Part VIII, Subpart i, Chapter 3, Section CEligibility and Development for Chapter 18 Benefits

Revised March 2, 2020

VIII.i.3.C.1.a#Application Requirement for Chapter 18 Benefits

A claimant seeking benefits associated with spina bifida and other covered birth defects may use VA Form 21-0304, Application for Benefits for a Qualifying Veteran’s Child Born With Disabilities. Whether another filing satisfies Department of Veterans Affairs (VA) claim criteria is determined by 38 CFR 3.151 and 38 CFR 3.155.Reference: For more information about Denver Regional Office (RO) jurisdiction in Chapter 18 claims and determinations see M21-1, Part VIII, Subpart i, 3.A.1.

VIII.i.3.C.1.b#Initial Review of Eligibility Requirements Before Undertaking Development

Do not develop for additional evidence from the claimant if it can be determined immediately that the claimant cannot meet all the qualifying requirements for

• service of the Veteran parent in
  • Vietnam
  • Korea, or
  • Thailand, and
• relationship to the Veteran.

When confirmation cannot be obtained that the above elements of basic eligibility have been met, prepare an administrative denial and notify the claimant. Important: When evidence received demonstrates that the disability in question is not a qualifying disability, do not develop for additional medical evidence. Refer to the rating activity any claim found to require

• a determination as to the existence of a qualifying disability, or
• denial due to immediate recognition that the claimant has only spina bifida occulta.

References: For more information on

• Denver RO jurisdiction in Chapter 18 claims and determinations see M21-1, Part VIII, Subpart i, 3.A.1
• development for medical evidence of a disability following rating activity review, see M21-1, Part VIII, Subpart i, 3.C.2.a, and
• decision-making by the authorization activity, see
  • M21-1, Part VIII, Subpart i, 3.D.1.a, and
  • M21-1, Part VIII, Subpart i, 3.E.

VIII.i.3.C.1.c#Example 1: When Additional Development Is Not Necessary for a Spina Bifida Claim

Situation :A child of a Veteran who served only during the Gulf War applies for spina bifida benefits. Action: Send a denial letter without developing for the nature of the disability or relationship evidence. Rationale: It is immediately apparent that the parent of the claimant cannot meet Vietnam, Korea, or Thailand service requirements for Chapter 18 benefits.

VIII.i.3.C.1.d#Example 2: When Additional Development Is Not Necessary for a Chapter 18 Claim

Situation: A child with spina bifida occulta applies for Chapter 18 benefits. Action: Refer the case to the rating activity for a rating decision denying the claim without developing for Vietnam, Korea, or Thailand service requirements and relationship evidence. Rationale: The claimant does not have a qualifying spina bifida disability that meets the requirements for Chapter 18 benefits. A rating decision is required to implement a denial of benefits when the child has spina bifida occulta or no spina bifida condition exists. Note: In addition to denying the claim for spina bifida benefits, the rating activity will address entitlement to benefits for other covered birth defects under 38 CFR 3.815 via annotation of the Codesheet for subsequent administrative denial.

VIII.i.3.C.1.e#Example 3: When Additional Development Is Not Necessary for a Chapter 18 Claim

Situation: A child submits a claim for multiple myeloma. Medical evidence confirms a diagnosis of multiple myeloma. Only the father has qualifying service. Action: The development activity refers the claim to the rating activity for a determination regarding VA’s duty to develop for medical evidence in accordance with 38 CFR 3.159(d). The rating activity will complete a formal rating decision denying the claim. Rationale: The claimant does not have a qualifying spina bifida disability that meets the requirements for Chapter 18 benefits. A rating decision is required to implement a denial of benefits when the child does not have a qualifying disability. Note: In addition to denying the claim for spina bifida benefits, the rating activity must also include an annotation on the Codesheet to address entitlement to benefits for other covered birth defects under 38 CFR 3.815 for subsequent denial by the authorization activity.

VIII.i.3.C.1.f#Character of Discharge Exception for Chapter 18 Eligibility

Eligibility for Chapter 18 benefits is not dependent on character of discharge. That is, regardless of the characterization of service of the Veteran parent, individuals may receive Chapter 18 benefits if the specific service and relationship requirements are met. Reference: For more information on character of service criteria for entitlement to Chapter 18 benefits, see

• 38 USC 1831(4) for Vietnam Veterans
• 38 USC 1821(c) for Korea Veterans, and
• 38 USC 1822(c) for Thailand Veterans.

2Development Process Overview

Revised March 2, 2020

VIII.i.3.C.2.a#Development Process for Chapter 18 Benefits

The table below describes the responsibilities of the development activity during the stages of the development process for Chapter 18 benefits.

Important: Refer to the rating activity for a decision only as provided by M21-1, Part VIII, Subpart i, 3.C.1.b and M21-1, Part VIII, Subpart i, 3.D.1.a.

Reference: For more information on Denver RO jurisdiction in Chapter 18 claims and determinations, see M21-1, Part VIII, Subpart i, 3.A.

3Vietnam Service Requirements and Development

Revised December 31, 2019

VIII.i.3.C.3.a#Vietnam Service Requirement

A Vietnam Veteran is a person who performed active military, naval, or air service in the Republic of Vietnam (RVN) during the period

• beginning on January 9, 1962, and ending on May 7, 1975, for the purpose of spina bifida benefits eligibility under 38 CFR 3.814(c)(1), and
• beginning on February 28, 1961, and ending on May 7, 1975, for the purpose of other covered birth defect benefits eligibility under 38 CFR 3.815(c)(1).

Notes:

• Service in RVN generally requires service on land within the country borders, on inland waterways, or in the eligible offshore waters of RVN, including specific bays and harbors.
• The dates of covered RVN service for spina bifida benefits eligibility in 38 CFR 3.814(c)(1) correspond with the dates to which the presumption of exposure to herbicide agents in RVN applies, as discussed in 38 CFR 3.307(a)(6)(iii).
• The dates of covered RVN service for eligibility for benefits for other covered birth defects benefits in 38 CFR 3.815(c)(1) correspond with the dates in the definition of the Vietnam era in 38 CFR 3.2(f).

References: For more information on

• Vietnam service requirements for
  • spina bifida benefits eligibility, see 38 CFR 3.814(c)(1), and
  • other covered birth defects benefits eligibility, see 38 CFR 3.815(c)(1), and
• developing for RVN service, see
  • M21-1, Part VIII, Subpart i, 1.A.1, and
  • M21-1, Part VIII, Subpart i, 1.B.2.

4Korea Service Requirements and Development

This topic contains information on Korea service requirements and development, including

• specific Korea service requirements
• presumption of herbicide exposure for Veterans with covered service in Korea, and
• establishing herbicide exposure.

Revised March 2, 2020

VIII.i.3.C.4.a#Specific Korea Service Requirements

Effective December 16, 2003, the Veterans Benefits Act of 2003, as codified at 38 U.S.C. 1821, provides benefits and services to children born with spina bifida who are the natural children of Veterans with covered service in Korea.Covered service in Korea requires

• active military, naval, or air service in or near the Korean demilitarized zone (DMZ) during the period beginning on September 1, 1967, and ending on August 31, 1971, and
• exposure to an herbicide agent during such service as determined by VA in consultation with the Department of War (DOW).

VIII.i.3.C.4.b#Presumption of Herbicide Exposure for Veterans With Covered Service in Korea

Under 38 U.S.C. 1821(c) and 38 CFR 3.814(c)(2), presume exposure to an herbicide agent for Veterans who served

• between September 1, 1967, and August 31, 1971, and
• in a unit that VA or DOW has determined to have operated in an area in or near the Korean DMZ.

Exception: The presumption of exposure that arises from the showing above will be rebutted where there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service.Notes:

• For a list of units or other military entities that DOW has identified as operating in or near the Korean DMZ during the qualifying time period, see M21-1, Part VIII, Subpart i, 1.B.4.c.
• The provisions of 38 CFR 3.814(c)(2) have been amended twice to revise the applicable dates for the concession of exposure to herbicides on a factual basis for Veterans who served in specific designated units operating in or near the Korean DMZ.
  • Before February 24, 2011, the applicable dates were April 1968 to July 1969.
  • Before amendment by Public Law (PL) 116-23, Blue Water Navy Vietnam Veterans Act , on January 1, 2020, the applicable dates were April 1, 1968, to August 31, 1971.

VIII.i.3.C.4.c#Establishing Herbicide Exposure

Use the table below to establish exposure to herbicides in claims based on Korea service.

Reference: For more information on requesting records from RAR in support of a Korean DMZ herbicide claim, see M21-1, Part VIII, Subpart i, 1.B.4.d.

5Thailand Service Requirements and Development

This topic contains information on Thailand service requirements and development, including

• specific Thailand service requirements, and
• establishing herbicide exposure for Veterans with covered service in Thailand.

Revised September 15, 2025

VIII.i.3.C.5.a#Specific Thailand Service Requirements

Effective January 1, 2020, PL 116-23 , as codified at 38 U.S.C. 1822, provides benefits and services to children born with spina bifida who are the natural children of Veterans with covered service in Thailand. Covered service in Thailand requires

• active military, naval, or air service in Thailand during the period beginning on January 9, 1962, and ending on May 7, 1975, and
• exposure to an herbicide agent during such service as determined by VA in consultation with DOW.

Reference: For more information on developing claims based on herbicide exposure in Thailand, see M21-1, Part VIII, Subpart i, 1.B.2.

VIII.i.3.C.5.b#Establishing Herbicide Exposure for Veterans With Covered Service in Thailand

For the purpose of establishing herbicide exposure for entitlement to spina bifida benefits, covered service in Thailand means service in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on May 7, 1975, without regard to where on the base the Veteran was located or what military job specialty the Veteran performed. Reference : For more information on historical policies for concession of herbicide exposure in Thailand, see M21-1, Part VIII, Subpart i, 1.A.2.b.

6Date of Conception Considerations

This topic contains information on date of conception considerations in claims involving Vietnam, Korea, or Thailand service, including

• requirement for conception during or after qualifying service, and
• estimating date of conception and taking next action.

Revised December 31, 2019

VIII.i.3.C.6.a#Requirement for Conception During or After Qualifying Service

To be eligible for Chapter 18 benefits, the individual must have been conceived after the date on which the Veteran parent first had qualifying service in RVN, Korea, or Thailand.

VIII.i.3.C.6.b#Estimating Date of Conception and Taking Next Action

Follow the steps in the table below to estimate the date of conception and determine the next action to take.

Note: Questions about the child’s date of conception will be resolved by an administrative decision.

7Relationship Requirements and Developing for Relationship Evidence

This topic contains information on relationship requirements and developing for relationship evidence, including

• general relationship eligibility requirements of an individual
• definition of natural child
• effect of parent sex
• development for relationship evidence for
  • spina bifida, and
  • other covered birth defects.

Revised December 31, 2019

VIII.i.3.C.7.a#General Relationship Eligibility Requirements of an Individual

To be eligible for Chapter 18 benefits, the individual must be the natural child of a Veteran with qualifying service.Important: VA requires more than a written statement to establish parentage. A birth certificate will always be required.Note: Specific relationship requirements exist, separately, for spina bifida benefits and other covered birth defects benefits.References: For more information on the

• specific relational requirements for benefits for
  • spina bifida, see M21-1, Part VIII, Subpart i, 3.C.7.d, and
  • other covered birth defects, see M21-1, Part VIII, Subpart i, 3.C.7.e
• Vietnam service requirement for benefits for spina bifida or other covered birth defects, see M21-1, Part VIII, Subpart i, 3.C.3, and
• the service requirements for spina bifida benefits in
  • Korea, see M21-1, Part VIII, Subpart i, 3.C.4, and
  • Thailand, see M21-1, Part VIII, Subpart i, 3.C.5.

VIII.i.3.C.7.b#Definition: Natural Child

A parent’s natural child is the parent’s biological child, regardless of the child’s

• age
• marital status, or
• dependency status.

An individual cannot become eligible for Chapter 18 benefits through an adoptive parent. Only a biological parent of an adopted individual can make that individual eligible.

VIII.i.3.C.7.c#Effect of Parent Sex

Use the table below to determine the effect of the Veteran parent’s sex on a child’s entitlement to benefits.

VIII.i.3.C.7.d#Development for Relationship Evidence for Spina Bifida

Review the parents’ names on the birth certificate in the Veteran’s claims folder. Ensure the birth certificate lists the Veteran(s) as the parent of the claimant.Notes:

• A birth certificate with the parents’ names on it or a photocopy of the birth certificate is considered sufficient evidence to verify the claim.
• If the child lives with adoptive parents, evidence is still required to show that one of the biological parents is a Vietnam Veteran or a Veteran meeting the specific Korea or Thailand service requirements.
• In circumstances where paternity is an issue (for example, the birth certificate shows no father or shows someone other than the Veteran father as the informant),
  • request the types of evidence specified in 38 CFR 3.209 and 38 CFR 3.210 to establish parentage, and
  • note that the provisions of 38 CFR 3.204(a)(1) for accepting only a written statement are not applicable to these cases per 38 CFR 3.814(c)(3).

VIII.i.3.C.7.e#Development for Relationship Evidence for Other Covered Birth Defects

Review the mother’s name on the birth certificate in the Veteran’s claims folder. Ensure that the birth certificate lists the Veteran as the mother of the claimant.Note: A birth certificate with the mother’s name on it or a photocopy of the birth certificate is considered sufficient evidence to verify the claim.

8Disability Requirement for Spina Bifida Benefits

Revised December 12, 2018

VIII.i.3.C.8.a#Qualifying Types of Spina Bifida for Eligibility Under Chapter 18

Spina bifida benefits are payable for all types of spina bifida except spina bifida occulta.The term spina bifida refers to a defective closure of the bony encasement of the spinal cord but does not include other neural tube defects, such as encephalocele and anencephaly (VAOPGCPREC 5-1999).Note: The rating activity is responsible for assessing disability level for spina bifida.

9Disability Requirement for Other Covered Birth Defects

This topic contains information on the disability requirement for other covered birth defects, including

• definition of birth defect
• limitation on birth defects and conditions covered
• covered birth defects for benefits under Chapter 18
• birth defects not covered due to
  • familial disorders
  • birth-related disorders, chromosomal disorders, or congenital malignancies, and
  • lack of permanent physical or mental disability, and
• conditions not covered due to
  • birth-related injury or fetal/neonatal infirmity, and
  • developmental etiology.

Revised October 20, 2016

VIII.i.3.C.9.a#Definition: Birth Defect

A birth defect is an abnormality of

• structure
• function, or
• metabolism.

The abnormality may be

• genetically determined, or
• a result of environmental influence during embryonic or fetal life.

VIII.i.3.C.9.b#Limitation on Birth Defects and Conditions Covered

Not all birth defects and conditions qualify an individual for Chapter 18 benefits. VA will only cover birth defects that are potentially linked to a female Veteran’s Vietnam service and have resulted in a permanent mental or physical disability.Birth defects and conditions that have been excluded fall under one of the categories listed below. The condition

• has been determined by VA not to be associated with Vietnam service by reason of its classification as a
  • chromosomal abnormality, or
  • congenital malignancy
• is related to a familial or hereditary condition of the parent
• is likely to have occurred due to actions during the prenatal or postnatal period, including a
  • birth-related injury, or
  • fetal or neonatal infirmity with well-established causes
• is a developmental disorder rather than a birth defect, or
• does not result in a permanent mental or physical disability.

VIII.i.3.C.9.c#Covered Birth Defects for Benefits Under Chapter 18

Covered birth defects include, but are not limited to

• achondroplasia
• cleft lip and cleft palate
• congenital heart disease
• congenital talipes equinovarus (clubfoot)
• esophageal and intestinal atresia
• Hallerman-Streiff syndrome
• hip dysplasia
• Hirschprung’s disease (congenital megacolon)
• hydrocephalus due to aqueductal stenosis
• hypospadias
• imperforate anus
• neural tube defects (including spina bifida, encephalocele, and anencephaly)
• Poland syndrome
• pyloric stenosis
• syndactyly (fused digits)
• tracheoesophageal fistula
• undescended testicle, and
• Williams syndrome.

Note: If any of the birth defects listed above are determined to be familial in a particular family, they are not covered birth defects.

VIII.i.3.C.9.d#Birth Defects Not Covered Due to Familial Disorders

Birth defects that are familial disorders are not covered birth defects. These include, but are not limited to

• albinism
• alpha-antitrypsin deficiency
• Crouzon syndrome
• cystic fibrosis
• Duchenne’s muscular dystrophy
• galactosemia
• hemophilia
• Huntington’s disease
• Hurler syndrome
• Kartagener’s syndrome (primary ciliary dyskinesia)
• Marfan syndrome
• neurofibromatosis
• osteogenesis imperfecta
• pectus excavatum
• phenylketonuria
• sickle cell disease
• Tay-Sachs disease
• thalassemia, and
• Wilson’s disease.

Note: If any of the birth defects listed above are determined not to be familial in a particular family, then they are covered birth defects.

VIII.i.3.C.9.e#Birth Defects Not Covered Due to Birth-Related Disorders, Chromosomal Disorders, or Congenital Malignancies

Conditions identified in the table below are not considered covered birth defects by reason of their respective classifications as

• birth-related injuries
• chromosomal disorders, or
• congenital malignancies.

Note: These listings are not necessarily exhaustive.

VIII.i.3.C.9.f#Birth Defects Not Covered Due to Lack of Permanent Physical or Mental Disability

Birth defects that are not covered because they lack permanent physical or mental disability include, but are not limited to

• conditions rendered non-disabling through treatment
• congenital heart problems surgically corrected or resolved without disabling residuals
• heart murmurs unassociated with a diagnosed cardiac abnormality
• hemangiomas that have resolved with or without treatment, and
• scars (other than of the head, face, or neck) as the only residual of corrective surgery for birth defects.

VIII.i.3.C.9.g#Conditions Not Covered Due To Birth-Related Injury or Fetal/Neonatal Infirmity

Conditions that are due to a fetal or neonatal infirmity with well-established causes or that are miscellaneous pediatric conditions are not covered birth defects. These include, but are not limited to

• asthma and other allergies
• effects of maternal rubella, toxoplasmosis, syphilis, or other maternal infection during pregnancy
• fetal alcohol syndrome or fetal effects of maternal drug abuse
• hyaline membrane disease
• maternal-infant blood incompatibility
• neonatal infections
• neonatal jaundice
• post-infancy deafness/hearing impairment (onset after the age of one year)
• prematurity, and
• refractive disorders of the eye.

VIII.i.3.C.9.h#Conditions Not Covered Due to Developmental Etiology

Conditions that are developmental disorders are not covered birth defects. These include, but are not limited to

• attention deficit disorder
• autism
• epilepsy diagnosed after infancy (after the age of one year)
• learning disorders, and
• mental retardation (unless part of a syndrome that is a covered birth defect).

10Developing for Medical and Lay Evidence

This topic contains information on developing for medical and lay evidence, including

• VA examinations under
  • 38 CFR 3.814, and
  • 38 CFR 3.815, and
• developing for medical evidence of
  • spina bifida under 38 CFR 3.814, and
  • a covered birth defect under 38 CFR 3.815.

Revised December 12, 2018

VIII.i.3.C.10.a#VA Examinations Under 38 CFR 3.814

For the purpose of claims seeking monetary allowance under 38 CFR 3.814 for spina bifida, VA will schedule an examination only under limited circumstances.Important:

• Only request an examination under 38 CFR 3.814 when
  • necessary to determine the degree of disability from spina bifida, and
  • the medical evidence is not sufficient for that purpose.
• VA may accept statements from private physicians or examination reports from government or private institutions in lieu of a VA examination.
• It is inappropriate to schedule an examination when the evidence of record does not show that spina bifida exists.
• Do not request magnetic resonance imaging.

VIII.i.3.C.10.b#VA Examinations Under 38 CFR 3.815

For claims seeking monetary allowance under 38 CFR 3.815 for other covered birth defects, VA will schedule an examination

• when necessary to determine whether an individual has a covered birth defect, and
• for rating claims for covered birth defects.

Note: VA may accept statements from private physicians or examination reports from government or private institutions in lieu of a VA examination.

VIII.i.3.C.10.c#Developing for Medical Evidence of Spina Bifida Under 38 CFR 3.814

Follow the steps in the table below to develop for medical evidence of spina bifida under 38 CFR 3.814.

VIII.i.3.C.10.d#Developing for Medical Evidence of a Covered Birth Defect Under 38 CFR 3.815

Follow the steps in the table below to develop for evidence of a covered birth defect under 38 CFR 3.815.