requirements under [38 CFR 3.311(b)(1)]() are met, and * development under this section, M21-1, Part VIII, Subpart iii, 4.B, is complete. ### VIII.iii.4.B.5.b. Process for Referring Claims to Compensation Service The table below describes the process for referring a claim based on exposure to ionizing radiation to Compensation Service._**Note**_ : It is not necessary to obtain the concurrence of the VSCM, PMCM, or their designee prior to referring a radiation claim to Compensation Service.| **Stage**| **Who Is Responsible**| **Description**| **References** 1| RO| * Refers the claim to Compensation Service for review once * the three requirements of the initial review have been satisfied, and * development has been completed, including receipt of a response from DOW regarding exposure to radiation, and * notifies the claimant of the referral to Central Office. | For more information on * what to include in the memorandum for a referral, see M21-1, Part VIII, Subpart iii, 4.B.5.c, and * procedures for referring claims to Compensation Service, see M21-1, Part VIII, Subpart iii, 4.B.5.d. 2| Compensation Service| * Reviews the claim * determines if a request for a medical opinion from the USH, and/or referral of the claim to an outside consultant is necessary, and * adds a note in VBMS if a referral is made to the USH. | For more information on referrals by Compensation Service to * the USH, see [38 CFR 3.311(c)](), and * an outside consultant, see [38 CFR 3.311(d)](). 3| Compensation Service| Provides the RO with * an opinion recommending either a grant or denial of the claim, and * the written response of both the USH and/or outside consultant (if solicited). | \--- ### VIII.iii.4.B.5.c. Required Memorandum for Referral to Compensation Service of a 38 CFR 3.311 Claim When referring a claim based on exposure to ionizing radiation to Compensation Service prepare a memorandum in the format shown below.| **DEPARTMENT OF VETERANS AFFAIRS**[RO Name]**[RO Address]** **[Date]** Executive Director In Reply Refer To:Compensation Service (214D) [**RO #]** Department of Veterans Affairs **[File Number]** Central Office **[Veteran’s Name]** 810 Vermont Ave. NWWashington, DC 20420 **SUBJECT** : _Request for an Advisory Opinion for radiation review per 38 C.F.R. 3.311_. **QUESTION AT ISSUE** : _Is it likely that the claimed diseases are a result of the Veteran’s exposure to ionizing radiation while in service?_ **VETERAN INFORMATION** 1. **[Enter pertinent service information.]** 2. **[Enter age at the time of exposure.]** 3. **[Enter sex.]** 4. **[Enter race.]** 5. **[Enter date of birth and date of death (if pertinent).]** **Example:** 1. _Served in the U.S. Navy from January 22, 1963, to August 26, 1983._ 2. _Exposure occurred from ages 34 to 36._ 3. _Male_ 4. _Caucasian_ 5. _DOB: October 14, 1946_ **CLAIMED DISEASES** 1. **[Enter name/description of the claimed disease(s), including the specific cell type and stage, if known. If skin cancer is claimed, specify the site of each lesion, type of cancer, and date of diagnosis.]** 2. **[Enter date the claimed disease(s) first manifested (date of diagnosis) and the time lapse between exposure and the onset of the disease(s).]** 3. **[Enter whether the claimed disease(s) are listed under 38 C.F.R. 3.311(b)(2). If not, list the medical and/or scientific evidence that supports a causal relationship between the disease(s) and exposure to radiation as required per 38 C.F.R. 3.311(b)(4).]** **Example:** 1. _Renal cell carcinoma of the left kidney._ 2. _Diagnosed with renal carcinoma in 2009, at age 63, and approximately 28 years after initial exposure to ionizing radiation in service._ 3. _Kidney cancer is noted as a “radiogenic disease” under 38 C.F.R. 3.311(b)(2)._ **EXPOSURE INFORMATION** 1. **[Enter date _Radiation_ _Risk Activity Information Sheet_ (or equivalent) received.]** 2. **[Enter how was the Veteran was exposed to ionizing radiation.** * **Result of participation in a radiation-risk activity (atomic) as defined in 38 C.F.R. § 3.309(d)(3), or** * **Exposure to ionizing radiation by reason of military duties (Occupational) as defined in 38 C.F.R. § 3.311, or** * **Other (please explain).]** 3. **[Enter circumstances surrounding the radiation exposure, including dates of the exposure (mm/dd/yr).]** **Example:** 1. _Radiation Risk Activity Information Sheet received on May 16, 2020._ 2. _The Veteran was exposed to ionizing radiation by reason of military duties (Occupational) as defined in 38 C.F.R. 3.311._ 3. _The Veteran was exposed to radiation while performing his military duties as a weapons instructor, which included inspecting nuclear weapons, from August 1980 to November 1982._ **DOSE INFORMATION AS SPECIFIED IN 38 C.F.R. 3.311(a)(2)** : ** [Provide the following information.]** 1. **[List the documentation available in the STRs, personnel records, and/or other records (DD Form 1141, NAVMED 6470/10, NAVMED 6470/11, NRC Form 5, AF Form 1527, etc). If not available, please enter _None_.]** 2. **[List the dose information provided by** * * **DTRA (for exposure as a result of participation in a radiation-risk activity/atomic), or** * **the applicable service department (for exposure as a result of military duties and/or occupational exposure), or** * **other source(s) (U.S. Department of Energy, medical professional/etc).]** **Example:** 1. _DD Forms 1141 document monitoring for exposure to ionizing radiation for periods beginning June 30, 1980 to November 30, 1982, with a Total Lifetime dose estimate as 00.066 rem. _ 2. _The Naval Dosimetry Center provided a dose estimate on August 11, 2020 of:_ _DDE-Photon 00.036_ _DDE-Neutron 00.030 _ **ADDITIONAL INFORMATION** 1. **[Enter Veteran’s relevant family medical history.]** 2. **[Enter employment history (military and post-military).]** 3. [Enter Veteran’s history of exposure to known carcinogens or radiation before and after service, including smoking history and, if claiming skin cancer, exposure to the sun and location of the cancer.] 4. **[Enter any other information relevant to determining the cause of the disease.]** 5. **[If a specific request was made by BVA remand, please indicate the date of the remand and the information requested.]** **Example:** 1. _The Veteran’s father had prostate cancer, and a sister had ovarian cancer._ 2. _After military service, the Veteran worked as a police officer until retirement._ 3. _The Veteran is a former smoker, having smoked from 1985 to 2001. The only other reported radiation exposure after service was from 2009 to 2010, when the Veteran received nine rounds of radiation treatment for his renal cancer._ 4. _The Veteran submitted a medical opinion from Dr. John Smith, Oncologist, dated November 8, 2019. The opinion provides a positive association between the Veteran’s exposure to radiation while in service and his renal cancer._ **_**_Important_**_** : * Each malignant skin neoplasm will be considered as a separate primary cancer (such as basal cell carcinoma or squamous cell carcinoma), unless it is noted in the medical record that the neoplasm is a metastatic lesion. * For the USH to prepare a dose estimate and provide an opinion, the date of diagnosis and the location (such as arm, neck, or back) for each skin cancer must be indicated. ### VIII.iii.4.B.5.d. Procedures for Referring Claims to Compensation Service Follow the procedures in the table below to request Compensation Service assistance with a radiation claim. **Important:** Prior to sending a request for Compensation Service assistance, * all documents in the claims folder must be scanned into VBMS * the eFolder must contain a copy of all available pathology reports that identify the type of cancer and the organ involved, and * all relevant records must be annotated or bookmarked for easy identification. | **Step**| **Action** 1| Complete a memo requesting Compensation Service review with the information shown in M21-1, Part VIII, Subpart iii, 4.B.5.c. 2| Upload the memo to the Veteran’s eFolder. 3| Refer the claim to Compensation Service based on the instructions in the following table. | **If the claim is …**| **Then …** part of the NWQ| assign the * _Compensation Service Review – Radiation_ special issue indicator to the contention at issue, and * _Compensation Service Case Review_ tracked item. outside the NWQ| * assign the * _Compensation Service Review – Radiation_ special issue indicator to the contention at issue, and * _Compensation Service Case Review_ tracked item, and * manually broker the claim to _Compensation Service (Washington DC)_. 4| Document the action taken by associating a VBMS eFolder note indicating the claim has been referred to Compensation Service for an opinion regarding radiation exposure. **References:** For more information on * shipping documents for scanning, see [M21-1, Part II, Subpart i, 1.B]() * annotating and bookmarking records in the eFolder, see the _VBMS Core User Guide_ * uploading documents to the eFolder, see [M21-1, Part II, Subpart ii, 2.A.1.b]() * adding special issues in VBMS, see * the _VBMS Core User Guide_ , and * [M21-1, Part III, Subpart i, 2.F.2.f and g]() * adding a tracked item, see the _VBMS Core User Guide_ , and * associating an eFolder note, see [M21-1, Part II, Subpart ii, 2.A.1.c](). ## 6. Exhibit 1: Exposure to Nuclear Radiation and DoD Secrecy Agreement September 5, 2008 ### VIII.iii.4.B.6.a. Exposure to Nuclear Radiation and DoD Secrecy Agreement The _Exposure to Nuclear Radiation and DoD Secrecy Agreement_ is shown below.| **Exposure to Nuclear Radiation and Department of Defense Secrecy Agreement** THE SECRETARY OF DEFENSEWASHINGTON THE DISTRICT OF COLUMBIA13 FEB 1996 MEMORANDUM FOR SECRETARIES OF THE MILITARY DEPARTMENTS CHAIRMAN OF THE JOINT CHIEFS OF STAFF UNDER SECRETARIES OF DEFENSE DIRECTOR, DEFENSE RESEARCH AND ENGINEERING ASSISTANT SECRETARIES OF DEFENSE GENERAL COUNSEL OF THE DEPARTMENT OF DEFENSE INSPECTOR GENERAL OF THE DEPARTMENT OF DEFENSE DIRECTOR, OPERATIONAL TEST AND EVALUATION ASSISTANTS TO THE SECRETARY OF DEFENSE DIRECTOR, ADMINISTRATION AND MANAGEMENT DIRECTORS OF THE DEFENSE AGENCIES SUBJECT: Exposure to Nuclear Radiation and Secrecy Agreement: Inquiries continue to be received regarding the appropriate action that should be taken to release Veterans from secrecy obligations so they may justify medical treatment for conditions allegedly arising from exposure to nuclear radiation. Congressman Bill Richardson specifically requested a public statement be issued announcing personnel are relieved of any security obligation they may have incurred in connection with their military involvement in nuclear testing to establish the validity of a service-connected disability. In the interest of fairness to the many Veterans who have so honorably served our country, in coordination with the Department of Energy, I hereby authorize Veterans seeking to establish a medical disability in connection with exposure to nuclear radiation to divulge to the Department of Veterans Affairs the name and location of their command, duties performed, dates of service, and related information necessary to validate exposure to nuclear radiation. This authorization does not relieve Veterans of responsibility for continuing to protect specific technical information that could contribute to the development of a weapon of mass destruction or the application of nuclear technology. /s/William J. Perry Cc: Honorable Bill Richardson U.S. House of Representatives Secretary of Energy Secretary of Veterans Affairs