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WELCOME

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  1. WELCOME AMERICAN FEDERATION OF GOVERNMENT EMPLOYEES

  2. A Veteran’s Guide to VA Benefits • This guide is design to help you understand the claims process and your rights and responsibilities. • We would like to come to your community and explain its contents and how you can help to improve the claims processing. • So please volunteer to setup a town hall meeting in your community.

  3. COMPENSATION CLAIMS VA disability compensation provides monthly benefits to Veterans in recognition of the effects of disabilities, diseases, or injuries incurred or aggravated during active military service. The program also provides monthly payments to surviving spouses, dependent children, and dependent parents in recognition of the economic loss caused by a Veteran’s death during military service or, after discharge from military service, as a result of a service-connected disability.

  4. TYPE OF COMPENSATION CLAIMS There are many types of claims for disability compensation. For example, if you're filing a VA claim for the very first time, you have anoriginal claim. Areopened claimmeans you have newandmaterial evidence and you want VA to reconsider a claim it once denied. There are also new claims,secondary claims, andspecial claims.

  5. HOW TO FILE A COMPENSATION CLAIM E-BENEFITS https://www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal you may print and mail-in VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits or call VA at 1-800-827-1000 to have the form mailed to you.http://www.vba.va.gov/pubs/forms/VBA-21-526EZ-ARE.pdf Dependency and Indemnity Compensation (DIC)VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits and mail it to your nearest VA regional office. http://www.vba.va.gov/pubs/forms/VBA-21-534EZ-ARE.pdf VISIT/CONTACT YOUR COUNTY VA OFC (CVAO) VISIT/CONTACT A VETERAN SERVICE REPRESENTATIVE (VSO) AL, DAV, VFW, PVA, ETC. VA FORM 526b - Supplemental Claims http://www.vba.va.gov/pubs/forms/VBA-21-526b-ARE.pdf

  6. Fully Developed Claims (FDC)http://benefits.va.gov/compensation/ The Fully Developed Claims (FDC) program is an optional new initiative that offers Veterans, and survivors faster decisions from VA on compensation, pension, and survivor benefit claims. Veterans and survivors simply submit all required records and documentation at the time they make their claim and certify that they have no further evidence. VA can then review and process the claim more quickly.

  7. PENSION CLAIMS VA helps Veterans and their families cope with financial challenges by providing supplemental income through the Veterans Pension and Survivors' Pension benefit programs. Veterans Pension:Tax-free monetary benefit payable to low-income wartime Veterans. Survivors' Pension:Tax-free monetary benefit payable to a low-income, un-remarried surviving spouse and/or unmarried child(ren) of a deceased Veteran with wartime service.

  8. HOW TO FILE A PENSION CLAIM E-BENEFITS https://www.ebenefits.va.gov/ebenefits-portal/ebenefits.portal you may print and mail-in VA Form 21-527EZ, Application for Disability Compensation and Related Compensation Benefits or call VA at 1-800-827-1000 to have the form mailed to you. http://www.vba.va.gov/pubs/forms/VBA-21-527EZ-ARE.pdf Dependency and Indemnity Compensation (DIC)VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits and mail it to your nearest VA regional office. http://www.vba.va.gov/pubs/forms/VBA-21-534EZ-ARE.pdf VISIT/CONTACT YOUR COUNTY VA OFC (CVAO) VISIT/CONTACT A VETERAN SERVICE REPRESENTATIVE (VSO) AL, DAV, VFW, PVA, ETC. VA FORM 527 - Supplemental Claims

  9. Step 1 - Honorable Active Military ServiceCFR 3.203 • In order to be eligible for disability compensation benefits, you must have a service-related disability and were discharged under other than dishonorable conditions. • Acceptable documents to established veteran’s status are: • An original copy or carbon copy of the original separation document • a copy of the separation document certified by a clerk of court or authorized VBA employee • A copy of the separation document certified by County Affairs Officer or Service organization member who has been approved by VA • Unacceptable documents to established veteran’s status are: • Notarized copies of separation documents • Zerox copies of separation documents that have not been properly certified • The separation documents must contain the entry on active duty and released from active duty dates, branch of service and characterization of service • If documents are not available, the VA will assistance you in verifying your service as long as you provide the your service dates, branch of service and serial number if different from your SSN.

  10. STEP 2 – Service Treatment Records (STR)38 CFR 3.159 • If you have the original copy of the STRS, VA will need it. • If you do not have the original VA will assist, you in obtaining it. • If you are an active member of a Reserve or National Guard Unit, VA will need: • Your unit’s name and complete mailing address

  11. STEP 3 – Medical Records38 CFR 3.159 • If you have been treated at a VA medical facility, tell VA the name of the facility, dates of treatment, and the disability treated for and VA will get these records. • If you have been treated at a Federal facility VA will assist you in getting those records or you can send in the relevant treatment records. • If you have been treated by a private doctor/facility, you can send in the relevant treatment records, or send a VA Form 21-4142, Authorization form (a separate one for each doctor/facility) and the VA will assist you in obtaining the records. • It is your responsibility to provide the VA with the necessary information to obtain the medical records – • complete mailing address • dates of treatment • and disability treated for.

  12. STEP 4 – Other EvidenceCFR 3.159 • VA will assist you in obtaining other relevant evidence, such as service records, employment info etc. • Reminder • It is your responsibility to provide the VA with the necessary information to obtain the evidence

  13. STEP 5 – Examinations38 CFR 3.326 & 3.159 • In claims for compensation a VA exam is not mandatory. The law requires that certain requirements be meet. • VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: • Contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; • Establishes that the veteran suffered an event, injury or disease in service, or has a disease or symptoms of a disease listed in §3.309, §3.313, §3.316, and §3.317 manifesting during an applicable presumptive period provided the claimant has the required service or triggering event to qualify for that presumption; and • Indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability.

  14. 38 CFR 3.159 VCAA - Veterans Claims Assistance Act Requires VA to notify the you and your representative (if any), in writing of: • any information or evidence that is necessary to substantiate your claim, including medical and lay evidence • the information or evidence you must submit, and • the information or evidence that VA will attempt to obtain on the your behalf.

  15. Federal Records 38 CFR 3.159 • The VA is responsible for assisting you in obtaining federal records: • Service records to include treatment records, VA medical records, records in the custody of a federal agencies to include National Guard records. • The VA will continue to pursue federal records until it is determine the records do not exists or further efforts to obtain them would be futile. • VA will notify you if efforts fail and give you 10 days to provide the evidence before deciding your claim. • However, remember you still have 12 months from the VCAA notification date to send the records to the VA.

  16. Non Federal Records38 CFR 3.159 • The VA is responsible for assisting you in obtaining private records. • It is limited to 30 days, initial request 15 days and 15 days follow-up. • VA is responsible for notifying you each time your private records are requested. • It is still your responsibility to ensure VA gets these records prior to the 40 days. • If the records are not received within 30 days, VA can make a decision on your claim. However, you still have 12 months from the date of VCAA notification to submit the evidence.

  17. 38 CFR 3.303-6Service Connection • Your disability must have occurred during or was aggravated by your military service • You must have a current disability • There must be a nexus (link) between your current disability and your military service • Example: If you broke your ankle in service, and now you are having problems with your ankle then there is a possibility that it is related to your service or • If you broke your ankle prior to service, but it was aggravated by your service then there is a possibility that it is related to your service.

  18. 38 CFR 3.156 New and material evidence • A claimant may reopen a finally adjudicated claim by submitting new and material evidence. • Final adjudicated means that you have been notified of the decision and 12 months have past since notification. • New evidence means existing evidence not previously submitted to agency decisionmakers. • Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. • New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. (Authority: 38 U.S.C. 501, 5103A(f), 5108)

  19. 38 CFR 3.307 Presumptive service connection A chronic, tropical, prisoner of war related disease, or a disease associated with exposure to certain herbicide agents listed in CFR 3.309 will be considered to have been incurred in or aggravated by service under the circumstances outlined in this section even though there is no evidence of such disease during the period of service. No condition other than one listed in §3.309(a) will be considered chronic.

  20. 38 CFR 3.309(a) Chronic diseases The following diseases shall be granted service connection as a result of chronic diseases if all provisions of law are meet and it is manifested to a compensable degree within one year of service, except for Hansen’s disease and Tuberculosis which is 3 years and Multiple Sclerosis which is 7 years following service in a period of war or following peacetime service on or after January 1, 1947 • Anemia, primary.Arteriosclerosis.Arthritis.Atrophy, progressive muscular.Brain hemorrhage.Brain thrombosis.Bronchiectasis.Calculi of the kidney, bladder, or gallbladder.Cardiovascular-renal disease, including hypertension. (This term applies to combination involvement of the type of arteriosclerosis, nephritis, and organic heart disease, and since hypertension is an early symptom long preceding the development of those diseases in their more obvious forms, a disabling hypertension within the 1-year period will be given the same benefit of service connection as any of the chronic diseases listed.) Cirrhosis of the liver.Coccidioidomycosis.Diabetes mellitus.Encephalitis lethargica residuals.Endocarditis. (This term covers all forms of valvular heart disease.) Endocrinopathies.Epilepsies.Hansen's disease (3 years).Hodgkin's disease.Leukemia.Lupus erythematosus, systemic Myasthenia gravis.Myelitis.

  21. 38 CFR 3.309(a) Chronic diseases con’t • Myocarditis.Nephritis.Other organic diseases of the nervous system.Osteitis deformans (Paget's disease).Osteomalacia.Palsy, bulbar.Paralysis agitans.Psychoses.Purpura idiopathic, hemorrhagic.Raynaud's disease.Sarcoidosis.Scleroderma.Sclerosis, amyotrophic lateral.Sclerosis, multiple (7 Years).Syringomyelia.Thromboangiitis obliterans (Buerger's disease).Tuberculosis, active (3 Years).(Tumors, malignant, or of the brain or spinal cord or peripheral nerves. • Ulcers, peptic (gastric or duodenal) (A proper diagnosis of gastric or duodenal ulcer (peptic ulcer) is to be considered established if it represents a medically sound interpretation of sufficient clinical findings warranting such diagnosis and provides an adequate basis for a differential diagnosis from other conditions with like symptomatology; in short, where the preponderance of evidence indicates gastric or duodenal ulcer (peptic ulcer). Whenever possible, of course, laboratory findings should be used in corroboration of the clinical data.

  22. The following diseases shall be granted service connection as a result of tropical service if all provisions of law are meet and it is manifested to compensable degree within one year following service in a period of war or following peacetime service Amebiasis.Blackwater fever.Cholera.Dracontiasis.Dysentery.Filariasis.Leishmaniasis, including kala-azar.Loiasis.Malaria. Onchocerciasis.Oroya fever.Pinta.Plague.Schistosomiasis.Yaws.Yellow fever.Resultant disorders or diseases originating because of therapy administered in connection with such diseases or as a preventative thereof. 38 CFR 3.303(b) Tropical diseases

  23. 38 CFR 3.309(c) POW • WERE YOU A POW? • If a veteran is a former prisoner of war, the following diseases shall be service connected if manifest to a degree of disability of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of §3.307 are also satisfied. • DO YOU HAVE A DISEASE LISTED IN 309(C) • Psychosis. • Any of the anxiety states. • Dysthymic disorder (or depressive neurosis). • Organic residuals of frostbite, if it is determined that the veteran was interned in climatic conditions consistent with the occurrence of frostbite. • Post-traumatic osteoarthritis. • Atherosclerotic heart disease or hypertensive vascular disease (including hypertensive heart disease) and their complications (including myocardial infarction, congestive heart failure, arrhythmia). • Stroke and its complications. • On or after October 10, 2008, Osteoporosis, if the Secretary determines that the veteran has posttraumatic stress disorder (PTSD).

  24. 38 CFR 3.309(c) POW Con’t • Were you interned or detained for not less than 30 days? • The following diseases shall be service connected if manifest to a degree of 10 percent or more at any time after discharge or release from active military, naval, or air service even though there is no record of such disease during service, provided the rebuttable presumption provisions of §3.307 are also satisfied. • Avitaminosis. • Beriberi (including beriberi heart disease). • Chronic dysentery. • Helminthiasis. • Malnutrition (including optic atrophy associated with malnutrition). • Pellagra. • Any other nutritional deficiency. • Irritable bowel syndrome. • Peptic ulcer disease. • Peripheral neuropathy except where directly related to infectious causes. • Cirrhosis of the liver. • On or after September 28, 2009, Osteoporosis.

  25. DID YOU PARTICIPATE IN A RADIATION RISK ACTIVITY? A) Onsite participation in a test involving the atmospheric detonation of a nuclear device.(B) The occupation of Hiroshima or Nagasaki, Japan, by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946.(C) Internment as a prisoner of war in Japan(or service on active duty in Japan immediately following such internment) during World War II which resulted in an opportunity for exposure to ionizing radiation comparable to that of the United States occupation forces in Hiroshima or Nagasaki, Japan, during the period beginning on August 6, 1945, and ending on July 1, 1946. DO YOU HAVE ANY DISEASE LISTED IN CFR 3.309(d)? Leukemia (other than achronic lymphocytic leukemia. Cancer of the thyroid. Cancer of the breast. Cancer of the pharynx. Cancer of the esophagus. Cancer of the stomach. Cancer of the small intestine. Cancer of the pancreas. Multiple myeloma. Lymphomas (except Hodgkin’s disease). Cancer of the bile ducts. Cancer of the gall bladder. Primary liver cancer (except if cirrhosis or hepatitis B is indicated). Cancer of the salivary gland. Cancer of the urinary tract (urinary tract means the kidneys, renal pelves, ureters, urinary bladder, and urethra) Bronchiolo-alveolar carcinoma. Cancer of the bone. Cancer of the brain. Cancer of the colon. Cancer of the lung. Cancer of the ovary. 38 CFR 3.309(d) Radiation-Risk Activity

  26. 38 CFR 3.309(e) Agent Orange • Were you exposed to Agent Orange? • Exposure conceded by VA? • service in the RVN or its inland waterways, or • service in other locations if the conditions of service involved duty or visitation in the RVN. • service along the DMZ in Korea, and was assigned to one of the units recognized by VA between April 1968 and July 1969. • The National Archives and Records Administration (NARA) has confirmed that the Navy destroyer USS Ingersoll (DD 652) traveled into the inland waterways of RVN on October 24 and 25, 1965 • Any exposure to herbicide agents during service in locations other than the ones listed above must be established on a factual basis • How were you exposed? • provide the approximate dates, location, and nature of the alleged exposure.

  27. 38 CFR 3.309(e) Agents Orange Con’t Do you have a disease listed 3.309(e) • AL amyloidosis • Chloracne or other acneform disease consistent with chloracne • Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes) • Hodgkin's disease • Ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina) • All chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia) • Multiple myeloma • Non-Hodgkin's lymphoma • Parkinson's disease • Acute and subacute peripheral neuropathy • Porphyria cutanea tarda • Prostate cancer • Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) • Soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma) The term soft-tissue sarcoma includes the following: Adult fibrosarcoma; Dermatofibrosarcoma protuberans; Malignant fibrous histiocytoma; Liposarcoma; Leiomyosarcoma; Epithelioid leiomyosarcoma (malignant leiomyoblastoma); Rhabdomyosarcoma; Ectomesenchymoma; Angiosarcoma (hemangiosarcoma and lymphangiosarcoma); Proliferating (systemic) angioendotheliomatosis; Malignant glomus tumor; Malignant hemangiopericytoma; Synovial sarcoma (malignant synovioma); Malignant giant cell tumor of tendon sheath; Malignant schwannoma, including malignant schwannoma with rhabdomyoblastic differentiation (malignant Triton tumor), glandular and epithelioid malignant schwannomas; Malignant mesenchymoma; Malignant granular cell tumor;Alveolar soft part sarcoma; Epithelioid sarcoma; Clear cell sarcoma of tendons and aponeuroses; Extraskeletal Ewing’s sarcoma; Congenital and infantile fibrosarcoma; Malignant ganglioneuroma

  28. 38 CFR 3.814 AO Certain Children With Disabilities Born Of Vietnam And Certain Korea Service Veterans • 38 CFR 3.814 Monetary allowance under 38 U.S.C. chapter 18 for an individual suffering from spina bifida whose biological father or mother is or was a Vietnam veteran. • Under Public Law 106-419, VA identified the birth defects of children of women Vietnam veterans that 1) are associated with Vietnam service; and 2) result in permanent physical or mental disability. Birth defects not included in this benefit program as those abnormalities that result from the following: 1) a familial disorder; 2) a birth-related injury, 3) a fetal or neonatal infirmity with well-established causes. The law defines the term "child" as an individual, regardless of age or marital status that is the natural child of a woman Vietnam veteran, and was conceived after the veteran first entered Vietnam. The legislation provides for health care services, vocational training, and a monthly allowance for eligible children • TO APPLY COMPLETE VA FORM IS 21-0304 AND MAIL IT TO: VA Regional Office, Veterans Service Center (339/21), Box 25126, Denver, CO 80225 • All CLAIMS FOR THIS BENEFIT IS HANDLED BY BY THE DENVER RO.

  29. 38 CFR 3.304 Posttraumatic Stress Disorder WHAT IS NEEDED FOR SERVICE CONNECTION? • Per 38 CFR 3.304(f), a finding of service connection for PTSD requires • credible supporting evidence that the claimed in-service stressor actually occurred • medical evidence diagnosing the condition in accordance with 38 CFR 4.125, and • a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. • Note: The lay testimony of a Veteran alone may, under certain circumstances, establish the occurrence of an in-service stressor if the stressor is related to the Veteran’s • PTSD is diagnosed in service, and the stressor is related to that service, or the stressor is related to the Veteran’s • engagement in combat with the enemy • experience as a POW as defined by 38 CFR 3.1(y), or • fear of hostile military or terrorist activity, if a VA psychiatrist or psychologist, or contract equivalent, confirms • the claimed stressor is adequate to support a diagnosis of PTSD, and • the Veteran’s symptoms are related to the claimed stressor.

  30. Stressor Definitions • Engaging in combat with the enemy means personal participation in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality. It includes presence during such events either as a • combatant, or • service member performing duty in support of combatants, such as providing medical care to the wounded • Fear of hostile military or terrorist activity means • the Veteran experienced, witnessed, or was confronted with an event or circumstance that involved • actual or threatened death or serious injury, or • a threat to the physical integrity of the Veteran or others, and the Veteran’s response to the event or circumstances involved a psychological or psycho-physiological state of fear, helplessness, or horror. • Examples of exposure to hostile military or terrorist activity include presence at events involving • actual or potential improvised explosive devices (IEDs) • vehicle-imbedded explosive devices • incoming artillery, rocket, or mortar fires • small arms fire, including suspected sniper fires, or • or attacks upon friendly aircraft.

  31. 38 CFR 3.304 Posttraumatic Stress DisorderDO YOU HAVE A VERIFABLE STRESSOR? • If you have receive any of the combat decorations listed below, VA will presume that the you engaged in combat with the enemy, unless there is clear and convincing evidence to the contrary: • Air Force Achievement Medal with “V” Device • Air Force Combat Action Medal • Air Force Commendation Medal with “V” Device • Air Force Cross • Air Medal with “V” Device • Army Commendation Medal with “V” Device • Bronze Star Medal with “V” Device • Combat Action Badge • Combat Action Ribbon (Note: Prior to February 1969, the Navy Achievement Medal with “V” Device was awarded.) • Combat Aircrew Insignia • Combat Infantry/Infantryman Badge • Combat Medical Badge • Distinguished Flying Cross • Distinguished Service Cross • Joint Service Commendation Medal with “V” Device • Medal of Honor • Navy Commendation Medal with “V” Device • Navy Cross • Purple Heart, and/or • Silver Star. • Important: Receipt of one of the decorations cited above is not the only acceptable evidence of engagement in combat.

  32. Stressor Related to Fear of Hostile Military or Terrorist Activity • Under 38 CFR 3.304(f)(3), a Veteran’s lay statement alone may establish the occurrence of a stressor related to the fear of hostile military or terrorist activity if • evidence shows the Veteran served in an area of potential hostile military or terrorist activity, and • a VA psychiatrist or psychologist (or contract equivalent) • accepts the Veteran’s statement as being adequate to support a diagnosis of PTSD, and • relates the Veteran’s symptoms to the claimed stressor. • Notes: • The receipt of military awards such as, but not limited to, the Vietnam Service or Campaign Medal, Kuwait Liberation Medal, Iraq Campaign Medal, and Afghanistan Campaign Medal is generally considered evidence of service in an area of potential hostile military or terrorist activity. • The receipt of military awards such as the National Defense Service Medal, Armed Forces Service Medal, and Global War on Terrorism (GWOT) Service Medal generally does not indicate service in locations that involve exposure to hostile military or terrorist activity, because these are general medals that do not denote service in a particular area or campaign. If the Veteran served in an area of potential hostile military or terrorist activity, he/she would have received a more specific medal for such service.

  33. Stressor Corroboration Required • Examples of claimed stressors that must be corroborated are • a plane crash caused by severe weather • a severe motor vehicle accident • witnessing the death, injury, or threat to the physical being of another person caused by something other than hostile military or terrorist activity, and • actual or threatened death or serious injury, or other threat to one’s physical being, caused by something other than hostile military or terrorist activity.

  34. PTSD Personal Trauma • Personal trauma is an event of human design that threatens or inflicts harm, Veterans claiming service connection for disability due to in-service personal trauma face unique problems documenting their claims. • These incidents are often violent and may lead to the development of PTSD. • Examples: Rape, physical assault, domestic battering, robbery, mugging, stalking, and harassment. • Note: Service connection for PTSD based on in-service personal trauma derives from the PTSD personal assault regulation, 38 CFR 3.304(f)(5)

  35. MST Incidents • DoD offers two reporting options for MST, restricted and unrestricted. Restricted reporting allows a servicemember to file a report confidentially without initiating the investigative process. • Following an MST incident, a servicemember may elect one of these reporting options by completing DD Form 2910, Victim Reporting Preference Statement. • The servicemember may also elect an optional sexual assault forensic examination (SAFE), which is performed by a healthcare provider and is documented on DD Form 2911, Forensic Medical Report: Sexual Assault Examination. • Notes: • DoD may have used other forms prior to the issuance of DD Form 2910. For example, the Department of the Navy used the form NAVPERS 1752/1,Sexual Assault Incident Data Collection Report. • In restricted reporting cases, DoD stores the evidence, including results from the SAFE, for one year following the date of the victim’s report of sexual assault. If the victim does not claim the evidence or elect an unrestricted report within one year, DoD destroys it.

  36. 38 CFR 3.311Ionizing Radiation • Were you exposed to Ionizing Radiation? • atmospheric testing of nuclear weapons • the occupation of Hiroshima or Nagasaki, Japan from September 1945 • other radiation-risk activities as claimed (I.E. X-RAY TECHNICIAN, REACTOR PLANT ACTIVITIES, NUCLEAR MEDICINE, RADIOGRAPHY, ETC) • Do You have a disease in CFR 3.311(b)(2) and disease first manifested within the period specified in 38 CFR 3.311(b)(5) Or • Do you have a disease not listed, but can cite or have competent scientific or do you have medical evidence that the claimed condition is a radiogenic disease • Medical or scientific EVIDENCE IS REQUIRED

  37. Do You have a disease in CFR 3.311(b)(2) and disease first manifested within the period specified in 38 CFR 3.311(b)(5) All forms of leukemia except chronic lymphatic (lymphocytic) leukemia; Thyroid cancer; Breast cancer; Lung cancer; Bone cancer; Liver cancer; Skin cancer; Esophageal cancer; Stomach cancer; Bone cancer must become manifest within 30 years after exposure; Leukemia may become manifest at any time after exposure; Posterior subcapsular cataracts must become manifest 6 months or more after exposure; and Other diseases specified in paragraph (b)(2) of this section must become manifest 5 years or more after exposure Colon cancer; Pancreatic cancer; Kidney cancer; Urinary bladder cancer; Salivary gland cancer; Multiple myeloma; Posterior subcapsular cataracts; Non-malignant thyroid nodular disease; Ovarian cancer; Parathyroid adenoma; Tumors of the brain and central nervous system; Cancer of the rectum; Lymphomas other than Hodgkin’s disease; Prostate cancer; and Any other cancer. a disease not listed, but can cite or have competent scientific or do you have medical evidence that the claimed condition is a radiogenic disease 38 CFR 3.311Ionizing Radiation Con’t.

  38. 38 CFR 3.316 Mustard Gas • a) Except as provided in paragraph (b) of this section, exposure to the specified vesicant agents during active military service under the circumstances described below together with the subsequent development of any of the indicated conditions is sufficient to establish service connection for that condition: • (1) Full-body exposure to nitrogen or sulfur mustard during active military service together with the subsequent development of chronic conjunctivitis, keratitis, corneal opacities, scar formation, or the following cancers: Nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin. • (2) Full-body exposure to nitrogen or sulfur mustard or Lewisite during active military service together with the subsequent development of a chronic form of laryngitis, bronchitis, emphysema, asthma or chronic obstructive pulmonary disease. • (3) Full-body exposure to nitrogen mustard during active military service together with the subsequent development of acute nonlymphocytic leukemia. • (b) Service connection will not be established under this section if the claimed condition is due to the veteran’s own willful misconduct (See §3.301(c)) or there is affirmative evidence that establishes a nonservice-related supervening condition or event as the cause of the claimed condition (See §3.303).

  39. 38 CFR 3.317 Undiagnosed Illnesses. ARE YOU EXPERIENCING ANY OR A COMBINATION OF THE FOLLOWING CONDITIONS: • An undiagnosed illness; • The following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: • (1) Chronic fatigue syndrome; • (2) Fibromyalgia; • (3) Irritable bowel syndrome; or • (4) a medically unexplained chronic multisymptom illness • The term medically unexplained chronic multisymptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained.

  40. 38 CFR 3.317 Undiagnosed illnesses Cont. • SIGNS OR SYMPTOMS WHICH MAY BE MANIFESTATIONS OF UNDIAGNOSED ILLNESS OR MEDICALLY UNEXPLAINED CHRONIC MULTISYMPTOM ILLNESS INCLUDE, BUT ARE NOT LIMITED TO: • (1) Fatigue • (2) Signs or symptoms involving skin • (3) Headache • (4) Muscle pain • (5) Joint pain • (6) Neurologic signs and symptoms • (7) Neuropsychological signs or symptoms • (8) Signs or symptoms involving the respiratory system (upper or lower) • (9) Sleep disturbances • (10) Gastrointestinal signs or symptoms • (11) Cardiovascular signs or symptoms • (12) Abnormal weight loss • (13) Menstrual disorders. • DO YOU HAVE SOUTHWEST ASIA SERVICE ? The Southwest Asia theater of operations includes the following locations and the airspace above them: • Iraq • Kuwait • Saudi Arabia • the neutral zone between Iraq and Saudi Arabia • United Arab Emirates • Bahrain • Qatar • Oman • the Gulf of Aden • the Gulf of Oman • the Persian Gulf • the Arabian Sea, and • the Red Sea.

  41. 38 CFR 3.318 ALS - Amyotrophic Lateral Sclerosis • (a) Except as provided in paragraph (b) of this section, the development of amyotrophic lateral sclerosis manifested at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease. • (b) Service connection will not be established under this section: • (1) If there is affirmative evidence that amyotrophic lateral sclerosis was not incurred during or aggravated by active military, naval, or air service; • (2) If there is affirmative evidence that amyotrophic lateral sclerosis is due to the veteran’s own willful misconduct; or • (3) If the veteran did not have active, continuous service of 90 days or more. (Authority: 38 U.S.C. 501(a)(1))

  42. ASBESTOS-RELATED DISEASESM21-1MR PART IV • Many people with asbestos-related diseases have only recently come to medical attention because the latent period varies from 10 to 45 or more years between the first exposure and development of a disease. • Note: The exposure may have been direct or indirect; the extent and duration of exposure is not a factor. Inhalation of asbestos fibers can produce: • fibrosis, the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis • tumors • pleural effusions and fibrosis • pleural plaques • mesotheliomas of pleura and peritoneum • cancers of the • lung • bronchus • gastrointestinal tract • larynx • pharynx, and • urogenital system, except the prostate. Specific effects of exposure to asbestos include • lung cancer that • originates in the lung parenchyma rather than the bronchi, and • eventually develops in about 50 percent of persons with asbestosis • gastrointestinal cancer that develops in 10 percent of persons with asbestosis • urogenital cancer that develops in 10 percent of persons with asbestosis, and • mesothelioma that develops in 17 percent of persons with asbestosis.

  43. 38 CFR 3.310 SECONDARY S/C • (a) General. Except as provided in §3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. • (b) Aggravation of nonservice-connected disabilities. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. The rating activity will determine the baseline and current levels of severity under the Schedule for Rating Disabilities (38 CFR part 4) and determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. (Authority: 38 U.S.C. 1110 and 1131) • (c) Cardiovascular disease. Ischemic heart disease or other cardiovascular disease developing in a veteran who has a service-connected amputation of one lower extremity at or above the knee or service-connected amputations of both lower extremities at or above the ankles, shall be held to be the proximate result of the service-connected amputation or amputations. (Authority: 38 U.S.C. 501(a), 1110-1131)

  44. INCREASE • Your service connected disability must get worse.

  45. 38 CFR 4.29-30 Temporary 100% • Paragraph 29 - periods of hospitalization in excess of 21 days for medical treatment of an Service Connected disability, • Paragraph 30 – Assign a temporary 100-percent convalescent rating under 38 CFR 4.30only following regular hospital discharge or outpatient release, regardless of the length of hospitalization, if treatment of an Service Connected disability resulted in • surgery necessitating at least one-month convalescence • surgery with severe postoperative residuals, or • immobilization of at least one major joint by cast without surgery, including procedures performed at an outpatient clinic.

  46. 38 CFR 4.16 IU • a) To establish entitlement to compensation as if 100 percent disabled based on individual unemployability (IU), a Veteran must be unable to secure or retain employment by reason of service-connected (SC) disability. The Veteran must be unemployable in fact by reason of SC disability and either • meet the schedular requirements of 38 CFR 4.16, • 4.16 - Total disability ratings for compensation based on unemployability of the individual.(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran's earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination.(Authority: 38 U.S.C. 501)or • have an extra-schedular evaluation approved by the Compensation and Pension (C&P) Service (211B). • (b) It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.

  47. CFR 3.340 P&T - Permanent Total Ratings (a) Total disability ratings —(1) General. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule. (2) Schedule for rating disabilities. Total ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent evaluation or, with less disability, where the requirements of paragraph 16, page 5 of the rating schedule are present or where, in pension cases, the requirements of paragraph 17, page 5 of the schedule are met. (3) Ratings of total disability on history. In the case of disabilities which have undergone some recent improvement, a rating of total disability may be made, provided: (i) That the disability must in the past have been of sufficient severity to warrant a total disability rating; (ii) That it must have required extended, continuous, or intermittent hospitalization, or have produced total industrial incapacity for at least 1 year, or be subject to recurring, severe, frequent, or prolonged exacerbations; and (iii) That it must be the opinion of the rating agency that despite the recent improvement of the physical condition, the veteran will be unable to effect an adjustment into a substantially gainful occupation. Due consideration will be given to the frequency and duration of totally incapacitating exacerbations since incurrence of the original disease or injury, and to periods of hospitalization for treatment in determining whether the average person could have reestablished himself or herself in a substantially gainful occupation. (b) Permanent total disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. The permanent loss or loss of use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or bedridden constitutes permanent total disability. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of disability by way of residuals. The age of the disabled person may be considered in determining permanence. (c) Insurance ratings. A rating of permanent and total disability for insurance purposes will have no effect on ratings for compensation or pension.

  48. CFR 3.381  Dental Claims DENTAL TRAUMA (CLASS II(a) • VETERANS HAVING A DENTAL CONDITION RESULTING FROM COMBAT WOUNDS OR SERVICE TRAUMA MAY BE AUTHORIZED ANY REASONABLE NECESSARY TREATMENT FOR THE CONDITION. • CLAIMS FOR TREATMENT ONLY IS HANDLED BY THE VA MEDICAL CENTER

  49. 38 CFR 3.361 1151 Claim • Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy program. • (a) Claims subject to this section?(1) General. Except as provided in paragraph (2), this section applies to claims received by VA on or after October 1, 1997. This includes original claims and claims to reopen or otherwise readjudicate a previous claim for benefits under 38 U.S.C. 1151 or its predecessors. The effective date of benefits is subject to the provisions of ? 3.400(i). For claims received by VA before October 1, 1997, see ? 3.358.(2) Compensated Work Therapy. With respect to claims alleging disability or death due to compensated work therapy, this section applies to claims that were pending before VA on November 1, 2000, or that were received by VA after that date. The effective date of benefits is subject to the provisions of ?? 3.114(a) and 3.400(i), and shall not be earlier than November 1, 2000.(b) Determining whether a veteran has an additional disability. To determine whether a veteran has an additional disability, VA compares the veteran's condition immediately before the beginning of the hospital care, medical or surgical treatment, examination, training and rehabilitation services, or compensated work therapy (CWT) program upon which the claim is based to the veteran's condition after such care, treatment, examination, services, or program has stopped. VA considers each involved body part or system separately.(c) Establishing the cause of additional disability or death. Claims based on additional disability or death due to hospital care, medical or surgical treatment, or examination must meet the causation requirements of this paragraph and paragraph (d)(1) or (d)(2) of this section. Claims based on additional disability or death due to training and rehabilitation services or compensated work therapy program must meet the causation requirements of paragraph (d)(3) of this section.

  50. 38 CFR 351 A&A and Housebound • General. This section sets forth criteria for determining whether:(1) Increased pension is payable to a veteran by reason of need for aid and attendance or by reason of being housebound.(Authority: 38 U.S.C. 1521(d), (e))(2) Increased compensation is payable to a veteran by reason of the veteran's spouse being in need of aid and attendance.(Authority: 38 U.S.C. 1115(1)(E))(3) Increased dependency and indemnity compensation is payable to a surviving spouse or parent by reason of being in need of aid and attendance.(Authority: 38 U.S.C. 1311(c), 1315(h))(4) Increased dependency and indemnity compensation is payable to a surviving spouse who is not in need of aid and attendance but is housebound.(Authority: 38 U.S.C. 1311(d))(5) Increased pension is payable to a surviving spouse by reason of need for aid and attendance, or if not in need of aid and attendance, by reason of being housebound.(Authority: 38 U.S.C. 1541(d), (e))(6) Increased death compensation is payable to a surviving spouse by reason of being in need of aid and attendance.(Authority: 38 U.S.C. 1122)(b) Aid and attendance; need. Need for aid and attendance means helplessness or being so nearly helpless as to require the regular aid and attendance of another person. The criteria set forth in paragraph (c) of this section will be applied in determining whether such need exists.