M21-1, Part IV, Subpart Ii, Chapter 1, Section I

M21-1, Part IV, Subpart ii, Chapter 1, Section I

Section I. Developing Claims for Service Connection (SC) Based on Other Exposure Types

Overview

In This Section / This section contains the following topics:
Topic / Topic Name
1 / Developing Claims for SC for Positive Tuberculin Reactions
2 / Developing Claims for SC for Chronic or Tropical Diseases
3 / Developing Claims for SC for Asbestos-Related Diseases
4 / Developing Claims for SC for Acquired Immune Deficiency Syndrome (AIDS)
5 / Developing Claims Based on Participation in Special Operations Incidents
6 / Developing Claims Based on Exposure to Environmental Hazards
7 / Developing Claims Based on Participation in the Shipboard Hazard and Defense (SHAD) Project
8 / Developing Claims Based on Chemical Biological Radiological Nuclear and Explosives (CBRNE) Testing
9 / Exhibit 1: FACT SHEET Burn Pits in Iraq, Afghanistan, and the Horn of Africa
10 / Exhibit 2: FACT SHEET Particulate Matter Throughout Iraq, Afghanistan, and Djibouti
11 / Exhibit 3: FACT SHEET Sulfur Fire at the Mishraq State Sulfur Mine Near Mosul, Iraq
12 / Exhibit 4: FACT SHEET Qarmat Ali Water Treatment Plant in Basrah, Iraq
13 / Exhibit 5: FACT SHEET Naval Air Facility, Atsugi, Japan
14 / Exhibit 6: Internet Websites Related to the Issue of Contaminated Water at Camp Lejeune
15 / Exhibit 7: Diseases Potentially Associated With Exposure to Contaminants Present in the Camp Lejeune Water Supply Between 1953 and 1987
16 / Exhibit 8: Internet Websites Describing Potential Health Effects of Exposure to Chemical Contaminants Present in the Water Supply of Camp Lejeune Between 1953 and 1987
17 / Exhibit 9: Notice to Examiners Evaluating Claims Based on Service at Camp Lejeune

1. Developing Claims for SC for Positive Tuberculin Reactions

Introduction

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

• action to take when a positive tuberculin reaction only is claimed
• action to take when a positive tuberculin reaction and other disabilities are claimed, and
• reporting responsibilities of the Department of Veterans Affairs (VA) outpatient clinics and VA medical centers (VAMCs).

Change Date

/ October 23, 2015

a. Action to Take When a Positive Tuberculin Reaction Only Is Claimed

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

b. Action to Take When a Positive Tuberculin Reaction and Other Disabilities Are Claimed

/ If a positive tuberculin reaction is claimed together with other disabilities

• complete any appropriate development required for the other disabilities, and
• refer the claims folder to the rating activity for rating of all the claimed disabilities.

c. Reporting Responsibilities of VA Outpatient Clinics and VAMCs

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

2. Developing Claims for SC for Chronic or Tropical Diseases

Introduction

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

• definition of a chronic disease
• establishing whether a disease is chronic
• considering

SC for a chronic or tropical disease, and
presumptive SC

• locations of lists of chronic and tropical diseases, and
• action to take if a chronic or tropical disease was

treated in service, or
not treated in service.

Change Date

/ October 23, 2015

a. Definition: Chronic Disease

/ A chronicdisease is a disease

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

b. Establishing Whether a Disease Is Chronic

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

c. Considering SC for a Chronic or Tropical Disease

/ When deciding any claim for SC for a chronic or tropical disease, it is also necessary to consider

• SC based on manifestation of the claimed disease during service, and
• SC based on a presumption that the disease, which was first manifested following discharge from service, is nevertheless related to service.

d. Considering Presumptive SC

/ Once a substantially complete claim is ofrecord, the following conditions apply

• the possibility of entitlement to presumptive SC exists when the Veteran alleges inception within the limiting periods contained in

38 U.S.C. 1112, or
38 U.S.C. 1133, when appropriate

• the Veteran does not need to establish that the disease in question was definitely diagnosed within the presumptive period, and
• the evidence should show that manifestations of the condition, disabling to the degree of at least 10 percent, became apparent prior to the expiration of the presumptive period shown in 38 CFR 3.307.

e. Locations of Lists of Chronic and Tropical Diseases

/ The conditions listed in

• 38 U.S.C. 1101(3) and 38 CFR 3.309(a) are chronic diseases, and
• 38 U.S.C. 1101(4) and 38 CFR 3.309(b) are tropical diseases.

f. Action to Take if a Chronic or Tropical Disease Was Treated in Service

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

• what constitutes a substantially complete claim, see

M21-1, Part I, 1.B.1.b, and
38 CFR 3.159(a)(3), and

• soliciting claims for chronic, unclaimed disabilities, see M21-1, Part IV, Subpart ii, 2.A.1.f.

g. Action to Take if a Chronic or Tropical Disease Was Not Treated in Service

/ Even though certain chronic and tropical diseases were not treated during service, SC may still be established on a presumptive basis under the provisions of

• 38 U.S.C. 1112
• 38 U.S.C. 1133, or
• 38 U.S.C. 1137.

Reference: For more information on the diseases for which SC may be established on a presumptive basis and the service requirements that must be met, see 38 CFR 3.307.

3. Developing Claims for SC for Asbestos-Related Diseases

Introduction

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

• entitlement to SC for conditions based on exposure to asbestos

• development action to take when no disability related to asbestos exposure is claimed
• use of Military Occupational Specialty (MOS) to determine probability of in-service asbestos exposure
• developing for evidence of in-service asbestos exposure in substantially complete claims
• consideration of all evidence in the claims folder in determining in-service asbestos exposure, and
• requesting an examination and opinion for claims based on asbestos exposure.

Change Date

/ August 7, 2015
a. Entitlement to SC for Conditions Based on Exposure to Asbestos / Veterans who were exposed to asbestos while in service and developed a disease related to that asbestos exposure may receive compensation benefits.
Claims based on exposure to asbestos require

• a military occupational skill with exposure to asbestos or other exposure event associated with servicesufficient to request an examination with medical opinion as described in M21-1, Part IV, Subpart ii, 1.I.3.f, and
• a diagnosed disability that has been associated with in-serviceasbestos exposure.

Note: Occupational exposure is the most common cause of asbestosis, but the condition also can have other causes.
Reference: For more information on asbestos exposure to include rating guidance, see M21-1, Part IV, Subpart ii, 2.C.2.

b. DevelopmentAction to Take When No Disability Related to Asbestos Exposure Is Claimed

/ A claim is not substantially complete if a Veteran alleges exposure to asbestos during service, but does not claim SC for a specific disability. In such cases, send a letter to the Veteran to

• inform the Veteran that exposure, in and of itself, is not a disability, and
• ask the Veteran to identify the disability(ies) that resulted from exposure to asbestos during service.

Usethe Veterans Benefits Management System(VBMS) or Modern Awards Processing - Development(MAP-D) to generate the applicable paragraphs to send in the development letter to the Veteran by selecting the entry ASB – TELL US SPECIFIC DISABILITY FM ASBESTOS EXPOSURE.
Important:

• Do not

process the claim as a denial, or
establishend product (EP) control for the incomplete claim.

• Whenever possible, telephone the Veteran to obtain the information needed to substantiate the claim.

Reference: For more information on what constitutes a substantially complete application, see

• 38 CFR 3.159(a)(3), and
• M21-1, Part I, 1.B.1.b.

c. Use of MOS to Determine Probability of In-Service Asbestos Exposure / The table below describesprobability of asbestos exposure by military occupational specialty(MOS).

Asbestos MOS Handout

MOS Code

/

Job Title

/

Probability of Exposure

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

• code O16 for paper claims, or
• code O50 for claims processed in VBMS.

This is necessary in order to determine all MOSs the Veteran performed while in service.
At the same time, send a development letter to the Veteran requesting additional exposure information if not already of record, or if exposure has not been conceded. Use VBMS or MAP-D to generate the applicable paragraphs for placement in the letter by selecting the following entries:

• ASB – TELL US WHERE, WHEN, HOW EXPOSED, and
• ASB – MEDICAL EVID OF DISEASE (BIOPSY) NEEDED.

Important: The determination as to whether to concede exposure to asbestos is based on a complete review of the claims folder. Therefore, continue to develop for asbestos exposure via PIES even if no response from the Veteran to the development letter has been received. If exposure is confirmed by records to include military personnel records, follow the guidance contained at M21-1, Part IV, Subpart ii, 1.I.3.e.
Notes:

• Upon selection, a VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, is generated and is to be included in the letter for the Veteran to complete if the Veteran wishes for the VA to attempt to obtain any doctor, hospital, or medical reports on his/her behalf.

• Obtaining the military personnel records before scheduling an examination for an MOS listed as having minimal exposure probability ensures that examiners know about any other MOS that the Veteran may have served under that may have resulted in asbestos exposure.

e. Consideration of All Evidence in the Claims Folder in Determining In-Service Asbestos Exposure / If an MOS is listed as minimal, probable, or highly probable in the table above, concede asbestos exposure for purposes of scheduling an examination.
As discussed at M21-1, Part IV, Subpart ii, 1.I.3.c, asbestos exposure may be demonstrated upon review of the claims folder on a basis other than MOS. Any evidence that is probative of (serves to establish) asbestos exposure may be used to support a determination that asbestos exposure occurred. Determining whether evidence proves a Veteran was exposed to asbestos requires an evaluation of all of the evidence in the case, including

• an assessment of the credibility of the evidence, and

• whether the evidence establishes that the exposure occurred.

In determining whether asbestos exposure has been demonstrated by the evidence of record, consider

• exposure information that the Veteran provides in response to the asbestos development letter to include lay testimony
• service personnel records
• service treatment records
• buddy statements, and
• all other evidence located in the claims folder or identified by the Veteran relevant to the determination of asbestos exposure.

Note: The term credibilityrefers to believable evidence that tends to support the Veteran’s assertion based on consideration of plausibility, consistency with other evidence in the case, and source. Once asbestos exposure has been demonstrated by the evidence of recordand the evidence contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability, accept the Veteran’s lay testimony as sufficient evidence of current symptoms or disease that could potentially be related to asbestos exposure for purposes of requesting an examination and medical opinion.
f. Requesting an Examination and Opinion for Claims Based on Asbestos Exposure / Use the table below in determining the actions to take, to include when to request an examination and medical opinion, following review of the evidence in the claims folder.
If the Veteran’s claims folder contains evidence of a current disability and… / Then ...
demonstrates asbestos exposure /

• do not continue to develop for additional records to verify asbestos exposure

• request an examination with medical opinion using the Examination Request Builder (ERB), and
• refer the claim to the rating activity for a decision upon receipt of the requested examination.

Notes:

• When selecting a respiratory examination in ERB, a system prompt will be generated as to whether examination is being scheduled based on a Navy Veteran and asbestos exposure. If asbestos exposure is conceded based on MOS, select yes and pick the Veteran’s MOS, which will then generate the exposure probability.

• Additional evidence should be tabbed to identify all records the examiner should review in making a medical opinion.

• While the ERB indicates exposure based on a Navy Veteran, the asbestos guidance contained in this topic applies to all branches of service.

• Ensure that the examination request states all applicable information as to asbestos exposure to include the Veteran’s MOS(s) and probability of asbestos exposure.

does not demonstrate asbestos exposure /

• ensure that the development procedures detailed at M21-1, Part IV, Subpart ii, 1.I.3.d have been completed
• review any evidence received as a result of the development for any evidence of asbestos exposure to include personnel records and information on the MOS(s) the Veteran performed in service, and
• if exposure is shown as demonstrated by an MOS with a MINIMAL or higher indicator of probability of asbestos exposure or based on other evidence of exposure, request an examination with medical opinion and send to the rating activity following receipt of the requested examination, or

• if exposure is not shown as indicated by lack of evidence demonstrating at least a MINIMAL indicator of probability of asbestos exposure based on MOS and other evidence does not establish asbestos exposure, refer the claims folder to the rating activity for a decision without requesting an examination.

4. Developing Claims for SC for AIDS

Introduction