Radiation-risk activities
38 C.F.R. § 3.309(d) defines qualifying activities and listed diseases. § 3.311 provides dose-development procedures for radiogenic disease outside the strict presumption.
1945–1991
Cold War Exposures
Cold War claims can involve atmospheric nuclear testing, Enewetak cleanup, Palomares or Thule response, Project 112/SHAD, chemical-agent training, calibration sources, fuels, solvents, and contaminated installations.
All wartime eras
Hazards and evidence questions
Project 112 / SHAD
DoD conducted chemical and biological vulnerability tests from 1962–1974. Roughly 6,000 service members, primarily Army and Navy, participated.
Chemical and biological agents
Reported test agents included Coxiella burnetii, Francisella tularensis, SEB, sarin, VX, tabun, and soman; participation and agent must be verified.
Watch this first
VA benefits: toxic exposure update
VA’s general overview of toxic-exposure benefits and the PACT Act. Cold War service is the hardest exposure history to prove because most of it never happened in a combat theater and much of it was never written down as an exposure at all. Watch this for the framework, then build the record: the installation, the shop, the equipment, and the job you actually performed.
Source: U.S. Department of Veterans Affairs, official channel
Accuracy safeguard: “Radiation” is not one undifferentiated exposure. Identify the source, activity, dose evidence, disease, and latency.
Unique and shared
What this generation is up against
These are the hardest exposure claims in the system, and not because the exposures were smaller. They are hard because the proof is classified, destroyed, or was never created in the first place. Project 112 and Project SHAD participants were not told what they were being tested with. Atmospheric nuclear test participation was recorded by unit and by operation, not by name. Dose records were reconstructed decades later from assumptions about where a man stood and what he was doing. And the July 1973 fire at the National Personnel Records Center destroyed roughly 80 percent of Army personnel records for service members discharged between November 1, 1912 and January 1, 1960 — the exact population that took part in the early tests.
The second problem is that “radiation” is one thing to a veteran and three separate things in law. 38 CFR § 3.309(d) is a strict presumption for a radiation-exposed veteran with a listed disease. 38 CFR § 3.311 is a development regulation: VA obtains a dose estimate and an opinion for a radiogenic disease. 38 CFR § 3.303(d) sits underneath both and asks only for evidence, a diagnosis, and an opinion. Project 112 and SHAD have no general presumption at all and are decided case by case. A claim that argues “radiation exposure” without naming its door gets denied on procedure rather than on merit, and the veteran is told he lost on the medicine when he never got to the medicine.
Two veterans of the same conflict rarely carry the same claim, and veterans of different conflicts often carry the same one. The first panel is what belongs to this era alone. The second is the layer this era shares with the rest of the site — and it is the layer that reopens old denials.
Only this era
Unique to Cold War service
Every item here is a named program, operation, or site. Naming yours is what turns a vague radiation claim into a developed one.
- On-site participation in atmospheric nuclear testing — Operations Crossroads, Sandstone, Ranger, Greenhouse, Buster-Jangle, Tumbler-Snapper, Upshot-Knothole, Castle, Teapot, Wigwam, Redwing, Plumbbob, Hardtack I and Hardtack II, Argus, and Dominic.
- Occupation duty at Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946, and prisoner-of-war status in Japan during the Second World War. Both are radiation-risk activities in their own right.
- Nuclear accident and cleanup duty: the Enewetak Atoll cleanup from 1977 to 1980, the Palomares, Spain recovery in 1966, and the Thule, Greenland recovery in 1968.
- Project 112 and Project SHAD, 1962 to 1974. Roughly 6,000 service members were involved in chemical and biological agent testing. Agents used included Coxiella burnetii, Francisella tularensis, staphylococcal enterotoxin B, sarin, VX, tabun, and soman.
- Nasopharyngeal radium irradiation performed on active duty, and duty at the Paducah, Kentucky, Portsmouth, Ohio, or K-25 Oak Ridge, Tennessee gaseous diffusion plants for 250 days or more before February 1, 1992.
- Duty on or near Amchitka Island, Alaska before January 1, 1974, in connection with the Longshot, Milrow, or Cannikin underground tests.
Crosses eras
Shared with veterans of other eras
The Cold War ran underneath all the other eras, which means a Cold War file often contains the same exposures a Vietnam or post-9/11 file does — and can use the same regulations.
- Camp Lejeune water contamination between August 1, 1953 and December 31, 1987 falls squarely inside the Cold War period. Thirty cumulative days or more at Camp Lejeune or MCAS New River supports presumptive service connection for eight conditions.
- Domestic installations with documented contamination: Fort McClellan and its chemical training mission, Edgewood Arsenal and its volunteer chemical testing program, and Dugway Proving Ground.
- Asbestos, industrial solvents, leaded fuel, lead-based paint, and polychlorinated biphenyls in electrical and transformer work — the standard industrial exposure profile of American military installations from the 1940s into the 1990s.
- PFAS and aqueous film-forming foam, in use on flight lines and in fire training since the 1970s, and now the subject of drinking water investigations at installations nationwide.
- Stateside herbicide testing, storage, and transport sites. A Cold War veteran who never left the country can still fall inside the herbicide regulations if he worked at one of those sites — and can then use the same § 3.309(e) disease list a Vietnam veteran uses.
Conditions
What these exposures can cause
Radiation claims live or die on which list your diagnosis appears on, because the two lists carry completely different burdens. One concedes causation outright. The other only opens a development process. Below are both lists, in full, plus the exposures that have no list at all.
Presumptive
Presumptive diseases for a radiation-exposed veteran
Under 38 CFR § 3.309(d), if you took part in a qualifying radiation-risk activity and you are diagnosed with a disease on this list, service connection is presumed. No dose estimate and no medical opinion are required.
- All forms of leukemia except chronic 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 other than Hodgkin disease
- Cancer of the bile ducts
- Cancer of the gall bladder
- Primary liver cancer, except where cirrhosis or hepatitis B is indicated
- Cancer of the salivary gland
- Cancer of the urinary tract
- Bronchiolo-alveolar carcinoma
- Cancer of the bone
- Cancer of the brain
- Cancer of the colon
- Cancer of the lung
- Cancer of the ovary
Dose development
Radiogenic diseases — the development pathway
Under 38 CFR § 3.311, these diseases trigger a dose assessment and a medical opinion rather than an automatic grant. VA obtains a dose estimate — frequently with the Defense Threat Reduction Agency — and then decides whether the exposure caused the disease.
- All forms of leukemia except chronic lymphocytic leukemia
- Thyroid cancer
- Breast cancer
- Lung cancer
- Bone cancer
- Liver cancer
- Skin cancer
- Esophageal cancer
- Stomach cancer
- 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 disease
- Prostate cancer
- Any other cancer, when there is competent scientific or medical evidence that it is a radiogenic disease
Facts-found
Project 112, SHAD, and chemical agent testing
There is no presumption here. These claims are built from the participation record, the agent involved, and a medical opinion. VA and the Department of Defense have released participation rosters, and being named on one is powerful evidence.
- Respiratory disease and airway hyperreactivity following exposure to aerosolized biological and chemical simulants
- Peripheral neuropathy and persistent cognitive complaints following exposure to nerve agents including sarin, VX, tabun, and soman
- Chronic effects reported after exposure to Coxiella burnetii, Francisella tularensis, and staphylococcal enterotoxin B
- Skin, eye, and respiratory injury from mustard agent and Lewisite testing, including the volunteer programs at Edgewood Arsenal
- Cardiac and neurologic conditions claimed by Edgewood volunteers, argued from the program records rather than from any presumption
One overlap is worth knowing. Chronic lymphocytic leukemia is excluded from both radiation lists — but it is presumptive for herbicide exposure as a chronic B-cell leukemia. A veteran with both a radiation-risk activity and qualifying herbicide exposure can claim under both regulations in the same claim, and should.
Rating criteria
Possible ratings, spelled out
Cancer, kidney disease, and lung disease carry most of the rating weight in this era. The cancer rule below is the one that catches families off guard, because it does not last forever and the day it ends is a day with a deadline attached to it.
DC 6819, 7343, 7528, 7703, 7709, 7712, 7715Presumptive or facts-found, depending on the door
Active malignancy — the 100 percent rule
38 CFR §§ 4.97, 4.114, 4.115b, 4.117
CODES THAT CARRY THIS RULE
6819Neoplasms, malignant, any specified part of the respiratory system
7343Malignant neoplasms of the digestive system
7528Malignant neoplasms of the genitourinary system
7703Leukemia
7709Hodgkin disease
7712Multiple myeloma
7715Non-Hodgkin lymphoma
100%
Assigned with active malignancy or during a treatment phase. The 100 percent evaluation continues for six months following the cessation of surgical, X-ray, antineoplastic chemotherapy, or other therapeutic procedure.
After six months
A mandatory VA examination is required. If there is no local recurrence or metastasis, the disability is then rated on its residuals.
In plain terms: Residuals are rated under whatever code fits what the cancer and its treatment left behind — kidney function, breathing capacity, voiding dysfunction, neuropathy from chemotherapy, or fatigue. Each is separately ratable, and each has to be measured by the examiner to count.
Any reduction
A reduction that lowers compensation must follow 38 CFR § 3.105(e): VA issues a rating proposing the reduction, states the facts and reasons for it, and gives you 60 days to submit additional evidence or request a predetermination hearing.
In plain terms: That letter is a proposal, not a final decision, and you are entitled to answer it. Sixty days is the whole window — losing it is how a 100 percent rating quietly becomes a 30 percent rating.
Rated under § 4.115aResidual or facts-found
Renal dysfunction
38 CFR § 4.115a
100%
Requiring regular dialysis, or precluding more than sedentary activity from one of the following: persistent edema and albuminuria; or BUN more than 80mg%; or creatinine more than 8mg%; or markedly decreased function of the kidney or other organ systems, especially cardiovascular.
80%
Persistent edema and albuminuria with BUN 40 to 80mg%, or creatinine 4 to 8mg%, or generalized poor health characterized by lethargy, weakness, anorexia, weight loss, or limitation of exertion.
60%
Constant albuminuria with some edema, or definite decrease in kidney function, or hypertension at least 40 percent disabling under diagnostic code 7101.
30%
Albumin constant or recurring with hyaline and granular casts or red blood cells, or transient or slight edema, or hypertension at least 10 percent disabling under diagnostic code 7101.
0%
Albumin and casts with history of acute nephritis, or hypertension that is non-compensable under diagnostic code 7101.
Renal dysfunction and voiding dysfunction are rated on whichever produces the higher evaluation — not both. Look closely at the 60 percent and 30 percent tiers: each can be met through blood pressure alone. A veteran with kidney disease and hypertension may be sitting at 10 percent for the blood pressure when the same readings support a far higher rating under the kidney criteria.
DC 6600, 6603, 6604Facts-found for this era
Chronic obstructive pulmonary disease, bronchitis, and emphysema
38 CFR § 4.97, General Rating Formula
100%
FEV-1 less than 40% predicted; or FEV-1/FVC less than 40%; or DLCO (SB) less than 40% predicted; or maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiac or respiratory limitation; or cor pulmonale (right heart failure); or right ventricular hypertrophy; or pulmonary hypertension; or episodes of acute respiratory failure; or requires outpatient oxygen therapy.
60%
FEV-1 of 40 to 55% predicted; or FEV-1/FVC of 40 to 55%; or DLCO (SB) of 40 to 55% predicted; or maximum oxygen consumption of 15 to 20 ml/kg/min.
30%
FEV-1 of 56 to 70% predicted; or FEV-1/FVC of 56 to 70%; or DLCO (SB) of 56 to 65% predicted.
10%
FEV-1 of 71 to 80% predicted; or FEV-1/FVC of 71 to 80%; or DLCO (SB) of 66 to 80% predicted.
Asbestos and solvent exposure at Cold War installations produces this disease pattern constantly, and it is never presumed for this era — it is proven. Note that the 100 percent tier can be met by the need for outpatient oxygen therapy alone, with no breathing-test number at all.
For scarring diseases of the lung tissue, including asbestosis and pulmonary fibrosis, the rating turns on forced vital capacity and diffusing capacity rather than on airflow — which is why a veteran with fibrosis can blow a normal number and still be badly impaired. The full breathing schedule is reproduced in plain language on our respiratory evidence page.
Combine your ratingsEligibility
Who qualifies — and how to file
Three doors, and in this era the door you name is very nearly the whole claim. Radiation exposure argued without a regulation gets denied on procedure.
Door 1 — § 3.309(d), the strict presumption
A radiation-exposed veteran — on-site test participation, Hiroshima or Nagasaki occupation, prisoner of war in Japan, the gaseous diffusion plants, or Amchitka Island — with a disease on the presumptive list. Exposure is conceded and causation is presumed.
What the file needs
The operation or activity, namedUnit and dates placing you thereThe diagnosis, on the § 3.309(d) listNo dose estimate and no medical opinion required
Door 2 — § 3.311, dose development
A radiogenic disease with claimed radiation exposure. VA is required to obtain a dose estimate, frequently working with the Defense Threat Reduction Agency, and then to obtain an opinion. This is a process VA owes you, not a favor.
What the file needs
Your account of the exposure, in specific detailAny film badge or dosimetry record you can locateUnit history, operation order, or ship movement recordsA request that VA develop the dose estimate under § 3.311
Door 3 — Direct service connection for everything else
Project 112 and SHAD, Edgewood, Fort McClellan, Dugway, asbestos, solvents, PCBs, and contaminated installation water. No list, no dose threshold — evidence, a diagnosis, and an opinion under 38 CFR § 3.303(d).
What the file needs
The named program, site, or installation and your dates thereThe agent or material involved, named specificallyEvery duty actually performed, not the MOS code aloneA clinician who addresses the exposure by name in writing
The filing sequence, in order
Order matters more than speed. Every step below is free, and the first one protects money you have not been awarded yet.
- 1
File the Intent to File first, today
VA Form 21-0966An Intent to File locks your effective date for one year. Everything you are later awarded is paid back to the date VA received that form, not the date you finished gathering evidence. It takes minutes and costs nothing.
- 2
File the claim and name every diagnosis separately
VA Form 21-526EZOne form can carry many conditions, but each one has to be named. "Breathing problems" is not a claim; asthma, chronic sinusitis, and chronic rhinitis are three claims with three sets of criteria, and each is rated on its own before the ratings are combined.
- 3
Pull the exposure record VA already holds
The Individual Longitudinal Exposure Record compiles what the government already knows about where you served and what was there. For exposure that is not on a presumptive list, ask for a Toxic Exposure Risk Activity determination under 38 U.S.C. § 1168 — that determination is what turns an unlisted exposure into a developed one.
- 4
Decide whether you want representation
VA Form 21-22aForm 21-22a appoints an accredited agent or attorney; form 21-22 appoints a veterans service organization. Representation is never required. No one may lawfully charge you a fee to prepare or file an original claim.
- 5
If a decision is already wrong, choose the correct lane
VA Form 20-0995 / 20-0996 / 10182A Supplemental Claim (20-0995) is for new and relevant evidence. Higher-Level Review (20-0996) is for a decision that got the existing evidence wrong and allows no new evidence. A Board appeal (10182) is for the law itself. Choosing the wrong lane can cost a year and, in the worst case, an effective date.
If your records were lost in the 1973 St. Louis fire, that is not the end of the claim. Alternate records exist: unit morning reports, pay records, hospital admission ledgers, Surgeon General office extracts, and Defense Threat Reduction Agency test participation files. VA has a heightened duty to assist when service records are unavailable through no fault of the veteran, and to consider alternate evidence. Filing is free, and no one may lawfully charge a fee to prepare or file an original claim.
Sign up for the VA registry
The Ionizing Radiation Registry health exam
A free VA health examination for veterans with possible ionizing radiation exposure. It is not a claim and not a compensation and pension examination, but it creates the one thing most Cold War files lack entirely: a contemporaneous VA record that you reported this exposure and what your health looked like when you reported it.
- Open to on-site participants in atmospheric nuclear testing, including tests conducted by any nation; occupation duty at Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946; prisoners of war in Japan during the Second World War; veterans who received nasopharyngeal radium irradiation while on active duty; duty of 250 days or more before February 1, 1992 at the Paducah, Portsmouth, or K-25 Oak Ridge gaseous diffusion plants; and duty on or near Amchitka Island, Alaska before January 1, 1974 in connection with the Longshot, Milrow, or Cannikin tests.
- You do not have to be enrolled in VA health care to get the exam, and there is no copay for it.
- Eligibility is based on your own recollection of your service. You do not need Department of Defense confirmation of participation before you can be examined.
- The exam includes an exposure history, a physical examination, and any laboratory work the clinician orders. Everything goes into your VA medical record.
- For a claim, that is a separate process: VA verifies participation through service records and, in most radiation cases, works with the Defense Threat Reduction Agency, which may prepare a dose reconstruction.
- Spouses and children are not eligible for this exam.
How to get on the registry
Ask the Environmental Health Coordinator at your VA medical center, or contact VET-HOME, the Veterans Exposure Team — Health Outcomes Military Exposures. If you do not know who to ask, call MyVA411 at 800-698-2411, available 24 hours a day, seven days a week, and ask to be connected to the Environmental Health Coordinator at your facility.
MyVA411, 24 hours a day800-698-2411
A registry exam is not a claim and registry enrollment is not evidence of exposure. Get the exam so your health and your concern are documented, and file the claim so the effective date starts running — the two do different jobs.
Need this looked at by a doctor?
Registry exams and exposure evaluations start with a clinician. Our doctor page has the words to use at the appointment, the direct phone number and VA email of the exposure coordinator at your own VA medical center, and every VA registry you can sign up for.
Who else this touched
The family this era reached
Cold War radiation and chemical-test claims are hard-won, but once a condition is service-connected the survivor and dependent benefits follow the same rules as every other era. Do not assume the herbicide birth-defect programs apply here — spina bifida coverage is tied to herbicide service, not radiation.
- DIC for survivors when a service-connected radiogenic or chemical-exposure disease causes or contributes to death.
- CHAMPVA health coverage for dependents once the veteran is rated permanently and totally disabled.
- Needs-based Survivors Pension for eligible low-income surviving spouses and children of wartime veterans.