VA Disability Claims Process
for Presumptive Illnesses

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Welcome Veterans!

Introduction -

I am really excited to share this with you. It has been such an unexpected and valuable blessing for my family and friends. I hope it helps you, too.

More military veterans are eligible for VA (Veterans Affairs) disability compensation and healthcare benefits through several law changes in the last few years, including the PACT Act of 2022 and Blue Water Navy (BWN) Vietnam Veterans Act of 2019. I recently had the opportunity to learn about this and provide support for a family member and friend through the VA application process. I have compiled links to resources below that were helpful. Please share this valuable information with all of the veterans from any era in your life.

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Presumptive Illnesses for Disability Compensation -

Presumptive claims are a special category that has made the application process much easier and simpler for these eligible veterans. It is not too late to apply.

Presumptive means: If the veteran has this diagnosis now and was in this place at this time of presumed toxic exposure during military service, then the VA will verify all of that and approve a service-connected disability rating for compensation.

In other words, for any disability claim to be approved, the VA needs proof of 3 elements:
     1. current diagnosis
     2. in-service event (exposure, injury, illness, etc.)
     3. link or connection (or nexus) between #1 and #2
These presumptive lists (below) are #2 (toxic exposure) and #3 (connection to specific illnesses); the veteran just needs to provide proof of #1 a current diagnosis from the list.

Please do not miss how simple, important, and valuable this is!

Disability compensation is a tax-free monthly payment from the VA. It is medical-based (not financial-need based), and it does not mean that the veteran is disabled and cannot work. It is more like worker's compensation for chronic injuries and illnesses caused by military service. (For veterans who are unable to work due to disabilities, there are programs, like TDIU through the VA or SSDI through SSA.)

Please read these links carefully because the details matter:

Vietnam War and Agent Orange Presumptive List - includes locations outside of Vietnam
Also see Blue Water Navy link (below) and additional BWN Resources section at the bottom of this page.

Gulf War and recent Veterans and Burn Pits Presumptive List - includes places of deployment
Also see Other Exposures link (below) for 2 more lists with Gulf War Illnesses and locations.

Camp Lejeune Presumptive List - 1953-1987

Other Exposures and Presumptive Lists - includes 10 categories

Plan to check these lists again in the future as new locations, illnesses, and toxins may be added.

Remember the presumptive claim is for a diagnosed disability due to a toxic exposure. It is not a general claim for Agent Orange exposure or Burn Pits exposure without any illness involved. In other words, exposure by itself is not an approvable claim. (It is, however, a good reason to stay up-to-date on relevant medical screenings.)

On the other hand, even if the veteran does not qualify for the presumptive category, it can still be worth applying and seeing if the VA finds a connection to the diagnosed chronic illness or cancer. The VA has a new program through the PACT Act for this issue called TERA (toxic exposure risk activity).

More details -
PACT Act -
Blue Water Navy Act -
VA Disability Compensation -

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Example Claims - Always remember that each claim is different.

Example 1
A recent veteran had been deployed with the Marines to a certain country in the Middle East or Southwest Asia (SWA) and is now being treated for prostate cancer. Since it is a Burn Pits presumptive, the decision was made in 3 months. It is service-connected at a temporary rating of 100% during treatment. (A 100% rating is about $3740/month or $44,900/year +dependents tax free.) Six months after treatment ends, the rating will be reduced to 0%, and the veteran will be evaluated for secondary ratings for any chronic residual issues caused by the cancer and treatment. He can also apply later for increased ratings, as needed, if these issues worsen by VA standards.

(The presumptive list is also helpful for the veteran's doctor to keep in mind and be watching for other health issues related to breathing and other cancers.)

Example 2
A Vietnam veteran's ship in the Navy was in a certain place at a certain time for Agent Orange exposure to be considered presumptive. 50 years after discharge, the veteran has applied and been approved for diabetes at a 20% rating because medication is prescribed. (A 20% rating is about $340/month or $4060/year tax free.) Diabetes causes many known secondary conditions (like for eyes, heart, kidneys, neuropathy, etc.), which can also be claimed for a combined higher rating. The veteran was also rated at 0% for hypertension (high blood pressure), since it has always been controlled by medication. (Again, any secondary issues can be added to this, despite the 0% rating.)

Like many presumptive conditions that are diagnosed with bloodwork and medical tests, these claims were not subjective; the veteran just had to submit medical records, get a blood test and have a C&P exam (Compensation and Pension Exam) with an approved VA benefits doctor. It took 4 months to get the decision, but the process was relatively "easy" and everyone along the way was very nice and helpful. The VA now has a record of the veteran, so the information can be updated and an increase can be requested for the veteran's disability rating as these health issues change.

(The presumptive list is also helpful for the veteran's doctor to keep in mind and be watching for other health issues and cancers.)

Example 3
Another Vietnam veteran was stationed in Korea. Over 50 years later, with the free help of a VSO (Veterans Service Officer), the Army veteran recently applied for the first time for hearing loss and tinnitus (ringing in the ears). The service records showed the hearing loss and tinnitus started during the veteran's military service, and the claims were approved for a 10% rating for each. (A 20% rating is about $340/month or $4060/year tax free.) The decision for this part of the claim was made in 6 months. 10% for tinnitus is the maximum rating. If his hearing gets worse in the future by VA standards, the veteran can apply for an increased rating.

The veteran also applied for Parkinson's Disease and hypothyroidism, due to the possibility of Agent Orange exposure. Those 2 issues were deferred (not the same as denied), which means the VA is still working on it and needs to collect more information before making a decision.

The VSO also signed up the veteran for VA healthcare, which gives access to free hearing aids, as well as many other free or low-cost health-related benefits.

Note: These examples are from 2023. The rules for ratings change periodically. The monthly payments have yearly cost-of-living increases.

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Family Matters -

Many veterans are understandably hesitant to apply for benefits and extra support for themselves, but please remember that these benefits also help the family of the veteran, which is an important consideration.

With a combined 30% disability rating, a veteran can apply to add all dependents (including spouse) for some extra money monthly.

There are many serious illnesses on the presumptive lists. If a veteran dies of a service-connected disability, the veteran's dependents are eligible to apply for benefits called DIC (Dependency and Indemnity Compensation).

Another reason to apply to get service-connected now is because there is a double benefit - extra money and free healthcare for the living veteran now and extra support for the grieving family later.

There are a lot of benefits for veterans and their families, so keep checking for updated details.

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Claims Process -

Intent to File -
If a veteran is thinking about applying, be sure to do an "intent to file" now, which is the start of the application process. That way the effective date for any backpay would be as early as this month. The veteran would then have one year from now to get organized and submit a completed application. (Even though it is set up differently than the online form, printing the pdf version of the application and filling it out as a draft copy is helpful for getting the claim organized.)
Also see Effective Date - Liberalizing Law link below for special rules for presumptive claims and extra backpay.

Presumptive Claim -
There is not a special form or claim type for presumptive issues, including PACT Act and Blue Water Navy Act. It is helpful to state that information on the initial claim form in the brief disability description section. It could include: the named diagnosed disability, due to presumptive exposure to the named toxin, the named service branch, with dates and places (or ship's name). Example: Hypertension (high blood pressure) due to presumptive exposure to Agent Orange during service in the Army in Vietnam from January-June 1967. The approximate date of diagnosis and/or start of treatment can also be added here.

VSO (Veterans Service Officer) - VA accredited free help with available benefits and applications
The VA claims system offers free help and advice through a VSO to submit claims. The VA will order the military and medical records needed to process the claims. If given permission, a VSO can access the VA system to see claim status and details that a veteran cannot. While it is possible for a veteran to submit their own claim, it can be helpful to have a consult and be in contact with a good VSO.
Search for VSO (can be available through county, DAV, VFW, AMVETS, American Legion) or VA accredited attorney

A veteran is also allowed to submit their own claim and/or records. The veteran is not expected to know everything about the process, but it is helpful to have a basic understanding and get educated about it. This can include how to organize a successful claim to make it as easy as possible for the VA rater. It is also helpful for setting realistic expectations about the time it takes and effort it takes for a claim, as well as the results. The veteran is the one who cares the most about the claim and can learn to be their own advocate. DIY is not for everyone and can be too hard for many veterans to manage, so do what is best for the veteran and claim.

VA Disability Compensation Rates -
tax-free monthly payment based on combined rating % (VA math) and dependents
Also see Combined Benefits link below for extra benefits.

VA Rating Calculator -
VA math is not a simple addition of ratings.
Also see VA Math link below.

VA CFR - Schedule for Rating Disabilities by VA standards
The VA rating system is used to determine severity and compensation % for each chronic health issue, but it is not user-friendly.
Also see Master Conditions List link below for easier-to-use version.

VA Manual -
Laws and rules VA raters use to make decisions. It is much more in-depth knowledge than veterans need for many claims. Keep it for future reference, if needed.

VA C&P Exams and DBQ Forms -
At the VA C&P exam (Compensation and Pension Exam), the doctor is filling out forms (like the ones called DBQ - Disability Benefits Questionnaires - in the link below). In many ways, they are taking the veteran's medical records and translating them for the VA to make decisions based on VA standards (about service connection when not presumptive, severity, secondaries, etc.). It may just take a few minutes at the exam to clarify some things or it may be longer and more detailed. The example DBQ forms should give the veteran an idea of what questions may be asked. The DBQ also gives information about possible secondary conditions to include on the disability claim, if applicable.

For quick reference, the veteran can make a short timeline for each illness of the highlights - dates of important tests and diagnoses, specialists, medication additions and changes, current status, symptoms and side effects, and any needed daily assistance. (I do not know if it helps or not, but this reference page can also be submitted to the claim as a personal statement by the veteran. I consider it to be a way to talk directly to the VA rater who is making the decision and make the claim easier for the rater to understand.)

Stress and Waiting -
Even if the claims process goes smoothly and successfully, it is still an emotional rollercoaster and can be stressful. You never feel like you know where you are in the process, what will happen next, how many exams there will be, if you have done enough, how long it will take to get a decision, what the outcome will be, and if you will need to appeal, etc. (Some of the form letters from the VA and online status updates are more confusing than helpful.)

Stay informed about the claim status but try not to obsess. Get a healthy hobby to take your mind off of the waiting and wondering and deal with the stress. Also get a healthy support system for the process, like a VSO, if needed, online forum (below), another veteran who has some positive experience with VA claims, or good friend. (Be careful about sharing this, though, because money and jealousy can cause problems in some relationships.)

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Decision Letter -

Even though it has already been a long wait, I consider the decision letter to be like the halftime score and stats of a sporting event (for lack of a better analogy). It is a report that tells the veteran where you stand in the process so far and how to proceed. It is not the final score, (unless you won with all claims approved and rated properly!). Read the decision letter carefully because the details matter.

More details -
Dependents -
Also see VA Healthcare section at the bottom of this page.

Appeal - Supplemental Claim Example
There are many aspects of the claims process that are in the veteran's favor. One is the ability to submit an appeal - multiple, if necessary. One type of appeal is called a Supplemental Claim, and the veteran is supposed to submit new and relevant evidence for it. As an example, on an original claim, the VA requested medical records from 4 doctors for the veteran. The VA only received records from 2 of the doctors, and the veteran did not know this until receiving the decision letter and seeing the evidence list. Apparently, the 2 medical systems rejected the records requests because of the electronic signature used by the VA and nobody told the veteran. (Another lesson: Follow-up with the doctor's office to get the records submitted.) The lack of records caused one of the ratings to be lower than it should have been. By submitting an appeal (as a Supplemental Claim) with more medical test results that showed the diagnosis and severity level back at the time of the effective date (important detail!), a corrected higher rating and earliest effective date were approved quickly on appeal. (For some reason, Supplemental Claims use an ITF - intent to file, so plan new claims and Supplemental Claims carefully to preserve backpay dates, as best as possible.)
(See Appeals link below for more about the types of appeals.)

Medical Opinion (MO) from C&P exam -
For element #1 diagnosis -
A presumptive claim is usually a serious illness that has already been diagnosed. If making any claim without a diagnosis, these are some things to be aware of: No diagnosis is a common reason for denials of claims. It is my understanding that a current diagnosis is required for every claim to be approved. On the initial application, a veteran can just provide a lay statement with a description of symptoms and without a diagnosis. Then, there needs to be enough evidence to be given a C&P exam - another milestone in the claim process. Then, the C&P examiner may or may not provide a diagnosis. If the diagnosis is provided for the first time at the C&P exam, that may establish a later than expected effective date for first payment/backpay based on the "date entitlement arose" instead of the intent to file date (ITF).

For element #3 connection (link/nexus) -
A presumptive claim does not require a medical opinion for service connection because element #3 is already established. Another claimed issue may require a medical opinion by the C&P examiner and the VA will request it. The decision letter should state this opinion. A favorable or positive MO is "as likely as not" or "more likely than not" or "is related". An unfavorable or negative MO is "less likely than not" or "is not related".

Routine Future Exam (RFE) -
The decision letter may include a statement about a Routine Future Exam (RFE). For some illnesses, especially cancer, these extra C&P exams are required until remission. The temporary rating of 100% for cancer is reduced to 0% six months after treatment ends. Then, the veteran is evaluated for secondary ratings for any chronic residual issues caused by the cancer and treatment.

Inferred and Invited -
The veteran is not expected to know some important aspects of claims, and the VA rater is allowed to assist further. Here are 2 more examples:

There are times when the VA rater can infer an issue and award a rating for it, even when it is not claimed by the veteran. In my experience, this was due to a related, similar, or secondary issue being covered on the DBQ at the exam and in medical records. This resulted in more issues being approved than the veteran claimed and a higher rating.

Read the decision letter carefully! A VA rater may also invite more claims from the veteran. If the rater finds enough evidence of other issues that are highly likely to be approved for service connection, the rater will include a note about those in the decision letter and invite the veteran to submit a claim for them. This is not a common occurrence, so do not miss this great opportunity for this extra blessing.

More Claim Terms -

Approved -
Good news, but do not underestimate the mixed emotions that come with the label of disabled veteran.

Increase -
Many veterans received a disability rating at discharge, but they do not know that they can apply for an increased rating, if that condition worsens by VA standards. (See Master Conditions List link below for rating charts.)

Secondary -
These conditions can be rated higher and more valuable than the primary (or other secondary) conditions that caused them! (See Master Conditions List link below for rating charts and common secondaries. Keep in mind that pyramiding rules can apply, though, see below.)

Pyramiding -
A veteran cannot be compensated for more than one related or similar issue within certain categories, such as mental health (MH), digestive system, kidney, etc. The VA will collect those issues under the larger category and give the highest individual rating for it. For example, a veteran can apply for depression, PTSD, and insomnia all at once, but the veteran will only receive compensation for the highest rated one within the mental health category. (This can be a tricky topic, and the VA rater will make the decision about it. This can help to understand what happened and why there were not multiple ratings awarded for some claims. See Master Conditions List for helpful examples.)

SMC - Special Monthly Compensation
There are many levels of SMC. Two of the common ones are SMC-K and SMC-S:

SMC-K is for loss of use of a creative/reproductive organ, like ED. It is often a secondary claim for some types of cancer, some illnesses, like diabetes, or as a side effect of some medications, like certain ones used for hypertension or mental health. (Yes, there are times when side effects of medications used to treat service-connected disabilities can be successfully claimed as secondaries!) The rating for ED is 0%, but SMC-K is added for some extra money monthly.

SMC-S called housebound has 2 types. SMC-S2 can be claimed by a veteran who is housebound due to service-connected disabilities. SMC-S1 should be automatically awarded when the veteran has a single service-connected disability that is rated at 100% (like actively treated cancer) plus other service-connected disabilities that are rated at 60% combined (by VA math). This type of automatic SMC-S is called statutory housebound; it does not mean that the veteran is limited to staying at home, and there are no limits on the veteran's ability to work and earn money.  SMC-S is paid instead of the 100% compensation rate, not in addition to it.

Biggest Mistake -
Based on the claim results, the biggest mistake my family with many veterans has made was not being aware of benefits through the VA and not applying years and years sooner. This is especially true for the presumptive conditions that are serious illnesses and have a good chance of being approved. The claims process is a lot to go through, but it helps knowing that the chance of approval is very high.

For a veteran whose case is not as clear, it can still be worth applying with realistic expectations because it is unknown what evidence the VA already has that could make a positive difference in the claim.

Also remember this is a legal decision made by a VA rater who must follow the rules, laws, and evidence. Do not assume for them that the claim will be denied or think someone else deserves it more, so it is not even worth applying. Also, do not judge yourself as undeserving, if the results are more than expected. Let the VA rater do their job and make the decision.

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Veterans Benefits forum (on reddit and unofficial) -

Knowledge Base - This forum has a user-friendly and extensive knowledge base with helpful explanations about many VA Benefits.
Be sure to scroll down through the entire page of the link above to see all of the topics covered.

Some good topics include:

Master Conditions List - includes Ratings, Common Secondaries, and Pyramiding issues
Presumptive Conditions -
TERA - Toxic Exposure -
Commonly Missed Disabilities -

Acronym and Abbreviation List -
Rating Schedule index - includes Pyramiding rule, Reduction rules, and more
VA Codes for Diagnosis - helpful for navigating CFR (above)
Claim Status Codes -

VA Claim - includes Intent to File, tips for organizing claims, and more
Claim Type - includes Increase, Secondary, Deferred, Inferred, and more
Appeals - multiple types -

VSO (Veterans Service Officer) -
VERA - VA help with claim status and issues
C-File - Order the records that the VA has for the veteran's claims, which are helpful to have for a follow-up claim or an appeal.
C&P Exam

VA Math -
Backpay - The VA does not pay for partial months and pays on the first of the month but one month behind.
Dependents - add to 30% rating -
Combined Benefits - extra benefits based on ratings
SMC - see K and S -

Effective Dates -
There are specific circumstances that allow presumptive claims to be awarded an extra year of backpay! Be sure to include the medical records that show the diagnosis in the correct time period.
This includes another tricky subject called "date entitlement arose". When the diagnosis or severity is proven later at the C&P Exam instead of through medical records dated before the Intent to File or claim submission, this changes the effective date of the rating.

Healthcare -
TDIU and SSDI - programs for veterans who are unable work due to service-connected or other disabilities
VA Pension - financial need-based for veterans
Survivor Benefits - includes Pension, DIC, and more

(Extra note for soon-to-be-veterans with BDD or other claims: As mentioned above, the VA does not pay for partial months. Having the separation date be on the last day of the month means becoming a veteran on the first day of the next month. This counts as a partial month without any payment from VA for that entire month! In this scenario, it would appear to be better to become a veteran on the last day of the month. However, I do not know anything about the military side of things for payment periods, separation date flexibility, etc. This is just a friendly warning to do some research on the subject and plan accordingly.)

Veterans Benefits Forum -
Besides the great knowledge base, it also has another section that is a searchable forum. Lots of questions are asked and answered daily about available benefits and going through the claims process. It is helpful to see other experiences and read the posted decision letters. Some of the active members are actually VA raters and people who develop the VA claims. Their generosity to share information gives a great insider perspective on how the process works and why decisions are made! When reading or asking questions here, many of the fellow veterans are helpful, knowledgeable, and supportive. Also, some of the posts are about sensitive topics and trigger strong reactions.

Success Stories (separate forum) - a new forum created to share VA claims success stories

VSR_RVSR (separate forum) - exclusively for VA raters (RVSR) and VA claims developers (VSR)
Reading the posts in this forum is another way to get insight into the behind-the-scenes workings of the claims process!

There are a lot of myths and misinformation about VA benefits in the military and veteran communities and online. This is partly because there are a lot of rules for every benefit. Be sure to verify everything through a reliable source, like

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Other VA Benefits - Healthcare and Pension

VA Healthcare - many veterans
Free for all service-connected disabilities (and low cost for other issues) or Free for all medical issues with a rating of 50% or more
Eligibility -
Priority groups -
Copays -
As a way to keep current doctors, ask about community care:
Community Care -
Free hearing aids -

VA Pension - financial need-based safety net
Keep this in mind for wartime veterans and their spouses (or dependents) who have low income and assets and/or high medical costs.
For a few years before my grandmother died, she received the VA pension as a WWII Marine. It was a Godsend and relieved a lot of financial pressure for her care, since her income and savings were quickly being spent on her medical bills. Our only regret is not knowing about it sooner for her.
Eligibility -
Rates -
Surviving Spouse/Dependents -
Rates -
Search for VSO or VA accredited attorney. (An Elder Law specialist would be especially helpful.)

Veteran Discounts -

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Blue Water Navy Resources -

The VA should already have access to the records needed to prove a Navy veteran and the ship were within 12 miles of South Vietnam. If more information is required, these are some resources that could help:

Ship List and Interactive Vietnam Map (unofficial but has official source records) -
Choose the ship; then click "view source" to access the spreadsheet. This has links to the specific deck logs!

Navy Deck Logs online at National Archives -

Blue Water Navy Association -
One of the resources on this site says, "If you served on a DD, DE, DLG, or CLD engaged in gunfire support or sighted the South Vietnamese mainland, you were within the 12 miles of shore."

VA Vietnam and Agent Orange Ship List dated July 1, 2019 (word document) -
While this is an official list and good starting point, I do not believe it is all-inclusive for BWN claims. It predates the BWN Act and research that has been done since that time by the VA for BWN claims.

Also, many Navy ships have a website or facebook group, so search for that, too.

Blue Water Navy Act -

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Please Share

I have received compliments from the veterans in my life and their families that I should work for the VA or become a VSO. That is not possible with my health, but I wanted to share these lessons and resources from our experiences with the application process. I hope this information is helpful and encourages many more veterans to pursue their claims successfully! Please keep it for future reference and thank you for sharing this with all of the veterans from any era in your life!

While I cannot help with claims, I would love to hear about your successes with them: Contact Info

Disclaimer: I am not a veteran, VA employee, VSO, or lawyer, and I am not giving any legal advice. This website is not affiliated, endorsed, supported, authorized, or accredited by the VA. The information shared here is not guaranteed to apply to any specific claim. There are many scenarios and rules involved. While I hope this helps with finding the needed information, please verify everything mentioned here with an official source, like, as it relates to the veteran's specific claims.

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