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M21-1, Part IV, Subpart ii, Chapter 1, Section I – Developing Claims for Service Connection (SC) Based on Other Exposure Types

Overview


In This Section

This section contains the following topics:
Topic
Topic Name
1
2
3
4
5
6
7
Developing Claims Based on Exposure to Contaminants in the Water Supply at Camp Lejeune
8
9
10
11
12
13
14

1.   Developing Claims for SC for Positive Tuberculin Reactions


Introduction

This topic contains information on developing claims for SC for positive tuberculin reactions, including the

Change Date

October 23, 2015

IV.ii.1.I.1.a.  Action to Take When Only a Positive Tuberculin Reaction Is Claimed

If a claim is submitted for only a positive tuberculin reaction, refer the claim to the rating activity for a determination as to whether or not a disability is present.
Reference:  For more information on medical treatment for a positive tuberculin reaction, see M21-1, Part III, Subpart v, 7.A.10.

IV.ii.1.I.1.b.   Action to Take When a Positive Tuberculin Reaction and Other Disabilities Are Claimed

If a positive tuberculin reaction is claimed together with other disabilities,
  • complete any appropriate development required for the other disabilities, and
  • refer the claim to the rating activity for rating of all the claimed disabilities.

IV.ii.1.I.1.c.  Reporting Responsibilities of VA Outpatient Clinics and VAMCs

As provided in M21-1, Part III, Subpart v, 7.A.10.c Department of Veterans Affairs (VA) outpatient clinic or VA medical center (VAMC) will furnish a report of the follow-up examination made at the expiration of the 12-month period of chemotherapy for discharged personnel who have had a tuberculin test conversion from negative to positive during service.
If a VA outpatient clinic or VAMC report or any other evidence indicates the presence of tuberculous disease, solicit a claim for service connection (SC).
Reference:  For more information on soliciting claims for chronic, unclaimed disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.e.

2.  Developing Claims for SC for Chronic or Tropical Diseases


Introduction

This topic contains information on developing claims for SC for chronic or tropical diseases, including

Change Date

October 23, 2015

IV.ii.1.I.2.a.  Definition:  Chronic Disease

chronic disease is a disease
  • of prolonged duration, producing incapacitating symptoms of varying degree
  • that may undergo remission, and
  • that is seldom entirely cured with all residuals of damage being completely eradicated.

IV.ii.1.I.2.b.  Establishing Whether a Disease Is Chronic

If a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic.
Important:  Whether a disease is chronic is a matter for a factual determination dependent on the nature of the disease and its manifestations.  Some diseases are inherently chronic, such as multiple sclerosis, while others, such as bronchitis, may be either acute or chronic.

IV.ii.1.I.2.c.  Considering SC for a Chronic or Tropical Disease

When deciding any claim for SC for a chronic or tropical disease, it is also necessary to consider
  • SC based on manifestation of the claimed disease during service, and
  • SC based on a presumption that the disease, which was first manifested following discharge from service, is nevertheless related to service.

IV.ii.1.I.2.d.  Considering Presumptive SC

Once a substantially complete claim is of record, the following conditions apply:
  • the possibility of entitlement to presumptive SC exists when the Veteran alleges inception within the limiting periods contained in
  • the Veteran does not need to establish that the disease in question was definitely diagnosed within the presumptive period, and
  • the evidence should show that manifestations of the condition, disabling to the degree of at least 10 percent, became apparent prior to the expiration of the presumptive period shown in 38 CFR 3.307.

IV.ii.1.I.2.e.  Locations of Lists of Chronic and Tropical Diseases

The conditions listed in

IV.ii.1.I.2.f.  Action to Take if a Chronic or Tropical Disease Was Treated in Service

Follow the instructions in the table below when service records show the Veteran was treated for a chronic or tropical disease.
If the Veteran …
Then …
files a substantially complete claim for the condition
refer the case to the rating activity.
did not file a claim for the condition
solicit a claim.
References:  For more information on

IV.ii.1.I.2.g.  Action to Take if a Chronic or Tropical Disease Was Not Treated in Service

Even though certain chronic and tropical diseases were not treated during service, SC may still be established on a presumptive basis under the provisions of
Reference:  For more information on the diseases for which SC may be established on a presumptive basis and the service requirements that must be met, see 38 CFR 3.307.

3.  Developing Claims for SC for Asbestos-Related Diseases


Introduction

This topic contains information on developing claims for SC for asbestos-related diseases, including

Change Date

May 23, 2018

IV.ii.1.I.3.a.  Entitlement to SC for Conditions Based on Exposure to Asbestos

Veterans who were exposed to asbestos while in service and developed a disease related to that asbestos exposure may receive compensation benefits.
In order to establish entitlement to compensation based on exposure to asbestos, the evidence must show
  • in-service asbestos exposure, and
  • a diagnosed disability that has been associated with in-service asbestos exposure.
Note:  Occupational exposure is the most common cause of asbestosis, but the condition also can have other causes.
Reference:  For more information on asbestos exposure to include rating guidance, see M21-1, Part IV, Subpart ii, 2.C.2.

IV.ii.1.I.3.b.  Development Action to Take When No Disability Related to Asbestos Exposure Is Claimed

A claim is not substantially complete if a Veteran alleges exposure to asbestos during service, but does not claim SC for a specific disability.  In cases such as these, follow the procedures for handling an incomplete application at M21-1, Part I, 1.B.1.g and h.
Reference:  For more information on what constitutes a substantially complete application, see

IV.ii.1.I.3.c.  Asbestos Claims Development Procedures

All claims based on asbestos exposure require
  • military personnel records
  • specific exposure information from the claimant, and
  • medical evidence of the specific diagnosis.
Follow the steps in the table below to obtain the necessary evidence in support of a substantially complete application based on exposure to asbestos.
Step
Action
1
Obtain military personnel records, if they are not of record, by completing a request in the
References:  For more information on
2
Concurrent with the PIES request, send a development letter to the Veteran requesting additional exposure information by selecting the following development paragraphs:
  • ASB – tell us where, when, how exposed, and
  • ASB – medical evid of disease (biopsy) needed.
Note:  If the claim was submitted under the Fully Developed Claim (FDC) Program, include the FDC language from M21-1, Part III, Subpart i, 3.B.3.g.
Exception:  If the claimant has already provided the specific information requested in the above development paragraphs, do not send a subsequent development letter.
3
After sending the development letter, when required, and obtaining the military personnel records, determine if asbestos exposure is established by reviewing the claim based on the table below.
If the Veteran served in
Then review the …
the Navy
another branch of the military
occupational exposure information in
4
Was asbestos exposure established in Step 3?
  • If yes, proceed to the next step.
  • If no, refer the claim to the rating activity after completing all other required development actions.
5
Is there evidence of a current disability sufficient to warrant an exam?
  • If yes, follow the procedures in M21-1, Part IV, Subpart ii, 1.I.3.f to request an exam.
  • If no, refer the claim to the rating activity after completing all other required development actions.
Reference:  For more information on the threshold for a direct SC examination, see M21-1, Part I, 1.C.3.d.

IV.ii.1.I.3.d.  Use of Navy MOS to Determine Probability of In-Service Asbestos Exposure

The table below describes the probability of asbestos exposure by Navy MOS.
Important:
  • If a Veteran from another branch of service, including, but not limited to, Coast Guard, held one of the occupations listed below, concede the probability of exposure accordingly.
  • This list is not exclusive and exposure may be otherwise demonstrated on review of the claims folder.  Each claim based on asbestos exposure must be adjudicated on its own merit with MOS being one consideration in determining whether there was an exposure event.
  • For non-Navy Veterans, review the claim under the guidance in M21-1, Part IV, Subpart ii, 1.I.3.e, and M21-1, Part IV, Subpart ii, 2.C.2.d and e, regarding occupational exposure to asbestos.
MOS Code
Job Title
Probability of Exposure
AA
Airman Apprentice
Minimal
ABE
Aviation Boatswain’s Mate (Launch & Rec Equip)
Probable
ABF
Aviation Boatswain’s Mate
Probable
ABH
Aviation Boatswain’s Mate (Aircraft Handler
Probable
AC
Air Traffic Controller
Minimal
ACM
Aviation Chief Metalsmith
Probable
ADJ
Aviation Machinist’s Mate (Jet Engine Mechanic)
Probable
ADR
Aviation Machinist’s Mate
Probable
AE
Aviation Electrician’s Mate
Probable
AFCM
Aircraft Maintenanceman (Master Chief)
Minimal
AG
Aerographer’s Mate
Minimal
AK
Aviation Storekeeper
Minimal
AM
Aviation Structural Mechanic
Probable
AME
Aviation Structural Mechanic (Safety Equipment)
Probable
AMH
Aviation Structural Mechanic (Hydraulics)
Probable
AMS
Aviation Structural Mechanic (Structural)
Probable
AN
Airman
Minimal
AO
Aviation Ordnanceman
Minimal
AQ
Aviation Fire Control Technician
Highly Probable
AR
Airman Recruit
Minimal
ARM
Aviation Radioman
Probable
AS
Aviation Support Equipment Technician
Probable
AT
Aviation Electronic Technician
Probable
AW
Aviation Antisubmarine Warfare Operator
Probable
AX
Aviation Antisub Warfare Technician
Probable
AZ
Aviation Maintenance Administrationman
Minimal
B
Boilermaker (WWII)
Highly Probable
BU
Builder
Probable
BM
Boatswain’s Mate
Minimal
BR
Boilermaker
Highly Probable
BT
Boiler Technician
Highly Probable
CD
Construction Driver
Probable
CE
Construction Electrician
Probable
CM
Construction Mechanic
Minimal
CN
Constructionman
Probable
Cox
Coxswain
Minimal
CS
Commissaryman
Minimal
CT
Communication Technician
Minimal
CTR
Cryptologic Technician (Collections)
Minimal
DC
Damage Controlman
Minimal
DK
Disbursing Clerk
Minimal
DP
Data Processing Technician
Minimal
DS
Data System Technician
Minimal
DT
Dental Technician
Minimal
EM
Electrician’s Mate
Probable
EN
Engineman
Probable
EO
Equipment Operator
Minimal
ET
Electronics Technician
Probable
FC
Fire Controlman
Highly Probable
FN
Fireman
Highly Probable
FP
Pipefitter
Highly Probable
FT
Fire Control Technician
Highly Probable
FTG
Fire Control Technician (Guns)
Highly Probable
GM
Gunner’s Mate
Minimal
GSM
Gas Turbine System Technician (Mechanical)
Probable
HC
Hospital Corpsman
Minimal
HN
Hospitalman
Minimal
HT
Hull Maintenance Technician
Highly Probable
IC
Interior Communication Technician
Probable
IM
Instrumentman
Highly Probable
LI
Lithographer
Minimal
M(ME)
Metalsmith
Minimal
MA
Master-At-Arms
Minimal
MLC
Molder
Probable
MM
Machinist Mate
Probable
MN
Mineman
Minimal
MOMM
Motor Machinist Mate
Probable
MR
Machinery Repairman
Minimal
MS
Mess Management Specialist
Minimal
MT
Missile Technician
Probable
MU
Musician
Minimal
NC
Navy Counselor
Minimal
OM
Opticalman
Minimal
OSPC
Operations Specialist
Minimal
PC
Postal Clerk
Minimal
PH
Photographer’s Mate
Minimal
PHM
Pharmacist
Minimal
PN
Personnelman
Minimal
Prtr
Printer
Minimal
PT
Photographic Intelligenceman
Minimal
PTR
Painter
Probable
QM
Quartermaster
Minimal
RD
Radarman
Minimal
RM
Radioman
Minimal
RN
Radarman
Minimal
SA
Seaman Apprentice
Minimal
SC
Ship’s Cook
Minimal
SD
Stewart
Minimal
SF
Shipfitter
Minimal
SFM
Shipfitter (Metal Smith)
Minimal
SFP
Shipfitter (Pipefitter)
Minimal
SH
Ship’s Serviceman
Minimal
SK
Storekeeper
Minimal
SM
Signalman
Minimal
SN
Seaman
Minimal
SO
Sonarman
Highly Probable
SoM
Soundman
Highly Probable
ST
Sonar Technician
Highly Probable
STG/SOG
Sonar Technician (Surface)
Highly Probable
STS
Sonar Technician (Submarine)
Highly Probable
StM
Steward’s Mate
Minimal
SW
Steelworker
Probable
TA
Stewart Apprentice
Minimal
TD
Trademan
Minimal
TE
Teletype
Minimal
TM
Torpedoman’s Mate
Probable
TN
Stewardsman
Minimal
UT
Utilitiesman
Highly Probable
WT
Water Tender
Highly Probable
Y
Yeoman
Minimal

IV.ii.1.I.3.e.  Consideration of All Evidence in the Claims Folder in Determining In-Service Asbestos Exposure

Asbestos exposure is not exclusive to Naval Veterans and may have been incurred in occupational capacities that are not included on the MOS list as discussed atM21-1, Part IV, Subpart ii, 1.I.3.d.  Asbestos exposure may be demonstrated upon review of the claims folder on a basis other than MOS.
Any evidence that is probative of (serves to establish) asbestos exposure may be used to support a determination that asbestos exposure occurred.  Determining whether evidence proves a Veteran was exposed to asbestos requires an evaluation of all of the evidence in the case, including
  • an assessment of the credibility of the evidence, and
  • whether the evidence establishes that the exposure occurred.
In determining whether asbestos exposure has been demonstrated by the evidence of record, consider
  • occupational exposure as explained in M21-1, Part IV, Subpart ii, 2.C.2.d and e
  • exposure information that the Veteran provides in response to the asbestos development letter, to include lay testimony
  • service personnel records
  • service treatment records (STRs)
  • buddy statements, and
  • all other evidence located in the claims folder or identified by the Veteran relevant to the determination of asbestos exposure.
Notes:
  • The term credibility refers to believable evidence that tends to support the Veteran’s assertion based on consideration of plausibility, consistency with other evidence in the case, and source.
  • Once asbestos exposure has been demonstrated by the evidence of record and the evidence contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability, accept the Veteran’s lay testimony as sufficient evidence of current symptoms or disease that could potentially be related to asbestos exposure for purposes of requesting an examination and medical opinion.

IV.ii.1.I.3.f.  Requesting a RespiratoryExamination and Opinion for Claims Based on Asbestos Exposure

Use the table below when requesting a respiratory examination and medical opinion for claims based on asbestos exposure.
Important:  Request an examination if the threshold is otherwise met, even if the Veteran fails to respond to the subsequent development letter referenced in M21-1, Part IV, Subpart ii, 1.I.3.c.  In these cases, request the examiner to solicit an exposure history from the Veteran.
If exposure is established based on a(n) …
Then use the appropriate tool/system and its embedded templates to request a respiratory examination and a …
Navy MOS
Note:  If exposure in an MOS is listed as minimal, probable, or highly probable in the table inM21-1, Part IV, Subpart ii, 1.I.3.d, concede asbestos exposure for purposes of scheduling an examination.
medical opinion based on MOS assignment and its probability of exposure to asbestos.
event or other occupational experience
direct medical opinion.
Note:  In all examination requests,
  • follow the guidance in M21-1, Part III, Subpart iv, 3.A.8.d to identify all relevant records the examiner should review in making a medical opinion, and
  • ensure that the examination request states all relevant information as to asbestos exposure to include, but not limited to,
    • the Veteran’s MOS(s) and probability of asbestos exposure or the event or other occupational experience on which exposure is based, and
    • all pre- and post-service exposure history.
References:  For more information on

4.  Developing Claims for SC for AIDS


Introduction

This topic contains information on developing claims for SC for AIDS, including

Change Date

April 12, 2019

IV.ii.1.I.4.a.  Definition:  AIDS

Acquired immune deficiency syndrome (AIDS) is defined by the Centers for Disease Control as “a disease at least moderately predictive of a defect in cell-mediated immunity occurring in a person with no known cause for diminished resistance to that disease.”

IV.ii.1.I.4.b.  Causative Agent of AIDS

AIDS is caused by the human immunodeficiency virus (HIV).

IV.ii.1.I.4.c.  Tests Available to Verify AIDS

The most commonly used lab test for AIDS is the HIV antibody test.
The following two HIV antibody tests are available:
  • the screening enzyme-linked immunosorbent assay (ELISA) test, and
  • the confirmatory Western Blot test.

IV.ii.1.I.4.d. Obtaining Medical Records Showing Treatment of AIDS

Request
  • STRs if they are not in the claims folder, and
  • records of treatment from a VAMC or VA outpatient clinic, if the Veteran indicates that he/she received treatment at one of these facilities.
  • reports treatment by a private hospital or physician, but
  • does not furnish the treatment records.

IV.ii.1.I.4.e.  When to Send the Claim to the Rating Activity

If a substantially complete claim exists, send the claim to the rating activity after all necessary development is complete.
Reference:  For more information on what constitutes a substantially complete claim, see

5.  Developing Claims Based on Participation in Special Operations Incidents


Introduction

This topic contains information on developing claims based on participation in Special Operations incidents, including

Change Date

April 12, 2019

IV.ii.1.I.5.a.  Definition:  Special Operations

Special Operations are small-scale covert or overt military operations of an unorthodox and frequently high-risk nature, undertaken to achieve significant political or military objectives in support of foreign policy.
Special Operations units are
  • typically composed of relatively small groups of highly-trained, armed personnel, and
  • often transported by helicopter, small boats, or submarines, or parachute from aircraft for stealthy infiltration by land.
Examples:
  • U.S. Army’s Special Forces, commonly called the “Green Berets.”
  • U.S. Navy sea, air, and land teams (SEALs).
Note:  Some Special Operations, such as counter-terrorism actions, may be carried out domestically under certain circumstances.

IV.ii.1.I.5.b.  Developing Claims Related to Special Operations Incidents

Follow the steps in the table below to determine the development action to take when a Veteran claims that an injury or disability occurred during a Special Operations assignment.
Step
Action
1
Generate and send a subsequent development letter to the Veteran by selecting the SPECIAL OPERATIONS UNIT development action.
Note:  This notice is required unless the evidence of record provides the information requested in the letter.
2
After waiting 30 days, did VA receive the Veteran’s response?
  • If yes, go to Step 3.
  • If no, go to Step 4.
3
Did the Veteran provide at least the location (city/province and country) where the incident took place and the approximate date (within a 60-day range) of the incident?
  • If yes,
    • add the Specialized Records Request special issue indicator
    • route the claim to the Military Records Specialist (MRS) to
    • disregard the remaining step in this table.
  • If no, go to Step 4.
Important:  MRSs must wait 60 days for a response to the referenced e-mail before sending a follow-up request.  After the MRS receives a response, he/she must
  • remove the Specialized Records Request special issue indicator, and
  • upload the response into the Veteran’s eFolder.
4
  • Continue to process the claim and promulgate a rating decision based on the evidence in the claims folder.
  • In the decision notice,
    • advise the Veteran that VA was unable to verify an incident in service related to the claimed disability, and
    • identify the information that is still needed to verify the incident.

IV.ii.1.I.5.c.  Exhibit:  Special Operations Forces Incident Document

A blank version of a Special Operations Forces Incident document is shown below.
Special Operations Forces Incident
Name of Veteran: _______________________
C#: ______________________
Social Security Number: ______________________
MOS/Specialty: _______________________
Branch of Service and component: _________________________
Rank/Grade: _________________________
Special Operations tour of duty dates: From: ________ To: _________
If not assigned, Veteran was attached to which Special Ops Unit/Service: _________
From: ___________ To: __________
Was the operation classified: Yes ___ No ___
Is there evidence in the eFolder to support the claim: Yes ___ No ___
List a brief description of the incidents reported by the Veteran:
Incident(s): Were the incidents classified: Yes ______ No _____
Date of incident #1 (60-day range): _________________
Location of incident: ________________________
Specific information regarding incident: ___________________________
____________________________________________________________
____________________________________________________________
Date of incident #2 (60-day range): _________________
Location of incident: ________________________
Specific information regarding incident: ___________________________
____________________________________________________________
____________________________________________________________

Submitted by (print): _______________________

VARO: _________________________
Telephone number: ________________________

IV.ii.1.I.5.d.  Responses From USSOCOM

Upon receipt of a request from VA, U.S. Special Operations Command (USSOCOM) will research each claimed incident and respond by
  • confirming whether the Veteran participated in Special Operations, or
  • providing a negative reply, if it finds no information.
Notes:
  • The response will not include copies of documentation related to claimed incidents.
  • For certain incidents, USSOCOM may report that it cannot release any information.
  • Because Special Operations have the characteristics of combat, 38 CFR 3.304(d) will apply in all cases where a Veteran’s participation in Special Operations is confirmed.

6.  Developing Claims Based on Exposure to Other Specific Environmental Hazards


Introduction

This topic contains information on developing claims based on exposure to environmental hazards, including

Change Date

April 12, 2019

IV.ii.1.I.6.a.  Locations of Specific Environmental Hazards Identified by DoD

The Department of Defense (DoD) has identified a number of environmental hazards at military installations in Iraq, Afghanistan, and elsewhere that could present health risks.
Reference:  For more information on specific environmental hazards and affected military installations identified by DoD, see M21-1, Part IV, Subpart ii, 2.C.5.

IV.ii.1.I.6.b.  Environmental Hazard EP Control and Tracking

Upon receipt of a substantially complete claim for SC based on exposure to one or more of the environmental hazards listed in M21-1, Part IV, Subpart ii, 2.C.5,
  • establish a standard end product (EP), such as EP 110, 010, or 020, and
  • if the claim is based on service in Southwest Asia, enter theEnvironmental Hazard in Gulf War special issue indicator for the related contention(s).
Note:  Do not use the Environmental Hazard in Gulf War special issue indicator for claims based on service at Atsugi, Djibouti, or Camp Lejeune.
Reference:  For specific instructions on processing Camp Lejeune claims, seeM21-1, Part IV, Subpart ii, 1.I.7.

IV.ii.1.I.6.c.  Action to Take When the Veteran Claims Environmental Hazards Exposure but Does Not Claim a Disability

A claim is not substantially complete if a Veteran alleges exposure to environmental hazards during service but does not claim SC for a specific disability.  In cases such as these, follow the procedures for handling an incomplete application at M21-1, Part I, 1.B.1.g and h.

IV.ii.1.I.6.d.  Guidelines for Developing Environmental Hazard Claims

Use the guidelines below when developing claims for SC based on exposure to environmental hazards.
  • Ask the claimant to provide at least some general information about the exposure event.  Send a subsequent development letter or telephone the Veteran if he/she fails to provide sufficient information regarding exposure and/or the disability claimed because of such exposure.
  • Develop for STRs and any VA and/or private medical records that are noted by the claimant.
  • Verify dates of military service and obtain military personnel records as per normal procedures.
  • It is unnecessary to issue Section 5103 notice if the Veteran files his/her claim on a form that provides or otherwise indicates he/she received the notice, such as VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.
References:  For more information on

IV.ii.1.I.6.e.  Establishing Exposure to Environmental Hazards

It is critical that VA employees rely upon all available sources of evidence when verifying and/or conceding exposure.  Review STRs, military personnel records, and all other available documents for evidence that corroborates the Veteran’s statement of exposure.
Important:  Carefully review the Post-Deployment Health Assessment (PDHA) andDischarge Examination, generally located in the STRs, for exposure information.  The PDHA includes specific questions relating to exposure incidents.
Reference:  For more information on using alternate evidence or lay statements to establish exposure, see

IV.ii.1.I.6.f.  Verifying Service at the Qarmat Ali Water Treatment Plant

DoD has confirmed with VA that National Guard personnel from Indiana, West Virginia, South Carolina, and Oregon served at the Qarmat Ali Water Treatment Plant in Iraq.  Therefore, verification of individual exposure is not required for Veterans who served in one of these National Guard units if their service in Iraq was from April through September 2003.
If the Veteran is claiming exposure to an environmental hazard at this location and service in one of the above National Guard units is not shown, follow the procedures in the table below.
If the claim is …
Then …
processed in the National Work Queue (NWQ) environment
  • create a VBMS eFolder note stating the claim is referred to Compensation Service for verification of service at the Qarmat Ali Water Treatment Plant in Iraq, and
  • assign the Compensation Service Review – Environmental Hazards Verification special issue indicator and Compensation Service Review tracked item in accordance with theNWQ Playbook to ensure proper routing to Compensation Service.
not processed in the NWQ environment
  • add the Compensation Service Reviewtracked item
  • send an e-mail request for verification of service at the Qarmat Ali Water Treatment Plant in Iraq to the following Compensation Service mailbox:VAVBAWAS/CO/211/ENVIRO, and
  • upload the e-mail to the Veteran’s VBMS eFolder.
References:  For more information on

IV.ii.1.I.6.g.  Using Alternate Evidence or Lay Statements to Establish Exposure to Environmental Hazards

Because military service records will not verify all incidents of exposure, it is important to consider alternate evidence in establishing whether the Veteran participated in or was affected by an in-service environmental hazard exposure incident.  Exposure may be verified or conceded if the statements provided by the Veteran and/or others are consistent with the facts, places, and circumstances of the Veteran’s service.
References:  For more information on

IV.ii.1.I.6.h.  What to Include in VA Examination and/or Medical Opinion Requests in Environmental Hazard Claims

When requesting a medical examination and/or medical opinion for a claim based on exposure to an environmental hazard listed in M21-1, Part IV, Subpart ii, 2.C.5.a,  follow the guidance below:
  • Advise the examiner of the nature of the claimed environmental hazard and the location and timeframe of exposure.
  • Remember that more than one environmental hazard may apply when Veterans are alleging exposure to a specific event.  Therefore, each fact sheet related to service in Iraq, as provided in Exhibits 1 through 4 (M21-1, Part IV, Subpart ii, 1.I.1013) should be provided to the VA examiner.  This is necessary for Iraq Veterans since the Veteran served in Iraq and could have been exposed to burn pit emissions and the same high levels of particulate matter (PM) as others in the Southwest Asia theater of operations.
  • Forward the claims folder to the examiner and ask him/her to
    • review the medical and other evidence in the claims folder, including the fact sheet or other documents for Camp Lejeune or other exposure claims, and
    • provide an opinion, and rationale for the opinion, as to the likelihood that the Veteran’s claimed disability is related to the hazardous environmental exposure.
In some cases, an opinion based on a records review only may suffice, but other cases may require a current examination.  When initially requesting an opinion only, ask the examiner to schedule an examination if he/she believes it is needed to render the requested medical opinion.
Important:
  • In all claims where service in the Southwest Asia theater of operations is established, review M21-1, Part IV, Subpart ii, 2.C.5.c to determine if the provisions of 38 CFR 3.317 must be applied.
  • Do not request an examination or medical opinion until exposure has been established.
References:  For more information on

 7.  Developing Claims Based on Exposure to Contaminants in the Water Supply at Camp Lejeune


Introduction

This topic contains information on developing claims based on exposure to contaminants in the water supply at Camp Lejeune, including


Change Date

April 12, 2019

IV.ii.1.I.7.a.Presumption of SC Based on Exposure to Contaminated Water at Camp Lejeune

On March 14, 2017, 38 CFR 3.307(a)(7) effectuated a presumption of SC for specific disabilities for Veterans who served no less than 30 days (consecutive or nonconsecutive) at the U.S. Marine Corps Base Camp Lejeune, North Carolina, between August 1, 1953, and December 31, 1987, based on exposure to contaminants present in the base’s water supply.
Important:  This presumption also applies to former reservists and National Guard members if their military record includes orders or other records of no less than 30 days service (consecutive or nonconsecutive) at Camp Lejeune during the contamination period.
References:  For more information on

IV.ii.1.I.7.b.  Definition:  Camp Lejeune Issue

Camp Lejeune issue, for the purpose of processing under the procedures listed in this topic, is a claim for compensation for either
  • any disability specifically claimed as due to exposure to contaminants at Camp Lejeune, or
  • one of the conditions listed at either 38 CFR 3.309(f) or 38 CFR 17.400, regardless of whether service at Camp Lejeune during the contamination period is
    • expressly claimed by the claimant, or
    • it is otherwise established by the evidence of record.
Reference:  For more information on Camp Lejeune claims jurisdiction, see M21-1, Part IV, Subpart ii, 1.I.7.c.

IV.ii.1.I.7.c.  Processing Jurisdiction of Camp Lejeune Claims 

All substantially complete claims for compensation containing at least one Camp Lejeune issue will be routed based on the table below.
Note:  For the purposes of the table below, the regional office (RO) of jurisdiction (ROJ) is the next available RO in the NWQ environment.
If the claim is for …
And evidence shows …
And military records document during the contamination period …
Then the claim is decided by the …
a condition recognized under 38 CFR 3.309(f)
a diagnosis of a 38 CFR 3.309(f) condition
30 days or more of service at Camp Lejeune
ROJ.
Important:  If the claim was received prior to March 14, 2017, ROs must follow the procedures inM21-1, Part IV, Subpart ii, 2.C.6.k.
at least one, but less than 30 days of service at Camp Lejeune
Louisville RO.
no Camp Lejeune service.
ROJ.
no diagnosis
n/a
ROJ.
a condition not recognized under 38 CFR 3.309(f), but recognized for healthcare purposes under 38 CFR 17.400
n/a
no Camp Lejeune service
ROJ.
at least one day of Camp Lejeune service
Louisville RO.
any other disability claimed specifically as due to exposure at Camp Lejeune
n/a
no Camp Lejeune service
ROJ.
at least one day of Camp Lejeune service
Louisville RO.
Exception:  The following types of claims qualify for other centralized processing and will not be processed by the ROJ or Louisville RO:
  • Veterans residing in foreign territories
  • original pre-discharge claims
  • restricted access claims, and
  • other specific special mission claims, as needed.

IV.ii.1.I.7.d.  ROJ Processing of Camp Lejeune Claims  

Claims containing at least one Camp Lejeune issue will not be referred to the Louisville RO when
  • the Veteran did not serve at Camp Lejeune between August 1, 1953, and December 31, 1987
  • the claim is for a disability recognized under 38 CFR 3.309(f) and
    • the Veteran had at least 30 days of service at Camp Lejeune during the contamination period, or
    • the evidence does not establish a diagnosis of the claimed condition
  • no disability is specifically claimed as a result of exposure, such as claims stating “Camp Lejeune” or “exposure at Camp Lejeune”
  • Veteran status needs to be established, such as through a character-of-discharge (COD) determination, or
  • the only claim is for a disability of a dependent, including birth defects.  VA has no statutory authority to compensate a Veteran’s dependents exposed to Camp Lejeune water contamination.  Follow the procedures inM21-1, Part III, Subpart v, 2.A to administratively decide these claims.
Important:  If a claim is clarified and found to be for a specific disability, or if Veteran status is established, such as by administrative decision, then follow the procedures in M21-1, Part IV, Subpart ii, 1.I.7.e to ensure proper routing of the claim.
References:  For more information on

IV.ii.1.I.7.e.  Initial Actions to Take on Camp Lejeune Claims

The table below describes the initial actions to take upon receipt of a substantially complete claim containing at least one Camp Lejeune issue as defined in M21-1, Part IV, Subpart ii, 1.I.7.b.
Stage
Who Is Responsible
Description
1
ROJ
Receives the claim.
2
ROJ
  • Establishes the appropriate EP, and
  • assigns the Environmental Hazard – Camp Lejeune special issue indicator to the relevant contention(s).
3
ROJ
Resolves any COD issues.
Note:  If service is dishonorable for VA purposes, proceed to Stage 7.
Reference:  For more information on COD, see  M21-1, Part III, Subpart v, 1.B.
4
ROJ
Follows the procedures in M21-1, Part IV, Subpart ii, 1.I.7.f to verify and document service at Camp Lejeune.
5
ROJ
Verifies a diagnosis for the claimed condition, including
6
ROJ
Affixes the Environmental Hazard – Camp Lejeune – Louisville special issue indicator to the relevant contention(s) when the following conditions are met:
  • the claim involves
    • diagnosis of a 38 CFR 3.309(f)condition, and
    • at least one, but less than 30 days of service at Camp Lejeune, or
  • the claim involves
  • the claim involves
    • any other disability as due to exposure at Camp Lejeune, and
    • at least one day of service at Camp Lejeune.
Note:  The attachment of this second special issue indicator triggers assignment of the claim for centralized processing in the NWQ.
7
NWQ
Routes the claim to the appropriate RO as discussed inM21-1, Part IV, Subpart ii, 1.I.7.c.
Note:  The Louisville RO has jurisdiction for any legacy appeals received on Camp Lejeune claims and all other inextricably intertwined non-Camp Lejeune legacy appeals.
References:  For more information on

IV.ii.1.I.7.f.  ROJ’s Actions to Verify Service at Camp Lejeune

Before referring the claim for centralized processing, the ROJ must
  • verify the Veteran had at least one day of service at Camp Lejeune between August 1, 1953, and December 31, 1987, and
  • review all available service records to determine the number of days the Veteran served at Camp Lejeune during the contamination period.
Important:
  • When calculating the 30-day service requirement, consider the number of cumulative days a Veteran served at Camp Lejeune.  The 30 days of Camp Lejeune service do not have to be consecutive.
  • Regardless of the disability claimed, ROJs must retain jurisdiction of all claims where there is no qualifying service at Camp Lejeune during the contamination period.
  • If STRs document an official visit, such as for medical treatment, within the defined borders of Camp Lejeune, the days associated with the visit count as service at Camp Lejeune, even if personnel records indicate the Veteran had a different official duty station.
Example:  A Veteran’s official service personnel records list his/her official duty station as Marine Corps Air Station Cherry Point, North Carolina, but STRs indicate he/she received medical treatment at Camp Lejeune on June 1, 1983.  This episode of treatment counts as a day served at Camp Lejeune for the purposes of processing a claim for SC based on exposure to contaminants in the water supply at Camp Lejeune.
Follow the procedures in the table below to verify service at Camp Lejeune.
Step
Action
1
Do service records establish at least one day of service at Camp Lejeune between August 1, 1953, and December 31, 1987?
2
In the Veteran’s VBMS eFolder, edit the subject line of the relevant document(s) used to verify service at Camp Lejeune.
Example:
Image of a military personnel records document in VBMS.
Reference:  For more information on editing document properties, see the VBMS User Guide.
3
Calculate the cumulative number of days the Veteran served at Camp Lejeune between August 1, 1953, and December 31, 1987.
4
Did the claimant provide additional evidence sufficient to establish at least one day of service at Camp Lejeune between August 1, 1953, and December 31, 1987?
  • If yes, return to Step 2.
  • If no, undertake normal claims processing without routing the claim for centralized processing.
Reference:  For more information on Camp Lejeune service, see

IV.ii.1.I.7.g.  Obtaining Records of Camp Lejeune Service

Follow the procedures in the table below to obtain records of Camp Lejeune service during the contamination period.  These records may verify Camp Lejeune service through temporary duty (TDY) orders, performance evaluations, or in the case of National Guard or reserves, orders for active duty for training or inactive duty for training.
Note:  It is important the ROJ
  • verify that the Veteran’s service at Camp Lejeune occurred during the period of water contamination, August 1, 1953, to December 31, 1987
  • establish the number of days of Camp Lejeune service during this time frame, and
  • annotate the service records that verify service at Camp Lejeune.
Step
Action
1
Does VA already possess the Veteran’s service records (STRs andservice personnel records)?
  • If yes, no additional service records development is needed.
  • If no,
2
Request service records that are not already in VA’s possession through normal channels.
Note:  When initially requesting service personnel records through
  • PIES, use request code
    • O50 (if the corresponding claim is being processed in VBMS), or
    • O18 (if the corresponding claim is not being processed in VBMS), or
  • DPRIS, select the records identified on the OMPF REQUEST FORM as
    • SC1 – DD-214/215
    • SC6 – Disch/Sep/Ret
    • SC8 – Orders/Endorsements
    • PG2 – Commendatory Items, and
    • PH5 – Chron Assignment History.
3
Do service personnel records obtained through an initial request through PIES or DPRIS contain proof of the Veteran’s service at Camp Lejeune between August 1, 1953, and December 31, 1987?
  • If yes, service development procedures are complete.
  • If no, follow the instructions in the table below.
If the request used in Step 2 was …
Then …
PIES request code O18 or O50
no additional service records development is needed.
made through DPRIS
select the remainder of the records on DPRIS’s OMPF REQUEST FORM that were not selected under Step 2.
References:  For more information on

IV.ii.1.I.7.h.  Actions Taken by Centralized Processing RO on Camp Lejeune Claims

Once a claim has been transferred for centralized processing, the centralized processing RO is responsible for all additional development, rating, authorization, and legacy appeal activity.
The table below describes the stages of claims processing handled by the centralized processing RO.
Stage
Description
1
Ensures Camp Lejeune service information is verified and accurate.
2
Ensures any development letter, as noted in M21-1, Part IV, Subpart ii, 1.I.7.j, has been sent to the claimant.
3
Requests medical subject matter expert (SME) review, when needed.
4
Decides all claimed issues and sends notice of the decision to the claimant.
5
Retains jurisdiction for
  • any legacy appeals received on decisions on Camp Lejeune claims, and
  • all other inextricably intertwined non-Camp Lejeune legacy appeals.
References:  For more information on

IV.ii.1.I.7.i. Determining the Need for Medical SME Review

A claim based on exposure to contaminants in the Camp Lejeune water supply will require review by a medical SME in the following instances:
  • claims for compensation for a
    • 38 CFR 3.309(f) disability with less than 30 days of Camp Lejeune service, or
    • chronic disability recognized for healthcare purposes under 38 CFR 17.400 with at least one day of verified service at Camp Lejeune during the contamination period, and
  • any disability claim with
    • at least one day of verified service at Camp Lejeune during the contamination period, and
    • evidence sufficient to warrant an examination under 38 CFR 3.159.
Exception:  If the only service at Camp Lejeune was with a National Guard or Reserve unit while on active duty for training or inactive duty for training, do not request a SME review.

Important:

  • Medical SME reviews may be conducted by either Veterans Health Administration (VHA) or Veterans Benefits Administration (VBA) contract examination providers.
  • All SME reviews must be requested
    • by centralized processing ROs, and
    • in compliance with locally established and approved procedures.
Reference:  For more information on considering Camp Lejeune claims from former National Guard or Reserve members, see M21-1, Part IV, Subpart ii, 2.C.6.g.

IV.ii.1.I.7.j. Developing to the Claimant in Camp Lejeune Claims

It is unnecessary to issue Section 5103 notice when a claimant files his/her claim on a form that provides or otherwise indicates he/she received the notice, such asVA Form 21-526EZ.  In certain situations, a subsequent development letter must be sent requesting specific information not included in the standard notice.
Exception:  Do not send the development letter if the evidence of record
  • provides the information the development letter solicits, or
  • is otherwise sufficient to decide the claim.
Use the table below to develop for evidence from the claimant in specific Camp Lejeune claims.
If …
Then send a subsequent VBMS development letter using the …
initial review of the claim does not establish any service at Camp Lejeune between August 1, 1953, and December 31, 1987
CL-Requesting Service paragraph.

Important: This notice is required when any disability is claimed as due to Camp Lejeune service, even if the claimed disability is not one of the presumptive conditions listed at 38 CFR 3.309(f).
the disability claimed as due to exposure to contaminants in the Camp Lejeune water supply is not recognized as a presumptive condition under38 CFR 3.309(f)
CL-Proof of Non-Presumptive Disability paragraph.
Important: This notice is required for any claim where the Veteran served at Camp Lejeune between August 1, 1953, and December 31, 1987, even if the service at Camp Lejeune was for less than 30 days.
Exception:  If the only service at Camp Lejeune was with a National Guard or Reserve unit while on active duty for training or inactive duty for training, do not send the letter.
Reference:  For more information on considering Camp Lejeune claims from former National Guard or Reserve members, see  M21-1, Part IV, Subpart ii, 2.C.6.g.
References:  For more information on

IV.ii.1.I.7.k. Action to Take When the Veteran Claims Exposure to Contaminants but Does Not Claim a Disability

A claim is not substantially complete if a Veteran alleges exposure to contaminants in the Camp Lejeune water supply but does not claim SC for a specific disability.  In cases such as these, the receiving RO must follow the procedures for handling an incomplete application at M21-1, Part I, 1.B.1.g and h.
Important:  If the receiving RO is able to obtain clarification under M21-1, Part I, 1.B.1.g, follow the procedures at M21-1, Part IV, Subpart ii, 1.I.7.e.

IV.ii.1.I.7.l.  Inextricably Intertwined Non-Camp Lejeune Legacy Appeals

For non-Camp Lejeune legacy appeals that are inextricably intertwined with a Camp Lejeune legacy appeal, the ROJ will affix the Environmental Hazard – Camp Lejeune – Louisville special issue indicator to the relevant contention(s) and transfer the
  • legacy appeal EP to the Louisville RO, and
  • Veterans Appeals Control and Locator System (VACOLS) record to RO70.
Upon receipt of a non-Camp Lejeune claim or legacy appeal, the Louisville RO will review to determine whether the non-Camp Lejeune legacy appeal or claim is inextricably intertwined with the Camp Lejeune legacy appeal.  If not inextricably intertwined, the Louisville RO will
  • annotate the decision in VACOLS and VBMS
  • remove any special issue indicators, and
  • return the legacy appeal to the originating ROJ.
References:  For more information on

8.  Developing Claims Based on Participation in the SHAD Project


Introduction

This topic contains information on developing claims based on participation in the SHAD project, including

Change Date

April 12, 2019

IV.ii.1.I.8.a.Background on the SHAD Project
From 1962 to 1974, DoD conducted the Shipboard Hazards and Defense (SHAD) Project to identify the vulnerabilities of U.S. warships to chemical and biological warfare agents.
Project SHAD encompassed tests designed to identify U.S. warships’ vulnerabilities to attacks with chemical or biological warfare agents and to develop procedures to respond to such attacks while maintaining a war-fighting capability.
Reference:  For more information on Project SHAD, see the Project 112/SHAD Fact Sheets.

IV.ii.1.I.8.b.Identifying a SHAD Claim

Consider a claim to be a SHAD claim if the Veteran claims disease or injury as a result of participation in the SHAD Project.  SHAD involved service members from the Navy and Marine Corps as well as a small number of personnel from the Army and Air Force.
Notes:
  • The SHAD Project was part of a larger effort called Project 112, with tests being both ship- and land-based.  For VA purposes, all claims resulting from participation in ship-based or land-based chemical or biological testing under these projects are considered SHAD claims.
  • A claim in which the Veteran clearly served outside of the dates SHAD was conducted would not be considered a SHAD claim but could be considered a chemical-biological exposure claim that must be clarified with the claimant.

IV.ii.1.I.8.c.  EP Control of SHAD Claims

SHAD claims are controlled under traditional rating EPs (for example, 010, 110, 020).
Reference:  For more information on EP control, see M21-4, Appendix B.

IV.ii.1.I.8.d.  Requesting Access to the U.S. DoD and VA Chem-Bio Database

The U.S. DoD and VA Chemical Biological Warfare Exposure System (Chem-Bio) is a consolidated database for mustard gas, Shipboard Hazard and Defense (SHAD), and Chem-Bio participants.
All ROs must maintain primary and alternate points of contact (POCs) who are authorized access to DoD’s database.  These POCs are responsible for conducting preliminary research regarding claimed in-service chemical and biological agent testing-related exposures.  Access should be requested in advance of receipt of a claim based on exposure in order to ensure that claims processing is not unnecessarily delayed.
Important:  To request access to the Chem-Bio Database, send a completed DD Form 2875, System Authorization Access Request (SAAR), to the SHAD Mailbox at VAVBAWAS/CO/SHAD.

IV.ii.1.I.8.e.Verification of Participation  and SHAD Manager Notification

Follow the steps in the table below to verify a Veteran’s participation in Project SHAD at the RO-level based on review of the exposure database for the Veteran’s name.
If …
Then 
the Veteran’s name appears in the Chem-Bio Database
determine whether an examination and/or medical opinion is/are required to decide the claim.
the Veteran’s name does not appear in the Chem-Bio Database
it will be necessary to request a thorough search by DoD. To do so, a memorandum must be prepared with the following information:
  • the name of the individual requesting verification
  • the Veteran’s full name, claims folder number, Social Security number (SSN), and service number, and
  • the nature of the disabilities being claimed.
If available, also provide the
  • name of the test
  • name of the ship(s)
  • location of the test, and
  • dates of exposure.
Attach copies of the Veteran’s personnel records to the memorandum and mail them to
Department of Veterans Affairs
Compensation Service
ATTN: SHAD Manager
810 Vermont Ave, NW
Washington, DC 20420
DoD response confirms exposure
determine whether an examination and/or medical opinion is/are required to decide the claim. No further action necessary.
DoD response does not confirm exposure
proceed with denial of SC for disabilities claimed as resulting from SHAD-related exposure.

IV.ii.1.I.8.f. Action to Take Upon Receipt of Final Negative Response From DoD Regarding SHAD Participation

When a final negative response is received from DoD regarding a Veteran’s participation in Project SHAD,

  • upload a copy of the negative response received from the SHAD Manager to the claimant’s eFolder, and
  • deny the claim in accordance with M21-1, Part IV, Subpart ii, 1.I.8.e if exposure is not otherwise demonstrated.

IV.ii.1.I.8.g.Procedure When Receiving Confirmation of SHAD Participation

If a Veteran is found to have been a Project SHAD participant, schedule all appropriate examinations.  Examinations should include the following using fact sheets from the Project 112/SHAD Fact Sheets site:
  • a request for a medical opinion regarding any relationship between the claimant’s current disability and exposure to agents, simulants, tracers, and decontaminants used in the test(s) the Veteran was involved in, and
  • a copy of all applicable DoD fact sheets for the test(s) the Veteran participated in.
Notes:
  • If the name of the test(s) is/are known, in the comment section of the examination request include a list of the agents, simulants, tracers, and decontaminants listed in the DoD fact sheet.
  • Many claimants were involved in multiple tests.  Medical examiners need information about all tests in which the Veteran was involved.
  • SC should be considered on direct and presumptive bases, where applicable.

9.  Developing Claims Based on CBRNE Testing

Introduction

This topic contains information on developing claims based on CBRNE testing, including

Change Date

April 12, 2019

IV.ii.1.I.9.a.  Definition:  CBRNE Claims

Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) claims are claims in which a Veteran claims that a disease or injury resulted from participation in any test, chemical or biological, regardless of location, other than those tests discussed at M21-1, Part IV, Subpart ii, 1.I.8 and tests involving mustard gas.
Examples:  Exposures during tests conducted at
  • Edgewood Arsenal between 1955 and 1975
  • Fort (Ft.) Detrick, and
  • Dugway Proving Ground.
Important:  While the examples listed above are known test locations, other areas of exposure likely exist.

IV.ii.1.I.9.b.  Action to Take When the Veteran Claims Participation in CBRNE Testing but Does Not Claim a Disability

A claim is not substantially complete if a Veteran alleges participation in CBRNE testing during service, but does not claim SC for a specific disability.  In cases such as these, follow the procedures for handling an incomplete application at M21-1, Part I, 1.B.1.g and h.

IV.ii.1.I.9.c.  EP Control Procedures for Claims Based on CBRNE Testing
Upon receipt of a substantially complete CBRNE claim for SC, establish a traditional rating EP (for example, 010, 110, 020) and affix the ChemBio special issue indicator to the relevant contention(s).
Reference:  For more information on EP control, see M21-4, Appendix B, Section II.

IV.ii.1.I.9.d. Sending Notification of Entitlement to Medical Treatment at a VAMC for Individuals Claiming Exposure as a Test Participant

An individual claiming exposure as a test participant is entitled to receive medical treatment at a VAMC.  Include the following statement in initial correspondence following receipt of a claim based on CBRNE testing:
Although there is no specific medical test or evaluation for the types of exposures you might have experienced more than 30 years ago, VA is offering a clinical examination to Veterans who receive this notification letter.  If you have health concerns and wish to be medically evaluated, PLEASE BRING THIS LETTER WITH YOU TO THE NEAREST VA HEALTH CARE FACILITY.  This letter will help you apply for the examination by providing needed documentation.  Additional medical information about potential exposures is available through ‘environmental health coordinators’ located in every VA medical center.
Note:  The examination itself does not constitute, or provide eligibility for, enrollment in the VA health care system.  If you are not already enrolled, you are encouraged to apply for VA health care benefits at the time you apply for the examination.
Include notification to the Veteran to contact DoD at (800) 497-6261 for questions about chemical or biological tests conducted during military service, to include concerns about releasing classified information.

IV.ii.1.I.9.e.     CBRNE POCs and Chem-Bio Database Access

The U.S. DoD and VA Chemical Biological Warfare Exposure System (Chem-Bio) is a consolidated database for mustard gas, SHAD, and Chem-Bio participants.
All ROs must maintain primary and alternate POCs who are authorized access to DoD’s database.  These POCs are responsible for conducting preliminary research regarding claimed in-service chemical and biological agent testing-related exposures.  Access should be requested in advance of receipt of a claim based on exposure in order to ensure that claims processing is not unnecessarily delayed.
Important:  To request access to the Chem-Bio Database, send a completed DD Form 2875 to the CBRNE Mailbox at VAVBAWAS/CO/CBRNE.

IV.ii.1.I.9.f.  Procedure for Verifying Participation in CBRNE Testing

Follow the steps in the table below after attempting to verify participation in CBRNE testing.

Important:

  • Because DoD is declassifying tests on an irregular schedule, this verification must be done every time testing participation is alleged, even if a previous negative DoD response is of record.
  • Even if the claim seems implausible based on evidence in the claims folder (for example, Veteran claims exposure before or after the period of 1955 to 1975), it is DoD’s sole authority to validate whether an individual participated in any chemical or biological test.
Step
Action
1
The RO’s CBRNE POC or alternate POC either
  • directly consults DoD’s online Chem-Bio Database, or
  • follows the procedure in M21-1 Part IV, Subpart ii, 1.I.9.g to submit the inquiry to Compensation Service if he/she does not yet have access to the database.
2
Was participation verified by the action in Step 1?
  • If yes,
  • If no, proceed to the next step.
3
Has VA requested and received the Veteran’s military personnel records?
  • If yes, proceed to the next step.
  • If no, request the records.
Reference:  For more information on requesting military personnel records, see M21-1, Part III, Subpart iii, 2.B.5.
4
Once the RO receives the military personnel records, request DoD review by sending copies of the Veteran’s military personnel records, to include DD Form 214, to:
Department of Veterans Affairs
Compensation Service (211B)
ATTN:  Chem-Bio Manager
810 Vermont Ave, NW
Washington, DC  20420
Note:  When Compensation Service receives the records, it will forward a copy to DoD for further investigation.  Once Compensation Service receives DoD’s final response, they will notify the requestor by e-mail.
5

Is the claim being processed in the NWQ environment?

  • If yes,
    • transfer the claim to Compensation Service by assigning the Compensation Service Review – MG/CBRNE/Shad special issue indicator andCompensation Service Review tracked item, and
    • create a VBMS e-Folder note stating the claim is referred to Compensation Service for verification of participation in CBRNE testing.
  • If no, assign the Compensation Service Review tracked item.
References:  For more information on
6
Did DoD confirm participation?

IV.ii.1.I.9.g. Referring the Claim to Compensation Service to Verify Participation in CBRNE Testing

When an RO’s CBRNE POC or alternate POC does not have access to the Chem-Bio Database, follow the steps in the table below to refer claims to Compensation Service for verification of participation in CBRNE testing.
Step
Action
1
Prepare a memorandum requesting verification of participation in CBRNE testing containing the following information:
  • Veteran’s full name
  • VA claims folder number
  • branch of military service
  • SSN
  • service number, if applicable (older DoD records contain only the eight-digit service number of test participants)
  • available test information (for example, test location, description of the test, and/or how exposure occurred), and
  • the nature of the disability(ies) claimed as due to exposure to chemical or biological test agents during service.
2
Upload the memorandum and any other supporting documents to the VBMS eFolder.
3
Use the table below to refer the claim to Compensation Service.
If the claim is …
Then …
processed in the NWQ environment
  • create a VBMS e-Folder note stating the claim is referred to Compensation Service for verification of participation in CBRNE testing, and
  • assign the Compensation Service Review – MG/CBRNE/Shad special issue indicator and Compensation Service Review tracked item in accordance with the NWQ Playbook to ensure proper routing to Compensation Service.
not processed in the NWQ environment
  • add the Compensation Service Review tracked item
  • send an e-mail titled CBRNE Test requesting verification of participation in CBRNE testing to the following Compensation Service mailbox:VAVBAWAS/CO/CBRNE, and
  • upload the e-mail to the Veteran’s VBMS eFolder.

IV.ii.1.I.9.h.  Where to Schedule an Examination for Claims Based on CBRNE Testing

If an RO determines that an examination is needed in order to decide an initialCBRNE claim, the RO must submit the examination request to a VA medical facility and not to a contract examiner.
References:  For more information on

IV.ii.1.I.9.i.  Information to Include in Examination or Medical Opinion Requests for Claims Based on CBRNE Testing

VHA has prepared Under Secretary for Health Information Letter, 10-2006-010,Potential Health Effects Among Veterans Involved in Military Chemical Agent Experiments Conducted from 1955 to 1975, to address questions about the potential health effects to Veterans involved in the testing of warfare agents.  The letter should be brought to the examiner’s attention either on the examination request or in information placed in the claims folder.
When requesting an examination, also include in the Remarks section of the examination request a list of the agents, simulants, tracers, antidotes and other such substances, as applicable, to which Compensation Service has verified exposure for the Veteran or as shown in the Chem-Bio Database.
When requesting a medical opinion as to whether there is a relationship between a disease or disability and participation in CBRNE testing during service, identify for the examiner’s review the exposure information obtained from the Chem-Bio Database or provided in response to the request under M21-1, Part IV, Subpart ii, 1.I.9.g.
Important:  When requesting an examination and/or medical opinion for claims based on CBRNE testing, ensure the examiner is provided with the claims folder for consideration.
Reference:  For more information on the requirement to identify relevant evidence for the examiner’s review, see M21-1, Part III, Subpart iv, 3.A.8.d.

10.  Exhibit 1:  Fact Sheet Burn on Pits in Iraq, Afghanistan, and Djibouti


Change Date

October 23, 2015

IV.ii.1.I.10.a.  Fact Sheet: Burn Pits in Iraq, Afghanistan, and the Horn of Africa

Fact Sheet for Claims of Exposure Based on Burn Pits in Iraq, Afghanistan, and the Horn of Africa is shown below.
FACT SHEET
Burn Pits in Iraq, Afghanistan, and Djibouti on the Horn of Africa
NOTICE TO VA EXAMINERS
VA Considers this Veteran Exposed to Burn Pit Toxins

Large burn pits have been used throughout the operations in Iraq, Afghanistan, and Djibouti to dispose of nearly all forms of waste.  It is estimated that such pits, some nearly as large as 20 acres, are or have been located at every military forward operating base (FOB).  The pit at Joint Base Balad, also known as Logistic Support Area (LSA) Anaconda, has received the most attention.  The burned waste products include, but are not limited to: plastics, metal/aluminum cans, rubber, chemicals (such as, paints, solvents), petroleum and lubricant products, munitions and other unexploded ordnance, wood waste, medical and human waste, and incomplete combustion by-products.  Jet fuel (JP-8) is used as the accelerant.  The pits do not effectively burn the volume of waste generated, and smoke from the burn pit blows over bases and into living areas.

DoD has performed air sampling at Joint Base Balad, Iraq and Camp Lemonier, Djibouti on the Horn of Africa.  Subsequently, DoD has indicated that most of the air samples have not shown individual chemicals that exceed military exposure guidelines (MEG).  Nonetheless, DoD further concluded that the confidence level in their risk estimates is low to medium due to lack of specific exposure information, other routes/sources of environmental hazards not identified; and uncertainty regarding the synergistic impact of multiple chemicals present, particularly those affecting the same body organs/systems.

The air sampling performed at Balad and discussed in an unclassified 2008 assessment tested and detected all of the following: (1) Particulate matter (PM-10) (and PM 2.5); (2) Polycyclic Aromatic Hydrocarbons (PAHs); (3) Volatile Organic Compounds (VOCs); and (4) Toxic Organic Halogenated Dioxins and Furans (dioxins). Each of the foregoing is discussed below.
Some of the PAHs that were tested for and detected are listed below. These results are from DoD testing from January through April 2007.
Acenaphthene Acenaphthylene
Anthracene Benzo(a)anthracene
Benzo(a)pyrene Benzo(b)fluoroanthene
Benzo(b)fluoroanthene Benzo(g,h,i)perylene
Benzo(k)fluoroanthene Chrysene
Dibenz(a,h)anthracene Fluoranthene
Fluorene Indeno(1,2,3-cd)pyrene
Naphthalene Phenanthrene
Pyrene
The following list reveals some of the VOCs that were tested for and detected at Balad. These results are from DoD testing from January through April 2007.
Acetone Acrolein*
Benzene Carbon Disulfide
Chlorodifluoromethane Chloromethane
Ethylbenzene Hexane
Hexachlorobutadiene* m/p-Xylene
Methylene Chloride Pentane
Propylene Styrene
Toluene
* Acrolein and Hexachlorobutadiene were, although seldomly, detected far above the MEG ratio—once over 1800 percent above the MEG for Acrolein and over 500 percent above the MEG for Hexachlorobutadiene.
Below is a list of the dioxins and furans detected, all reportedly at low doses.
1,2,3,4,6,7,8 HPCDD 1,2,3,4,6,7,8 HPCDF
1,2,3,4,7,8,9 HPCDF 1,2,3,4,7,8 HXCDD
1,2,3,4,7,8 HXCDF 1,2,3,6,7,8 HXCDD
1,2,3,6,7,8 HXCDF 1,2,3,7,8,9 HXCDD
1,2,3,7,8,9 HXCDF 1,2,3,7,8 PECDD
1,2,3,7,8 PECDF 2,3,4,6,7,8 HXCDF
2,3,4,7,8 PECDF 2,3,7,8 TCDD
2,3,7,8 TCDF octachlorodibenzodioxin
octachlorodibenzofuran
For examination purposes, 22 of the VORs and PAHs, affect the respiratory system; 20 affect the skin; at least 12 affect the eyes; and others affect the liver, kidneys, central nervous system, cardiovascular system, reproductive system, peripheral nervous system, and GI tract. In at least seven, dermal exposure can greatly contribute to overall dosage. Therefore, when considering total potential exposure, please consider the synergistic effect of all combined toxins, primarily through inhalation and dermal exposure, but also through ingestion.
This information is not meant to influence examiners rendering opinions concerning the etiology of any particular disability; but rather to ensure that such opinions are fully informed based on all known objective facts. Therefore, when rendering opinions requested by rating authorities for a disability potentially related to such exposure, please utilize this information objectively and together with the remaining evidence, including lay evidence, in the Veteran’s record.
_____________________
Adjudication Authority

11.  Exhibit 2:  Fact Sheet on Particulate Matter Throughout Iraq, Afghanistan, and Djibouti


Change Date

October 23, 2015

IV.ii.1.I.11.a.  Fact Sheet:Particulate Matter Throughout Iraq, Afghanistan, and Djibouti

Fact Sheet for Claims of Exposure Based on Particulate Matter Throughout Iraq, Afghanistan, and Djibouti is shown below.
FACT SHEET

Particulate Matter throughout Iraq, Afghanistan, and Djibouti

NOTICE TO VA EXAMINERS
VA Considers this Veteran Exposed to High Levels of Particulate Matter
“Particulate matter” (PM), is a complex mixture of extremely small particles and liquid droplets made up of a number of components, including acids (such as nitrates and sulfates), organic chemicals, metals, and soil or dust particles. The PM levels in Southwest Asia are naturally higher than most of the world and may present a health risk to service members. There are two sizes of particles in the air that are a health concern—particles with a 10-micron (PM10) diameter or smaller, and those 2.5 microns (PM2.5) and smaller. The size is directly linked to potential for causing health problems. Once inhaled, 10-micron sized particles or smaller can affect the heart and lungs and cause serious health effects.
Primary sources of PM in Southwest Asia and Djibouti on the Horn of Africa include dust storms and emissions from local industries.  The DoD conducted a year-long sampling survey to characterize the chemistry and mineralogy of the PM at 15 sites in OIF and OEF.  These results were published by the Desert Research Institute in 2008 and are being reviewed by the National Academy of Sciences Committee on Toxicology.  DoD stated in their 2008 Balad assessment, that emission from burns pits, among other things, “may increase localized concentration of 2.5 micrometer PM and other potentially toxic air pollutants.”
Most studies relate PM exposure data to respiratory and cardiopulmonary health effects in specific susceptible general population subgroups to include young children, the elderly, and especially those with existing asthma or cardiopulmonary disease. Many variables influence the probability of health outcomes. The key variables are the size-fraction and chemical makeup of the PM, the concentration levels, the duration of exposures, and various human factors to include age, health status, existing medical conditions, and genetics. These variables combined with scientific data gaps limit the medical community’s ability to estimate health impacts to relatively healthy troops. Another key factor is that most studies have been on older or less healthy groups. Several studies to determine potential health effects/outcomes are currently underway.
DoD collected approximately 60 air samples at Balad from January to April 2007 and assessed for PM. The samples were taken from five different locations around Balad. The heaviest measured concentration of PM was taken in April 2007—the concentration level was 299 ug/m3 of PM10 sized particles. In total, 50 of the 60 samples registered above the military exposure guidelines.
This information is not meant to influence examiners rendering opinions concerning the etiology of any particular disability; but rather to ensure that such opinions are fully informed based on all known objective facts. Therefore, when rendering opinions requested by rating authorities for a disability potentially related to such exposure, please utilize this information objectively and together with the remaining evidence, including lay evidence, in the Veteran’s record.
_____________________
Adjudication Authority

12.  Exhibit 3:  Fact Sheet on the Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq


Change Date
August 7, 2015

IV.ii.1.I.12.a.  Fact Sheet: Sulfur Fire at the Mishraq State Sulfur Mine
Fact Sheet for Claims of Exposure Based on the Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq, is shown below.
FACT SHEET
Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq
NOTICE TO VA EXAMINERS
VA Considers this Veteran Exposed to Sulfur Dioxide and Hydrogen Sulfide
In June 2003, a fire ignited at the Mishraq State Sulfur Mine in northern Iraq. The sulfur mine is the largest in the world and resulted in the largest manmade sulfur fire in recorded history. It burned for approximately 3 weeks and caused the release of roughly 42 million pounds of sulfur dioxide (SO2) per day; hydrogen sulfide (H2S) was also released.
In early 2007, medical personnel from the U.S. Army Center for Health Promotion and Preventative Medicine visited Ft Campbell, Kentucky, which is the U.S. home base for the 101st Airborne Division. Members of the 101st were firefighters at the Mishraq State Sulfur Mine fire. The medical personnel learned that from late 2004 through February 2007, 41 soldiers, citing exposures to the sulfur fire and reporting unexplained shortness of breath on exertion, had been referred by the Blanchfield Medical Center to a pulmonary specialist at the Vanderbilt Medical Center. As of February 2007, nineteen (19) personnel had an open lung biopsy and were all diagnosed with constrictive bronchiolitis. Constrictive bronchiolitis is an inflammatory and fibrotic lesion of the terminal bronchioles of the lungs. This diagnosis is very uncommon and has been associated with inhalation exposures, organ transplantation, certain drugs, and collagen vascular disorders. Individuals with this finding typically have shortness of breath on exertion, but may have normal chest X-rays and inconclusive findings on pulmonary function testing. Due to some similarities, symptoms of constrictive bronchiolitis may be attributed to asthma or chronic obstructive pulmonary disease (COPD).
Examiners may have a difficult time evaluating this population. In most cases, the affected soldiers are comfortable at rest and are able to perform the activities of daily living. They have normal or near normal pulmonary function tests, but at the same time they become short of breath on slight physical exertion, cannot meet physical training requirements, and are considered unfit for deployment. This unique circumstance challenges those who must determine a disability rating.
While individual exposure levels cannot be accurately determined, DoD considers constrictive bronchiolitis (initially diagnosed as “bronchiolitis obliterans”) to be plausibly associated with exposure to the 2003 Mishraq State sulfur fire event. This health effect has been scientifically associated with high exposures to SO2 .
Both sulfur dioxide and hydrogen sulfide are gases that can produce irritation and reddening of the nose and throat, eye irritation/pain, and coughing. At high levels, sulfur dioxide can burn the skin and can cause severe airway obstruction, hypoxemia, pulmonary edema, and even death. The firefighters involved with suppressing this fire experienced irritation, minor burns, and other effects such as blood-tinged nasal mucous. Some have been found to have long-term respiratory conditions such as “constrictive bronchiolitis.”
Note: If the claim is for a respiratory condition possibly related to the sulfur fire exposure consider requesting tests for “bronchiolitis” be conducted in addition to other respiratory testing, while noting that many standard test results may be normal.
This information is not meant to influence examiners rendering opinions concerning the etiology of any particular disability; but rather to ensure that such opinions are fully informed based on all known objective facts. Therefore, when rendering opinions requested by rating authorities for a disability potentially related to such exposure, please utilize this information objectively and together with the remaining evidence, including lay evidence, in the Veteran’s record.
_____________________
Adjudication Authority

13.  Exhibit 4:  Fact Sheet on the Qarmat Ali Water Treatment Plant in Basrah, Iraq


Change Date

August 7, 2015

IV.ii.1.I.13.a.  Fact Sheet: Qarmat Ali Water Treatment Plant

Fact Sheet for Claims of Exposure Based on the Qarmat Ali Water Treatment Plant in Basrah, Iraq, is shown below.
FACT SHEET
Qarmat Ali Water Treatment Plant in Basrah, Iraq
NOTICE TO VA EXAMINERS
VBA Considers this Veteran Exposed to Hexavalent Chromium
From approximately April through September of 2003, Army National Guard (NG) personnel from Indiana, West Virginia, South Carolina, and Oregon operated at the Qarmat Ali Water Treatment Plant in Basrah, Iraq. They were assigned to guard contract workers who were restoring the plant. During that time, sodium dichromate, a source of hexavalent chromium was found on the ground and measured in the air. Hexavalent chromium, or Chromium VI (six), in sodium dichromate is a lung carcinogen through inhalation. Chromium VI is also an acidic compound that can cause immediate irritation of the eyes, nose, sinuses, lungs, and skin.
DoD provided a medical evaluation for certain soldiers there at the time, which took place in October 2003. Accordingly, 137 service members were evaluated. The results at the time showed some abnormalities in individuals, such as complaints of eye, nose, throat and/or lung irritation, or abnormal pulmonary function, kidney, or liver tests. However, the Army stated that it could not specifically trace these symptoms to chromium exposure.
The Veterans Health Administration (VHA) has begun to augment the Gulf War Registry to reflect service at Qarmat Ali. VHA is verifying the numbers of these Veterans who have either enrolled in care or received a Gulf War Registry examination. The involved Guard members who have had an initial examination will be recalled to have a complete exposure assessment as well as a more targeted physical examination and ancillary testing to detect indications of health outcomes that may be related to hexavalent Chromium. The Veteran, whose case you are reviewing, may or may not have completed this type of examination. Therefore, please be sure to review any such records if they exist in the VHA health record system for this Veteran.
This information is not meant to influence examiners rendering opinions concerning the etiology of any particular disability; but rather to ensure that such opinions are fully informed based on all known objective facts. Therefore, when rendering opinions requested by rating authorities for a disability potentially related to such exposure, please utilize this information objectively and together with the remaining evidence, including lay evidence, in the Veteran’s record.
_____________________
Adjudication Authority

14.  Exhibit 5:  Fact Sheet on the Naval Air Facility in Atsugi, Japan


Change Date

August 7, 2015

IV.ii.1.I.14.a.  Fact Sheet: Naval Air Facility in Atsugi, Japan

Fact Sheet for Claims of Exposure Based on the Naval Air Facility in Atsugi, Japan, is shown below.
FACT SHEET
Naval Air Facility, Atsugi, Japan
NOTICE TO VA EXAMINERS
VBA Considers this Veteran Exposed to Incinerator Emissions
The Department of Defense (DoD) has indicated that during the years between 1985 and 2001, personnel at Naval Air Facility (NAF) Atsugi, Japan were exposed to environmental contaminants. The source was an off-base waste incinerator business owned and operated by a private Japanese company. Known as the Jinkanpo or Shinkampo Incinerator Complex, the operation consisted of a combustion waste disposal complex equipped with four incinerators burning up to 90 tons of industrial and medical waste daily. The complex was located approximately 100 yards south of the NAF Atsugi perimeter and during the spring and summer months the prevailing winds would blow the incinerators’ emissions over the NAF.
Environmental assessment reports conducted during the years of incinerator operations stated that there was significant degradation of air quality at the sites sampled and identified the sources as incomplete burning of wastes in uncontrolled incinerators and evaporation of solvents poured onto outdoor waste piles prior to incineration. The identified chemicals of potential concern included: chloroform; 1,2-dichloroethane; methylene chloride; trichloroethylene; chromium; dioxins and furans; and other particulate matter.
Since the 1990s, the Navy has informed sailors and their family members about the possible long-term health effects of living at Atsugi. The Navy has also published various health information about Atsugi at the following website:
This information is not meant to influence examiners rendering opinions concerning the etiology of any particular disability; but rather to ensure that such opinions are fully informed based on all known objective facts. Therefore, when rendering opinions requested by rating authorities for a disability potentially related to such exposure, please utilize this information objectively and together with the remaining evidence, including lay evidence, in the Veteran’s record.
_____________________
Adjudication Authority
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