Overview
In This Section |
This section contains the following topics:
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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
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Change Date |
October 23, 2015
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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.
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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.
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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
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Change Date |
October 23, 2015
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IV.ii.1.I.2.d. Considering Presumptive SC |
Once a substantially complete claim is of record, the following conditions apply:
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IV.ii.1.I.2.e. Locations of Lists of Chronic and Tropical Diseases |
The conditions listed in
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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.
References: For more information on
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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.
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3. Developing Claims for SC for Asbestos-Related Diseases
Introduction |
This topic contains information on developing claims for SC for asbestos-related diseases, including
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Change Date |
May 23, 2018
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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
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.
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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
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IV.ii.1.I.3.c. Asbestos Claims Development Procedures |
All claims based on asbestos exposure require
Follow the steps in the table below to obtain the necessary evidence in support of a substantially complete application based on exposure to asbestos.
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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:
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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
In determining whether asbestos exposure has been demonstrated by the evidence of record, consider
Notes:
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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.
Note: In all examination requests,
References: For more information on
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4. Developing Claims for SC for AIDS
Introduction |
This topic contains information on developing claims for SC for AIDS, including
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Change Date |
April 12, 2019
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IV.ii.1.I.4.b. Causative Agent of AIDS |
AIDS is caused by the human immunodeficiency virus (HIV).
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IV.ii.1.I.4.d. Obtaining Medical Records Showing Treatment of AIDS |
Request
Send the Veteran VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA), if he/she
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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
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Change Date |
April 12, 2019
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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.
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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
Notes:
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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
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Change Date |
April 12, 2019
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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.
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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,
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.
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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.
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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.
References: For more information on
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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
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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.
References: For more information on
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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
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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:
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:
References: For more information on
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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
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Change Date |
April 12, 2019
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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
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IV.ii.1.I.7.b. Definition: Camp Lejeune Issue |
A Camp Lejeune issue, for the purpose of processing under the procedures listed in this topic, is a claim for compensation for either
Reference: For more information on Camp Lejeune claims jurisdiction, see M21-1, Part IV, Subpart ii, 1.I.7.c.
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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.
Exception: The following types of claims qualify for other centralized processing and will not be processed by the ROJ or Louisville RO:
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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
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
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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.
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
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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
Important:
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.
Reference: For more information on Camp Lejeune service, see
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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
References: For more information on
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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.
References: For more information on
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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:
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:
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.
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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
Use the table below to develop for evidence from the claimant in specific Camp Lejeune claims.
References: For more information on
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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.
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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
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
References: For more information on
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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
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Change Date |
April 12, 2019
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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.
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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:
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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.
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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.
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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.
Reference: For more information on Project 112/Project SHAD, see
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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,
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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:
Notes:
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Introduction |
This topic contains information on developing claims based on CBRNE testing, including
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Change Date |
April 12, 2019
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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
Important: While the examples listed above are known test locations, other areas of exposure likely exist.
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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.
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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.
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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.
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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.
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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:
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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.
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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
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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.
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10. Exhibit 1: Fact Sheet Burn on Pits in Iraq, Afghanistan, and Djibouti
Change Date |
October 23, 2015
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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.
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11. Exhibit 2: Fact Sheet on Particulate Matter Throughout Iraq, Afghanistan, and Djibouti
Change Date |
October 23, 2015
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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.
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12. Exhibit 3: Fact Sheet on the Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq
Change Date
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August 7, 2015
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Fact Sheet for Claims of Exposure Based on the Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq, is shown below.
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13. Exhibit 4: Fact Sheet on the Qarmat Ali Water Treatment Plant in Basrah, Iraq
Change Date |
August 7, 2015
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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.
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14. Exhibit 5: Fact Sheet on the Naval Air Facility in Atsugi, Japan
Change Date |
August 7, 2015
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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.
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