Jay Johnson

It definitely needs to be spelled out. I have never heard of the VA awarding anything more then was asked for by the veteran (I'm sure it happens, but rarely).....I would simply quote the regs to them on the matter and ask for the higher rate. Worst they can say is no. P.S. - I got a random quality survey from the VA (federal level) asking how the wife's recent claim inquiry went...man, this was a fun survey to fill out:-) Bet I don't get another survey......

Wife originally got 100% schedular for PTSD without a VA C&P exam (used civilian and military records), but didn't get P&T on initial rating.

It doesn't make sense IMO. The VA has complete access to SS records, so why ASK if a veteran is employed? Remember, if you submit ANY evidence to them, be it positive or negative, the RO can justify reopening a P&T case. Perhaps you should give them a call and see if you can ask SS to send over documentation instead (actually have the VA request so you're not the one submitting it).

Hmm, I wonder if by responding you will be giving "new material" evidence and allowing them to reopen your case? Doesn't make sense considering they have access to your SS records.

Sounds like a mutually beneficial move:-) Good to hear that finances won't be an issue and that you're taking steps to keep yourself safe. It bothers me sometimes, because vets don't get COLA depending on where they live like they do when in the military...obviously, it's going to cost a LOT more to live in SD then the midwest, but why should a vet have to suffer because they live in a higher cost of living area? As it stands now, I may have to move because the homes in my current area have well outpaced the wife's disability income and I'ld be lucky if I could afford to buy a lower-class home at the moment (average middle-class home here is well over 300K these days as compared to 180K just 3 yrs ago). At this pace, all disabled veterans are going to be forced into the poorest parts of the country, and I find that utterly repugnant.

That's a VERY expensive move. I think the houses in my area are way overpirced (WA), but my new neighbors found their 500K home to be quite cheap and paid for it in cash.....Apparently, they sold their small 3 bedroom ranch in SD for 725K and were able to buy a home here in cash (house is 3200sqft with many nice upgrades; whereas, their last home was about 1500sqft with NO upgrades). A townhome in the SD area can easily run 600K+ with many being over 1 mil...most of california is overpriced at the moment (a friend of mine in SF pays about 2500/mnth for a 2 bedroom apartment, which is considered a good deal there). But, if ya got the money, it's a great place to live:-)

Unfortunately, in a system of capitalism, you need money to get good health care...."free" or "cheap" health care is usually the worst.

I didn't really push the issue because she suffers from MST and lumps VA personnel with the "bad guys" and, therefore, I honestly believe that civilian health care is the best avenue for her at this time. The problem with the VA is that it works just like the military...if you want something done you have to get someone high up in the chain of command on your side. Example: My wife had been using civilian hospitals when she was accute, but I heard of perry point from my uncle (disabled vet) who said it was VERY good. I sent an email to a psychologist listed under "perry point" telling her (the psych) that my wife had terrible experiences with the wilmington VA hospital and that they told her it would be 6mnths+ before they could get her in to see a psych. Apparently, this psychologist was the HEAD psych for ALL of maryland and had the head psych from perry point call me the same day she recieved the email. My wife was suicidal at that time and needed to go in, so this doctor personaly sent an ambulance over 100 miles to pick her up and bring her in. They even brought in a sexual trauma specialist from baltimore (over an hr from perry point) just for her and gave her a special section in the hospital away from the other "male" vets. It's amazing what you can get when the right person is on your side. VA health care is very hit or miss...when it's good it can be great, but when it's bad it can be among the worst health care in the world. It's ashame that you need people on your side to get the health care you deserve:-(

That's good to know for my appeal, thanks. As for property taxes, WA state is horrible for veteran's benefits...I've already written some letters to state officials asking for, at least, some property tax relief (houses are pricey around here and so are the taxes linked to them).

As I tell everyone, get a private doctor (or 2) and get some IMOs. If you let the VA handle your claim from VA doctor to RO you will be starting off on the defensive. Be offensive and have your ammunition ready when you file your claim. Also, a private doctor will be more willing to diagnos you with PTSD related to combat then a VA doc will.

The spouses are always left to fend for themselves. Being the "husband" of a PTSD vet has been more difficult then anything I've ever done in my life. When a person is totally reliant on you for everything and cannot even be left alone, it's like having someone who is paralyzed from the neck down (in some cases worse). I deal with constant mood swings, nightly counseling sessions, etc.. The wife rarely helps with our 3 young kids (they cause her a HUGE amount of stress) and can only help with household chores on "good" days and only for very short periods of time. I am not able to work (trying to find something to do at home at the moment) and I play the role of husband, father, psychologist, psychiatrist, maid, accountant, mentor and VA repressentative on her case.....I increasingly find myself on the verge of insanity and egerly awaiting death, but suicide and depression don't fit into my schedule these days. What's worse, is that the wife looks normal for the most part (aside from missing eyelashes, eyebrows, and sores from picking and pulling)...Most people see her smile and think, "this guy is just lazy". You see, at least with physical disabilities you get empathy from the majority of the people you meet, in cases of psychiatric problems people just don't understand. The VA may have compensated her from her problems, but what do I get for giving up my life to ensure that she has one? The VA, and society in general, are still in the dark ages when it comes to mental health and the implications therein.

Hardest thing to prove either in the VA or civil court. There is a lot of data that shows even the most trusted vaccines can cause severe damage to susceptable people and the military uses vaccines that aren't fit for animals. P.S. - When you're fighting a vaccine issue, you're not only fighting for VA comp, but, potentially, a civil suite against the vaccine maker...the FDA and drug companies spend billions to make sure you don't make that connection.

Congratz....did they schedule you for a future exam? My wife was found P&T by seattle with an exam scheduled for one year (she even has housebound).

Wife was in perry point for PTSD for about a month...upon release she was scheduled to see a psych 2 mnths out. When the 2 mnths came we got a phone call saying the doc needed to cancel and rescheduled for 2 more mnths out...when that 2 mnths came we got a phone call saying the doc needed to reschedule and they gave us an appointment for 3 mnths out. Needless to say, we shop'd around for a civilian psych and paid for it out of pocket. P.S. - She is 100% SC

Good idea IMO....we'll have more rights to hold them liable if they aren't protected by the federal goverment (if they break regulation we can sue). Private health care would give vets choices, which is always good.

Alex, If this is true then why do we have so MANY vets being screwed by RO's that refuse to follow regulations? Why hasn't the DAV taken a strong stance against the new PTSD commission? Why do veterans have less rights then enemies of the state? Why are 250K+ veterans homeless when they should be receiving high levels of compensation? Why did more people die from PTSD after 'nam then died fighting the war itself? The DAV does NOTHING to help veterans on a national level...in fact, they do a great disservice by taking single claims. The DAV helps the VA by keeping these gross violations on a singular level.....the VA counts on these SO's to abuse the system to deny and low-ball claims. I'm sorry, but I feel SO's are among the lowest forms of life on the planet...it is my belief that they work with the VA against veterans rather then with.

Senators are useless...I have one of the better ones (female from WA that is on VA senate board) and the process for helping vets is ridiculous. I send in something showing a clear regulation's violation and the senator's aid sends it to the seattle RO...they, in turn, claim that no regulations are being broken and the senator's office says there's nothing more that can be done because the VA knows more then I do. A true waste of time, unless you can somehow get a one on one with the actual senator (good luck with that).

Alex, I think you're missing the point here. SOs do help vets win cases, but they do not help vets become less dependent on SOs by fixing the system. As it stands now, veterans have NO national voice to speak of accept SO's and these So's will not take a national public stand against the VA (never have, never will). This isn't an issue of "ify" claims or weak evidence...it's an issue of VAROs grossly violating regulations and getting away with it EVERY time because the SOs won't hold them accountable. Again, who cares if YOU or I win our claims if a thousand other vets loose or quit out of frustration for claims that should clearly be won? What do we gain as a nation of disabled vets if we keep having to fight one battle at a time? If these SO's won't stand up for us for the big issues, then who is supposed to? I say boycott the SO's until they truly decide to help vets and not just string them along, status quo, one at a time.

jstacy, The #1 reason why so many vets suffer is that there is no recourse for ROs if they do not follow congressional regualtions (title 38). The easiest and quickest fix to this problem would be to allow veterans to sue the ROs when they ignore regulations. The only thing that people care about in this nation is money and teh VA would go broke in a week if it had to answer for its crimes. As far as SO's are concerned - They make a living by helping vets one case at a time...if they were to fix the system rather then string along vets one by one, they would be out of a job. If the DAV/AmVets/etc would stand up to the VA nationally and bring these problems to the public the VA would change over night (not holding my breath).

Putting you through the hoops in order to establish a claim (SC) is almost to be expected...what bothers me are the RO's that put you through those same hoops for reevaluations. The regs clearly state that the VA's job in reevaluating a claim is NOT to make the veteran prove that he or she still deserves their current rating; rather, they are only supposed to act if any new evidence shows material improvements. The minute an RO start fishing for information on a reevaluation is the minute that the SO (or lawyer) representing the veteran needs to file a law suite (or refuses future examinations). In reevaluations the veteran must only prove that he or she has not made any signifcant material improvements...if a C&P does not show any of these improvements then the process is over. If the RO asks for more they are in violation of title 38 (not that any SO will ever even attempt to enforce regulations... that might put them out of job...IE - give a man a fish and he eats for a day, teach a man to fish and he eats for a lifetime..in the SO world it's "here's your fish, now get out").

It really depends on the doctor. I have had a horrible time finding doctors that will accept any form of government insurance, but others on hadit have said they have had no issues at all....IMO, it depends on where you live and what type of insurance the doctors normally accept (IE - a doctor who openly accepts medicare/tricare is more likely to accept your fee basis then one who refuses government insurance).

Spyware is a HUGE pain...the suggestions by Dataman are exactly what I would have suggested as well, but even those anit-spyware programs won't always catch all of the components of a newer trojan. I have had to wipe my HD twice due to spyware despite being quite good at getting rid of it. These programs hide deep in your registry and are designed to evade anti-spyware and deletion....In the past I have had to boot in safe mode and hand search for every file related to a trojan, which has taken me many hours. The long and short of spyware is that you cannot avoid it, no matter what firewall or virus protection programs you have..the best you can hope for is to catch the big ones before they infect everything. P.S. - To add to Dataman's list I would do a google for "hijackthis" (one word) and download it....it is very good at finding running processes that make it so you can't delete spyware files.

B + ) = smiley face...it's best to disable emotes before posting IMO.

I think this reg. - >>>§ 3.306 Aggravation of preservice disability. top (a) General. A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease.<<< is your best bet...if he was well enough to be admitted to jump school, but, due to jumping, was not able to finish, the VA would be hard pressed to deny the claim for aggravation. Also, I would argue that the condition is seperate from the football injury all together unless there is medical evidence to suggest that the current condition is a direct result of of prior injury (this is where reasonable doubt comes in).

So, what reason did they give as a possible cause of the problem? He had to have an intial physical before entering the military that shows healthy knees, so they have to show a cause before they can claim it wasn't aggravated by service. As for the regs in question - § 3.102 Reasonable doubt. top It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships. >>>This next one is long, but there are several points throughout that could help the case<<<< § 3.303 Principles relating to service connection. top (a) General. Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. This may be accomplished by affirmatively showing inception or aggravation during service or through the application of statutory presumptions. Each disabling condition shown by a veteran's service records, or for which he seeks a service connection must be considered on the basis of the places, types and circumstances of his service as shown by service records, the official history of each organization in which he served, his medical records and all pertinent medical and lay evidence. Determinations as to service connection will be based on review of the entire evidence of record, with due consideration to the policy of the Department of Veterans Affairs to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. (b) Chronicity and continuity. With chronic disease shown as such in service (or within the presumptive period under §3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. © Preservice disabilities noted in service. There are medical principles so universally recognized as to constitute fact (clear and unmistakable proof), and when in accordance with these principles existence of a disability prior to service is established, no additional or confirmatory evidence is necessary. Consequently with notation or discovery during service of such residual conditions (scars; fibrosis of the lungs; atrophies following disease of the central or peripheral nervous system; healed fractures; absent, displaced or resected parts of organs; supernumerary parts; congenital malformations or hemorrhoidal tags or tabs, etc.) with no evidence of the pertinent antecedent active disease or injury during service the conclusion must be that they preexisted service. Similarly, manifestation of lesions or symptoms of chronic disease from date of enlistment, or so close thereto that the disease could not have originated in so short a period will establish preservice existence thereof. Conditions of an infectious nature are to be considered with regard to the circumstances of the infection and if manifested in less than the respective incubation periods after reporting for duty, they will be held to have preexisted service. In the field of mental disorders, personality disorders which are characterized by developmental defects or pathological trends in the personality structure manifested by a lifelong pattern of action or behavior, chronic psychoneurosis of long duration or other psychiatric symptomatology shown to have existed prior to service with the same manifestations during service, which were the basis of the service diagnosis, will be accepted as showing preservice origin. Congenital or developmental defects, refractive error of the eye, personality disorders and mental deficiency as such are not diseases or injuries within the meaning of applicable legislation. (d) Postservice initial diagnosis of disease. Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and Department of Veterans Affairs regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. [26 FR 1579, Feb. 24, 1961] § 3.304 Direct service connection; wartime and peacetime. top (a) General. The basic considerations relating to service connection are stated in §3.303. The criteria in this section apply only to disabilities which may have resulted from service in a period of war or service rendered on or after January 1, 1947. (b) Presumption of soundness. The veteran will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. (Authority: 38 U.S.C. 1111) (1) History of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions but will be considered together with all other material evidence in determinations as to inception. Determinations should not be based on medical judgment alone as distinguished from accepted medical principles, or on history alone without regard to clinical factors pertinent to the basic character, origin and development of such injury or disease. They should be based on thorough analysis of the evidentiary showing and careful correlation of all material facts, with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof. (2) History conforming to accepted medical principles should be given due consideration, in conjunction with basic clinical data, and be accorded probative value consistent with accepted medical and evidentiary principles in relation to value consistent with accepted medical evidence relating to incurrence, symptoms and course of the injury or disease, including official and other records made prior to, during or subsequent to service, together with all other lay and medical evidence concerning the inception, development and manifestations of the particular condition will be taken into full account. (3) Signed statements of veterans relating to the origin, or incurrence of any disease or injury made in service if against his or her own interest is of no force and effect if other data do not establish the fact. Other evidence will be considered as though such statement were not of record. (Authority: 10 U.S.C. 1219) © Development. The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination. In initially rating disability of record at the time of discharge, the records of the service department, including the reports of examination at enlistment and the clinical records during service, will ordinarily suffice. Rating of combat injuries or other conditions which obviously had their inception in service may be accomplished pending receipt of copy of the examination at enlistment and all other service records. (d) Combat. Satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. (Authority: 38 U.S.C. 1154(b)) (e) Prisoners of war. Where disability compensation is claimed by a former prisoner of war, omission of history or findings from clinical records made upon repatriation is not determinative of service connection, particularly if evidence of comrades in support of the incurrence of the disability during confinement is available. Special attention will be given to any disability first reported after discharge, especially if poorly defined and not obviously of intercurrent origin. The circumstances attendant upon the individual veteran's confinement and the duration thereof will be associated with pertinent medical principles in determining whether disability manifested subsequent to service is etiologically related to the prisoner of war experience. (f) Post-traumatic stress disorder. Service connection for post-traumatic stress disorder requires medical evidence diagnosing the condition in accordance with §4.125(a) of this chapter; a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. Although service connection may be established based on other in-service stressors, the following provisions apply for specified in-service stressors as set forth below: (1) If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. (2) If the evidence establishes that the veteran was a prisoner-of-war under the provisions of §3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. (3) If a post-traumatic stress disorder claim is based on in-service personal assault, evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA will not deny a post-traumatic stress disorder claim that is based on in-service personal assault without first advising the claimant that evidence from sources other than the veteran's service records or evidence of behavior changes may constitute credible supporting evidence of the stressor and allowing him or her the opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. VA may submit any evidence that it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. (Authority: 38 U.S.C. 501(a), 1154) [26 FR 1580, Feb. 24, 1961, as amended at 31 FR 4680, Mar. 19, 1966; 39 FR 34530, Sept. 26, 1974; 58 FR 29110, May 19, 1993; 64 FR 32808, June 18, 1999; 67 FR 10332, Mar. 7, 2002] § 3.305 Direct service connection; peacetime service before January 1, 1947. top (a) General. The basic considerations relating to service connection are stated in §3.303. The criteria in this section apply only to disabilities which may have resulted from service other than in a period of war before January 1, 1947. (b) Presumption of soundness. A peacetime veteran who has had active, continuous service of 6 months or more will be considered to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities or disorders noted at the time thereof, or where evidence or medical judgment, as distinguished from medical fact and principles, establishes that an injury or disease preexisted service. Any evidence acceptable as competent to indicate the time of existence or inception of the condition may be considered. Determinations based on medical judgment will take cognizance of the time of inception or manifestation of disease or injury following entrance into service, as shown by proper service authorities in service records, entries or reports. Such records will be accorded reasonable weight in consideration of other evidence and sound medical reasoning. Opinions may be solicited from Department of Veterans Affairs medical authorities when considered necessary. © Campaigns and expeditions. In considering claims of veterans who engaged in combat during campaigns or expeditions satisfactory lay or other evidence of incurrence or aggravation in such combat of an injury or disease, if consistent with the circumstances, conditions or hardships of such service will be accepted as sufficient proof of service connection, even when there is no official record of incurrence or aggravation. Service connection for such injury or disease may be rebutted by clear and convincing evidence to the contrary. [26 FR 1580, Feb. 24, 1961, as amended at 28 FR 3088, Mar. 29, 1963; 39 FR 34530, Sept. 26, 1974] § 3.306 Aggravation of preservice disability. top (a) General. A preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. (Authority: 38 U.S.C. 1153) (b) Wartime service; peacetime service after December 31, 1946. Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. (1) The usual effects of medical and surgical treatment in service, having the effect of ameliorating disease or other conditions incurred before enlistment, including postoperative scars, absent or poorly functioning parts or organs, will not be considered service connected unless the disease or injury is otherwise aggravated by service. (2) Due regard will be given the places, types, and circumstances of service and particular consideration will be accorded combat duty and other hardships of service. The development of symptomatic manifestations of a preexisting disease or injury during or proximately following action with the enemy or following a status as a prisoner of war will establish aggravation of a disability. (Authority: 38 U.S.C. 1154) © Peacetime service prior to December 7, 1941. The specific finding requirement that an increase in disability is due to the natural progress of the condition will be met when the available evidence of a nature generally acceptable as competent shows that the increase in severity of a disease or injury or acceleration in progress was that normally to be expected by reason of the inherent character of the condition, aside from any extraneous or contributing cause or influence peculiar to military service. Consideration will be given to the circumstances, conditions, and hardships of service. [26 FR 1580, Feb. 24, 1961, as amended at 57 FR 59296, Dec. 15, 1992] § 3.307 Presumptive service connection for chronic, tropical or prisoner-of-war related disease, or disease associated with exposure to certain herbicide agents; wartime and service on or after January 1, 1947. top (a) General. A chronic, tropical, prisoner of war related disease, or a disease associated with exposure to certain herbicide agents listed in §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. (1) Service. The veteran must have served 90 days or more during a war period or after December 31, 1946. The requirement of 90 days' service means active, continuous service within or extending into or beyond a war period, or which began before and extended beyond December 31, 1946, or began after that date. Any period of service is sufficient for the purpose of establishing the presumptive service connection of a specified disease under the conditions listed in §3.309© and (e). (2) Separation from service. For the purpose of paragraph (a)(3) and (4) of this section the date of separation from wartime service will be the date of discharge or release during a war period, or if service continued after the war, the end of the war period. In claims based on service on or after January 1, 1947, the date of separation will be the date of discharge or release from the period of service on which the claim is based. (3) Chronic disease. The disease must have become manifest to a degree of 10 percent or more within 1 year (for Hansen's disease (leprosy) and tuberculosis, within 3 years; multiple sclerosis, within 7 years) from the date of separation from service as specified in paragraph (a)(2) of this section. (4) Tropical disease. The disease must have become manifest to a degree of 10 percent or more within 1 year from date of separation from service as specified in paragraph (a)(2) of this section, or at a time when standard accepted treatises indicate that the incubation period commenced during such service. The resultant disorders or diseases originating because of therapy administered in connection with a tropical disease or as a preventative may also be service connected. (Authority: 38 U.S.C. 1112) (5) Diseases specific as to former prisoners of war. The diseases listed in §3.309© shall have become manifest to a degree of 10 percent or more at any time after discharge or release from active service. (Authority: 38 U.S.C. 1112) (6) Diseases associated with exposure to certain herbicide agents. (i) For the purposes of this section, the term “herbicide agent” means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4–D; 2,4,5–T and its contaminant TCDD; cacodylic acid; and picloram. (Authority: 38 U.S.C. 1116(a)(4)) (ii) The diseases listed at §3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. (iii) A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. “Service in the Republic of Vietnam” includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. (Authority: 38 U.S.C. 501(a) and 1116(a)(3)) (b) Evidentiary basis. The factual basis may be established by medical evidence, competent lay evidence or both. Medical evidence should set forth the physical findings and symptomatology elicited by examination within the applicable period. Lay evidence should describe the material and relevant facts as to the veteran's disability observed within such period, not merely conclusions based upon opinion. The chronicity and continuity factors outlined in §3.303(b) will be considered. The diseases listed in §3.309(a) will be accepted as chronic, even though diagnosed as acute because of insidious inception and chronic development, except: (1) Where they result from intercurrent causes, for example, cerebral hemorrhage due to injury, or active nephritis or acute endocarditis due to intercurrent infection (with or without identification of the pathogenic micro-organism); or (2) where a disease is the result of drug ingestion or a complication of some other condition not related to service. Thus, leukemia will be accepted as a chronic disease whether diagnosed as acute or chronic. Unless the clinical picture is clear otherwise, consideration will be given as to whether an acute condition is an exacerbation of a chronic disease. (Authority: 38 U.S.C. 1112) © Prohibition of certain presumptions. No presumptions may be invoked on the basis of advancement of the disease when first definitely diagnosed for the purpose of showing its existence to a degree of 10 percent within the applicable period. This will not be interpreted as requiring that the disease be diagnosed in the presumptive period, but only that there be then shown by acceptable medical or lay evidence characteristic manifestations of the disease to the required degree, followed without unreasonable time lapse by definite diagnosis. Symptomatology shown in the prescribed period may have no particular significance when first observed, but in the light of subsequent developments it may gain considerable significance. Cases in which a chronic condition is shown to exist within a short time following the applicable presumptive period, but without evidence of manifestations within the period, should be developed to determine whether there was symptomatology which in retrospect may be identified and evaluated as manifestation of the chronic disease to the required 10-percent degree. (d) Rebuttal of service incurrence or aggravation. (1) Evidence which may be considered in rebuttal of service incurrence of a disease listed in §3.309 will be any evidence of a nature usually accepted as competent to indicate the time of existence or inception of disease, and medical judgment will be exercised in making determinations relative to the effect of intercurrent injury or disease. The expression “affirmative evidence to the contrary” will not be taken to require a conclusive showing, but such showing as would, in sound medical reasoning and in the consideration of all evidence of record, support a conclusion that the disease was not incurred in service. As to tropical diseases the fact that the veteran had no service in a locality having a high incidence of the disease may be considered as evidence to rebut the presumption, as may residence during the period in question in a region where the particular disease is endemic. The known incubation periods of tropical diseases should be used as a factor in rebuttal of presumptive service connection as showing inception before or after service. (2) The presumption of aggravation provided in this section may be rebutted by affirmative evidence that the preexisting condition was not aggravated by service, which may include affirmative evidence that any increase in disability was due to an intercurrent disease or injury suffered after separation from service or evidence sufficient, under §3.306 of this part, to show that the increase in disability was due to the natural progress of the preexisting condition. (Authority: 38 U.S.C 1113 and 1153) [26 FR 1581, Feb. 24, 1961, as amended at 35 FR 18281, Dec. 1, 1970; 39 FR 34530, Sept. 26, 1974; 43 FR 45347, Oct. 2, 1978; 47 FR 11655, Mar. 18, 1982; 58 FR 29109, May 19, 1993; 59 FR 5106, Feb. 3, 1994; 59 FR 29724, June 9, 1994; 61 FR 57588, Nov 7, 1996; 62 FR 35422, July 1, 1997; 67 FR 67793, Nov. 7, 2002; 68 FR 34541, June 10, 2003] § 3.308 Presumptive service connection; peacetime service before January 1, 1947. top (a) Chronic disease. There is no provision for presumptive service connection for chronic disease as distinguished from tropical diseases referred to in paragraph (b) of this section based on peacetime service before January 1, 1947. (b) Tropical disease. In claims based on peacetime service before January 1, 1947, a veteran of 6 months or more service who contracts a tropical disease listed in §3.309(b) or a resultant disorder or disease originating because of therapy administered in connection with a tropical disease or as a preventative, will be considered to have incurred such disability in service when it is shown to exist to the degree of 10 percent or more within 1 year after separation from active service, or at a time when standard and accepted treatises indicate that the incubation period commenced during active service unless shown by clear and unmistakable evidence not to have been of service origin. The requirement of 6 months or more service means active, continuous service, during one or more enlistment periods. (Authority: 38 U.S.C. 1133) [39 FR 34530, Sept. 26, 1974] § 3.309 Disease subject to presumptive service connection. top (a) Chronic diseases. The following diseases shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under §3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of §3.307 are also satisfied. 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. Hodgkin's disease. Leukemia. Lupus erythematosus, systemic. Myasthenia gravis. Myelitis. 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. Syringomyelia. Thromboangiitis obliterans (Buerger's disease). Tuberculosis, active. 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. (b) Tropical diseases. The following diseases shall be granted service connection as a result of tropical service, although not otherwise established as incurred in service if manifested to a compensable degree within the applicable time limits under §3.307 or §3.308 following service in a period of war or following peacetime service, provided the rebuttable presumption provisions of §3.307 are also satisfied. 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. © Diseases specific as to former prisoners of war. (1) 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. 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. (2) If the veteran: (i) Is a former prisoner of war and; (ii) Was 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. (Authority: 38 U.S.C. 1112(b)) (d) Diseases specific to radiation-exposed veterans. (1) The diseases listed in paragraph (d)(2) of this section shall be service-connected if they become manifest in a radiation-exposed veteran as defined in paragraph (d)(3) of this section, provided the rebuttable presumption provisions of §3.307 of this part are also satisfied. (2) The diseases referred to in paragraph (d)(1) of this section are the following: (i) Leukemia (other than chronic lymphocytic leukemia). (ii) Cancer of the thyroid. (iii) Cancer of the breast. (iv) Cancer of the pharynx. (v) Cancer of the esophagus. (vi) Cancer of the stomach. (vii) Cancer of the small intestine. (viii) Cancer of the pancreas. (ix) Multiple myeloma. (x) Lymphomas (except Hodgkin's disease). (xi) Cancer of the bile ducts. (xii) Cancer of the gall bladder. (xiii) Primary liver cancer (except if cirrhosis or hepatitis B is indicated). (xiv) Cancer of the salivary gland. (xv) Cancer of the urinary tract. (xvi) Bronchiolo-alveolar carcinoma. (xvii) Cancer of the bone. (xviii) Cancer of the brain. (xix) Cancer of the colon. (xx) Cancer of the lung. (xxi) Cancer of the ovary. Note: For the purposes of this section, the term “urinary tract” means the kidneys, renal pelves, ureters, urinary bladder, and urethra. (Authority: 38 U.S.C. 1112©(2)). (3) For purposes of this section: (i) The term radiation-exposed veteran means either a veteran who while serving on active duty, or an individual who while a member of a reserve component of the Armed Forces during a period of active duty for training or inactive duty training, participated in a radiation-risk activity. (ii) The term radiation-risk activity means: (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. © 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. (D)(1) Service in which the service member was, as part of his or her official military duties, present during a total of at least 250 days before February 1, 1992, on the grounds of a gaseous diffusion plant located in Paducah, Kentucky, Portsmouth, Ohio, or the area identified as K25 at Oak Ridge, Tennessee, if, during such service the veteran: (i) Was monitored for each of the 250 days of such service through the use of dosimetry badges for exposure at the plant of the external parts of veteran's body to radiation; or (ii) Served for each of the 250 days of such service in a position that had exposures comparable to a job that is or was monitored through the use of dosimetry badges; or (2) Service before January 1, 1974, on Amchitka Island, Alaska, if, during such service, the veteran was exposed to ionizing radiation in the performance of duty related to the Long Shot, Milrow, or Cannikin underground nuclear tests. (3) For purposes of paragraph (d)(3)(ii)(D)(1) of this section, the term “day” refers to all or any portion of a calendar day. (iii) The term atmospheric detonation includes underwater nuclear detonations. (iv) The term onsite participation means: (A) During the official operational period of an atmospheric nuclear test, presence at the test site, or performance of official military duties in connection with ships, aircraft or other equipment used in direct support of the nuclear test. (B) During the six month period following the official operational period of an atmospheric nuclear test, presence at the test site or other test staging area to perform official military duties in connection with completion of projects related to the nuclear test including decontamination of equipment used during the nuclear test. © Service as a member of the garrison or maintenance forces on Eniwetok during the periods June 21, 1951, through July 1, 1952, August 7, 1956, through August 7, 1957, or November 1, 1958, through April 30, 1959. (D) Assignment to official military duties at Naval Shipyards involving the decontamination of ships that participated in Operation Crossroads. (v) For tests conducted by the United States, the term operational period means: (A) For Operation TRINITY the period July 16, 1945 through August 6, 1945. (B) For Operation CROSSROADS the period July 1, 1946 through August 31, 1946. © For Operation SANDSTONE the period April 15, 1948 through May 20, 1948. (D) For Operation RANGER the period January 27, 1951 through February 6, 1951. (E) For Operation GREENHOUSE the period April 8, 1951 through June 20, 1951. (F) For Operation BUSTER-JANGLE the period October 22, 1951 through December 20, 1951. (G) For Operation TUMBLER-SNAPPER the period April 1, 1952 through June 20, 1952. (H) For Operation IVY the period November 1, 1952 through December 31, 1952. (I) For Operation UPSHOT-KNOTHOLE the period March 17, 1953 through June 20, 1953. (J) For Operation CASTLE the period March 1, 1954 through May 31, 1954. (K) For Operation TEAPOT the period February 18, 1955 through June 10, 1955. (L) For Operation WIGWAM the period May 14, 1955 through May 15, 1955. (M) For Operation REDWING the period May 5, 1956 through August 6, 1956. (N) For Operation PLUMBBOB the period May 28, 1957 through October 22, 1957. (O) For Operation HARDTACK I the period April 28, 1958 through October 31, 1958. (P) For Operation ARGUS the period August 27, 1958 through September 10, 1958. (Q) For Operation HARDTACK II the period September 19, 1958 through October 31, 1958. ® For Operation DOMINIC I the period April 25, 1962 through December 31, 1962. (S) For Operation DOMINIC II/PLOWSHARE the period July 6, 1962 through August 15, 1962. (vi) The term “occupation of Hiroshima or Nagasaki, Japan, by United States forces” means official military duties within 10 miles of the city limits of either Hiroshima or Nagasaki, Japan, which were required to perform or support military occupation functions such as occupation of territory, control of the population, stabilization of the government, demilitarization of the Japanese military, rehabilitation of the infrastructure or deactivation and conversion of war plants or materials. (vii) Former prisoners of war who had an opportunity for exposure to ionizing radiation comparable to that of veterans who participated in the occupation of Hiroshima or Nagasaki, Japan, by United States forces shall include those who, at any time during the period August 6, 1945, through July 1, 1946: (A) Were interned within 75 miles of the city limits of Hiroshima or within 150 miles of the city limits of Nagasaki, or (B) Can affirmatively show they worked within the areas set forth in paragraph (d)(4)(vii)(A) of this section although not interned within those areas, or © Served immediately following internment in a capacity which satisfies the definition in paragraph (d)(4)(vi) of this section, or (D) Were repatriated through the port of Nagasaki. (Authority: 38 U.S.C. 1110, 1112, 1131) (e) Disease associated with exposure to certain herbicide agents. If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of §3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of §3.307(d) are also satisfied. 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 Chronic lymphocytic leukemia Multiple myeloma Non-Hodgkin's lymphoma 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) Note 1: 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 Note 2: For purposes of this section, the term acute and subacute peripheral neuropathy means transient peripheral neuropathy that appears within weeks or months of exposure to an herbicide agent and resolves within two years of the date of onset.