Every toxic exposure, and the exact route to a decision.

A presumption and a TERA determination are not the same thing

These two get mixed together constantly — by veterans, by service officers, and sometimes in the decision letter itself. They are separate mechanisms that answer separate questions. One asks where and when you served. The other asks what you did while you were there. Treating either one as a substitute for the other is how a winnable claim gets prepared the wrong way and comes back denied.

Here is the fastest way to tell which lane you are standing in. A presumption almost always comes out of a deployment or an assignment to a place that has already been named — Vietnam, the Gulf, the Korean DMZ, the burn-pit countries, Camp Lejeune. Congress or VA drew a box around a region and a set of dates, and if your service falls inside that box and your diagnosis is on the list attached to it, you are in the presumptive lane and the law does the connecting for you. TERA is for everything else. If your exposure did not come from being sent to one of those named locations — if it came from the aircraft you turned wrenches on, the fuel you pumped, the foam you sprayed, the paint and solvent you stripped with, the engine room you stood watch in, the stateside installation where the work itself was the hazard — then no list is ever going to carry your claim. That is a TERA case, and it is proved with your duties.

Read both columns before you decide what to gather. If you are in the presumptive lane, the work is proving your service facts — orders, dates, locations. If you are in the TERA lane, the work is documenting what you actually did and then getting a medical opinion that ties it to the diagnosis. Those are two entirely different piles of paper, and preparing the wrong one costs months. And plenty of veterans are standing in both lanes at the same time — one condition that qualifies off a deployment, another that only ever gets connected through the work.

Set by law — where and when you served

A presumption

A presumption is written into statute and regulation. It has three moving parts and all three have to line up: a specific place, a specific date range, and a diagnosis that appears on the list attached to that place. When they do, VA presumes the exposure and presumes the connection — you never have to produce a medical opinion tying the disease to the service.

• It is decided on service records, not on medical evidence.
• Miss the location or the date window by anything at all and the presumption simply does not apply.
• The condition list is closed — a diagnosis that is not on it is not presumptive, however strong the science behind it.
• If you do qualify, it is the fastest route to a decision that exists.

Based on what you actually did

A TERA determination

TERA stands for Toxic Exposure Risk Activity. It is VA’s finding that your service involved an activity that put you at risk of a hazard, and it comes out of your duties, your assignments, and the work you actually performed — not out of a list of places and dates. It is not a presumption, and on its own it does not grant service connection.

• What it does: it puts the exposure into the record, and under 38 U.S.C. § 1168 it generally obligates VA to obtain an exam and a medical opinion when there is a current disability and the file is otherwise short of proof.
• What it does not do: it does not concede the medical link. VA can find TERA and still deny the claim for “no nexus.”
• It is also used on the health care side, to establish eligibility to enroll and to get the toxic exposure screening.
• It is frequently missing from the file, or built off your primary job code alone — which misses the duties that actually exposed you.