Part VIII, Subpart iii, Chapter 4, Section BDeveloping Claims for Service Connection (SC) for Disabilities Resulting from Ionizing Radiation Exposure Under 38 CFR 3.311

Revised 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.

2Developing 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.

Revised 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.

1. 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.

Revised 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.

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.

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.

4Obtaining 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.

Revised 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.

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.

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.

5Referring 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.

Revised 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.

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:

6. Served in the U.S. Navy from January 22, 1963, to August 26, 1983.

7. Exposure occurred from ages 34 to 36.

8. Male

9. Caucasian

10. 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:

4. Renal cell carcinoma of the left kidney.

5. Diagnosed with renal carcinoma in 2009, at age 63, and approximately 28 years after initial exposure to ionizing radiation in service.

6. 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:

4. Radiation Risk Activity Information Sheet received on May 16, 2020.

5. The Veteran was exposed to ionizing radiation by reason of military duties (Occupational) as defined in 38 C.F.R. 3.311.

6. 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:

6. The Veteran’s father had prostate cancer, and a sister had ovarian cancer.

7. After military service, the Veteran worked as a police officer until retirement.

8. 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.

9. 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.

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.

6Exhibit 1: Exposure to Nuclear Radiation and DoD Secrecy Agreement

Revised 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