M21-1 Manual  /  Part VIII, Subpart i, Chapter 1, Section C

Ratings for Disabilities Associated With Herbicide Exposure

M21-1, Part VIII, Subpart i, Chapter 1, Section C

Overview

In This Section

This section contains the following topics:
TopicTopic Name
1Considering Service Connection (SC) for Disabilities Associated With Exposure to Certain Herbicide Agents
2Considering SC for Disabilities Associated With Service in the Republic of Vietnam (RVN)
3Impact of Historical Herbicide Exposure Policies
4Effective Date Determinations in Herbicide Exposure Claims

1. Considering SC for Disabilities Associated With Exposure to Certain Herbicide Agents

Introduction

This topic contains information on considering SC for disabilities associated with exposure to certain herbicide agents, including
  • deciding presumptive SC based on herbicide exposure
  • rebutting presumption by affirmative evidence to the contrary
  • manifestation period for presumptive purposes under 38 CFR 3.309(e)
  • required degree of disability for presumptive herbicide disabilities
  • considering direct SC when entitlement to presumption does not exist
  • date disabilities became subject to presumptive SC based on herbicide exposure
  • processing claims based on early-onset peripheral neuropathy
  • metastasis of a cancer and presumptive SC based on herbicide exposure
  • herbicide rating decision requirements, and
  • centralized processing for rating and authorization of herbicide claims.

Change Date

September 15, 2025

VIII.i.1.C.1.a. Deciding Presumptive SC Based on Herbicide Exposure

When deciding service connection (SC) for a disability due to herbicide exposure, consider if the evidence establishes When these requirements are met, a presumption arises that the diagnosis is
  • related to the exposure, and
  • incurred in or aggravated by service.
The presumption removes the need to prove a nexus between the current diagnosis and the in-service exposure. Therefore, when the evidence is sufficient for the presumption to arise, SC is established (assuming that generally applicable requirements such as Veteran status based on a qualifying discharge have been met) unless other evidence rebuts the presumption. Important: References: For more information on
  • centralized processing of rating and authorization activities in herbicide claims, see M21-1, Part VIII, Subpart i, 1.C.1.j
  • rebutting the presumption by affirmative evidence to the contrary, see M21-1, Part VIII, Subpart i, 1.C.1.b
  • herbicide rating decision requirements, see M21-1, Part VIII, Subpart i, 1.C.1.i, and
  • presumptive herbicide disabilities, see M21-1, Part VIII, Subpart i, 1.A.1.f.

VIII.i.1.C.1.b. Rebutting Presumption by Affirmative Evidence to the Contrary

The presumption of a nexus between a disability listed in 38 CFR 3.309(e) or 38 U.S.C. 1116 established in-service exposure to an herbicide agent can be rebutted by evidence that the disability was not caused by the exposure.The standard in 38 CFR 3.307(d) is affirmative evidence to the contrary. The regulation does not specifically define the standard but notes that it means less than conclusive proof and requires sound medical reasoning and consideration of all evidence of record.Important:
  • Although the regulation and statute permit rebuttal, in practice evidence will infrequently support it.
  • A conclusory medical statement that a condition listed in 38 CFR 3.309(e) or 38 U.S.C. 1116 is not related to demonstrated or presumed herbicide exposure does not meet the sound medical reasoning requirement. There must be competent, credible, and persuasive medical evidence supported by all of the other pertinent evidence of record that the individual’s diagnosed disorder is more likely than not related to a specific non-service-related cause.

References: For more information on

VIII.i.1.C.1.c. Manifestation Period for Presumptive Purposes Under 38 CFR 3.309(e)

In order to establish presumptive SC, the following diseases listed in 38 CFR 3.309(e) must become manifest to a degree of 10 percent or more within one year of the last date of exposure to herbicides
  • chloracne or other acne-form disease consistent with chloracne
  • porphyria cutanea tarda (PCT), and
  • early-onset peripheral neuropathy.
Notes:
  • There is no time limit for the other listed presumptive diseases in 38 CFR 3.309(e) or 38 U.S.C. 1116.
  • Previously, respiratory cancers (cancers of the lung, bronchus, larynx, and trachea) had to become manifest within 30 years of last exposure. Public Law (PL) 107-103 eliminated this requirement effective January 1, 2002.
  • For the purposes of establishing onset within the required manifestation period, the last date of herbicide exposure is the last date on which the Veteran served in a location associated with a presumption of herbicide exposure as listed in 38 U.S.C. 1116.
Reference: For more information on time limits for manifestation of diseases subject to presumptive SC, see

VIII.i.1.C.1.d. Required Degree of Disability for Presumptive Herbicide Disabilities

To qualify for presumptive SC based on herbicide exposure, 38 U.S.C. 1116 and 38 CFR 3.307(a)(6) require certain disabilities to manifest to a specific level of severity.The following disabilities must manifest to a degree of 10 percent or more within any applicable manifestation period as discussed in M21-1, Part VIII, Subpart i, 1.C.1.c:
  • AL amyloidosis
  • chloracne or other acne-form disease consistent with chloracne
  • Type 2 diabetes mellitus
  • Hodgkin's disease
  • Ischemic heart disease (IHD)
  • chronic B-cell leukemias
  • multiple myeloma
  • non-Hodgkin's lymphoma (NHL)
  • Parkinson's disease
  • early-onset peripheral neuropathy
  • PCT
  • prostate cancer
  • respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and
  • soft-tissue sarcoma.
Exception: The following presumptive disabilities are not required to manifest to a specific degree of disability:
  • parkinsonism
  • bladder cancer
  • hypothyroidism
  • hypertension, and
  • monoclonal gammopathy of undetermined significance (MGUS).

VIII.i.1.C.1.e. Considering Direct SC When Entitlement to Presumption Does Not Exist

If entitlement to presumptive SC based on herbicide exposure does not exist, consider entitlement to SC on a direct, facts-found basis under the toxic exposure risk activity (TERA) procedures.Notes:
  • Under 38 CFR 3.303(d), the presumptive provisions of the statute and Department of Veterans Affairs (VA) regulations implementing them are intended as liberalizations that allow for another basis of SC. Therefore, these provisions do not preclude direct SC, where appropriate.
  • TERA procedures went into effect on August 10, 2022, under PL 117-168, Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022.
References: For more information on

VIII.i.1.C.1.f. Date Disabilities Became Subject to Presumptive SC Based on Herbicide Exposure

The table below shows the dates on which the diseases listed in 38 CFR 3.309(e) and 38 U.S.C. 1116 became subject to presumptive SC based on herbicide exposure.
DisabilityEffective Date
  • Chloracne or other acne-form disease consistent with chloracne, and
  • soft-tissue sarcoma, other than
    • osteosarcoma
    • chondrosarcoma
    • Kaposi’s sarcoma, or
    • mesothelioma
February 6, 1991Note: Originally, September 25, 1985, under 38 CFR 3.311a.
NHLFebruary 6, 1991Note: Originally, August 5, 1964, under 38 CFR 3.313.
  • PCT, and
  • Hodgkin’s disease
February 3, 1994
  • Respiratory cancers of the
    • lung
    • bronchus
    • larynx, or
    • trachea, and
  • multiple myeloma
June 9, 1994
  • Prostate cancer, and
  • acute and subacute peripheral neuropathy
November 7, 1996
Type 2 diabetes mellitusMay 8, 2001
Chronic lymphocytic leukemia (CLL)October 16, 2003
AL amyloidosisMay 7, 2009
  • IHD
  • chronic B-cell leukemia, and
  • Parkinson’s disease
August 31, 2010
Early-onset peripheral neuropathySeptember 6, 2013
  • Parkinsonism
  • bladder cancer, and
  • hypothyroidism.
Reference: For more information on presumptive SC for these disabilities, see		January 1, 2021
  • MGUS, and
  • hypertension
August 10, 2022
Important: The table above includes reference to acute and subacute peripheral neuropathy becoming subject to presumptive SC on November 7, 1996, for historical purposes. The covered disease was revised to early-onset peripheral neuropathy by change effective September 6, 2013. For claims on or after September 6, 2013, entitlement to presumptive SC based on peripheral neuropathy only exists when the Veteran meets qualifying service requirements specified at M21-1, Part VIII, Subpart i, 1.A.1.c and medical evidence establishes a confirmed diagnosis of early-onset peripheral neuropathy.Note: Unless an earlier effective date is determined pursuant to the Nehmer stipulation under 38 CFR 3.816 or PL 116-23, Blue Water Navy Vietnam Veterans Act of 2019 (BWN law) under 38 U.S.C. 1116A, the provisions pertaining to retroactive payment under 38 CFR 3.114(a) apply.Reference: For more information on the

VIII.i.1.C.1.g. Processing Claims Based on Early-Onset Peripheral Neuropathy

A change to 38 CFR 3.307(a)(6) and 38 CFR 3.309(e) (78 FR 54763) effective September 6, 2013, removed requirements that neuropathy must resolve within two years. Do not deny presumptive SC for early-onset peripheral neuropathy solely because the condition persisted for more than two years after initial diagnosis.Important:
  • The regulatory amendment does not change that peripheral neuropathy must manifest to a compensable degree of 10 percent or more within one year of the date of last herbicide exposure during active military, naval, or air service.
  • Claims of SC for later-occurring onset of peripheral neuropathy can only be evaluated under other bases (for example, direct or secondary). The National Academy of Science (NAS) has determined that evidence does not support an association between herbicide exposure and delayed-onset peripheral neuropathy, which NAS defined as having its onset more than one year after exposure.

VIII.i.1.C.1.h. Metastasis of a Cancer and Presumptive SC Based on Herbicide Exposure

Do not establish presumptive SC on the basis of herbicide exposure for a cancer listed in 38 CFR 3.309(e) or 38 U.S.C. 1116 when medical evidence factually shows that the cancer developed as the result of metastasis of a cancer located at a primary site that is not recognized by the VA as associated with herbicide exposure.Note: Such evidence constitutes affirmative evidence to rebut the presumption of SC based on herbicide exposure.

VIII.i.1.C.1.i. Herbicide Rating Decision Requirements

Follow existing guidance in M21-1, Part V, Subpart iv, 1.A to generate a rating decision that explains the basis of any decision. In addition to system-generated text, decision makers should use glossary fragments or free text, when applicable, to fully explain the basis of each decision.When deciding a claim based on presumptive herbicide exposure, apply the guidelines in the table below in addition to the general reasons for decision requirements outlined in M21-1, Part V, Subpart iv, 1.A.5.a.Exception: For claims based on nautical herbicide exposure, follow the rating guidelines outlined in M21-1, Part VIII, Subpart i, 1.D.4.b.
If ...Then ...
awarding SCapply the relevant effective date rules as outlined in M21-1, Part VIII, Subpart i, 1.C.4.a.
denying SClist the herbicide exposure or qualifying diagnosis as a favorable finding, if applicable.
awarding SC based on herbicide exposure through contaminated C-123 aircraftinclude the following in the rating decision narrative:The evidence of record shows that you were exposed to herbicides through regular and repeated duties operating, maintaining, or serving onboard contaminated C-123 aircraft used to spray herbicide agents in Vietnam.
denying SC based on herbicide exposure through contaminated C-123 aircraftinclude the following in the rating decision narrative:VA evaluates claims for service connection based on C-123 herbicide exposure on a case-by-case basis. In this case, the evidence is insufficient for VA to acknowledge herbicide exposure.
References: For more information on

VIII.i.1.C.1.j. Centralized Processing for Rating and Authorization of Herbicide Claims

Centralized processing of the rating and authorization activities is required for certain herbicide claims. These include cases with
  • explicit or implicit claims of Republic of Vietnam (RVN)-based nautical service, and
    • no in-country service at a presumptive herbicide location, or
    • a previously denied claim based on no qualifying service
  • service in the RVN, and potential Nehmer applicability under 38 CFR 3.816, or
  • herbicide exposure through contaminated C-123 aircraft.
References: For more information on


2. Considering SC for Disabilities Associated With Service in the RVN

Introduction

This topic contains information on considering SC for disabilities associated with service in the RVN, including
  • SC for NHL under 38 CFR 3.313 based on service in the RVN during the Vietnam era, and
  • subcategories of NHL qualifying for presumptive SC.

Change Date

December 4, 2023

VIII.i.1.C.2.a. SC for NHL Under 38 CFR 3.313 Based on Service in the RVN During the Vietnam Era

VA regulations at 38 CFR 3.313 provide for a presumption of SC for NHL based on service in the RVN during the Vietnam era. Important: Reference: For more information on presumptive SC for NHL based on presumptive herbicide exposure, see

VIII.i.1.C.2.b. Subcategories of NHL Qualifying for Presumptive SC

When 38 CFR 3.313 was promulgated, the U.S. Center for Disease Control identified a number of subcategories that are manifestations of NHL.Extend the presumption of SC to a Veteran who claims SC for NHL if
  • the Veteran had service in the RVN during the Vietnam era, including naval service in the offshore waters of the RVN, and
  • the medical evidence shows a diagnosis of any of the subcategories of low, intermediate, or high-grade lymphoma listed in the table below.
Low Grade LymphomaIntermediate Grade LymphomaHigh Grade Lymphoma
Small lymphocytic with plasmacytoid featuresDiffuse, small and largeDiffuse, small and large
Small lymphocytic lymphoma and B-cell CLLNote: Small lymphocytic lymphoma and B-cell CLL are considered slightly different forms of the same disease.Diffuse, small cleavedLymphoblastic
Intermediate cellDiffuse, large cleavedImmunoblastic
Follicular, mixed small and largeDiffuse, large non-cleavedBurkitt’s
Mantle zoneDiffuse, large---
Follicular, small cleavedFollicular, large---
Waldenstrom’s macroglobulinemia------
Mycosis fungoidesReference: For more information on considering claims for SC for mycosis fungoides, see M21-1, Part V, Subpart iii, 10.4.c.------

3. Impact of Historical Herbicide Exposure Policies

Introduction

This topic contains information on the impact of historical herbicide exposure policies, including
  • overview of historical policies regarding herbicide exposure and nautical service, and
  • benefits previously awarded under historical policies.

Change Date

September 15, 2025

VIII.i.1.C.3.a. Overview of Historical Policies Regarding Herbicide Exposure and Nautical Service

The table below represents time periods during which VA had specific policies in place regarding concessions of herbicide exposure, including those based on nautical service.
Guidance Time PeriodExposure Policy
pre-Haas (1991-2002)Exposure conceded based on receipt of the Vietnam Service Medal (VSM).
2002Removed concession for VSM from M21-1 guidance.
April 2005 – August 2022Fact sheet regarding storage of Agent Orange on Johnston Island added to the M21-1. Exposure established on a factual basis.
Fast Letter (FL) 06-26 (December 11, 2006)All blue water Navy claims stayed based on the Haas decision.
Haas stay lifted, FL 09-07 (February 6, 2009)Exposure conceded based on review of military records for
  • inland waterways service of the RVN, or
  • service on a ship that docked, if the Veteran provided a lay statement of going ashore.
July 2009 – August 2022Facts-found concessions of herbicide exposure in Thailand based on M21-1 procedures.
Training Letter 10-06 (September 9, 2010)Concession based on categories of ships on the Navy and Coast Guard Ships Associated with Service in Vietnam and Exposure to Herbicide Agents, a.k.a., the Ships List.
Veterans Service Center Manager (VSCM) Call (January 2011)Ships List updated with Category IV, Ships operating on Vietnam’s close coastal waters for extended periods with evidence that crew members went ashore (lay statement of going ashore required).
VSCM Call (May 2011)Ships List updated with Category V, Ships operating on Vietnam’s close coastal waters for extended periods with evidence that smaller craft from the ship regularly delivered supplies or troops ashore (lay statement of going ashore required).
PL 116-23 (January 1, 2020)Definition of service in the RVN expanded to include eligible offshore waters. Use of the Ships List discontinued and replaced with VBA’s internal claims processing tools used to determine a ship’s location(s).
PACT Act (August 10, 2022)Expanded presumptive herbicide exposure to additional nautical locations by amending 38 U.S.C. 1116.

VIII.i.1.C.3.b. Benefits Previously Awarded Under Historical Policies

When reviewing initial or supplemental claims decided under historical herbicide exposure policies, do not
  • propose to sever SC for the disabilities previously awarded when the presumption of herbicide exposure was conceded under former policies, or
  • concede herbicide exposure for any newly claimed disabilities unless evidence is presented that otherwise establishes the Veteran’s exposure based on current evidentiary requirements.
Important:
  • Before deciding any initial or supplemental claim based on herbicide exposure, always apply the most current standards and definitions of qualifying service and review all available records.
  • The protection noted above applies to SC for the disability awarded based on a historical policy. Once a disability has been service-connected (SC), even erroneously, and protection has attached, then the Veteran is entitled to increased evaluations for the disability, to SC for secondary conditions, and to awards of individual unemployability based solely or partly on those SC conditions.
References: For more information on
  • protection of SC, see
  • new interpretations of the law and clear and unmistakable error, see
    • Berger v. Brown, 10 Vet. App. 166 (1997), and
    • Jordan v. Nicholson, 401 F.3d 1296 (Fed. Cir. 2005), and
  • blue water Navy Veterans and herbicide exposure, see Haas v. Peake, 535 F.3d 1168 (Fed. Cir. 2008).


4. Effective Date Determinations in Herbicide Exposure Claims

Introduction

This topic contains information on effective date determinations in herbicide exposure claims, including
  • maximizing benefits with effective date determinations in herbicide claims
  • effective dates based on herbicide exposure and CFR 3.156(c)
  • determining applicability of 38 CFR 3.156(c) or 38 CFR 3.114 for exposure to herbicides in Korea, and
  • examples of determining an effective date in a claim based on herbicide exposure in Korea.

Change Date

September 15, 2025

VIII.i.1.C.4.a. Maximizing Benefits With Effective Date Determinations in Herbicide Claims

When awarding SC for a disability based on presumptive herbicide exposure, different provisions allow for assignment of an effective date. In such cases, consider each effective date rule and assign the most advantageous effective date that applies for the facts of the case. Use the table below to determine which effective date rule may apply to an award of SC based on herbicide exposure.
If ...Then consider entitlement to an effective date under ...Reference
the Veteran38 CFR 3.816.Note: Do not apply 38 CFR 3.816 to herbicide claims that are awarded based on a new PACT Act provision.M21-1, Part VIII, Subpart i, 2.B
the claimant met all eligibility criteria for a benefit on the effective date of a liberalizing law change as detailed in M21-1, Part V, Subpart ii, 4.A.6.h38 CFR 3.114(a).M21-1, Part V, Subpart ii, 4.A.6
the claimant is entitled to retroactive payment of benefits based on PL 116-2338 U.S.C. 1116A.M21-1, Part VIII, Subpart i, 1.D.4
  • the claim was previously denied because available service records did not establish the Veteran had qualifying service, and
  • newly received service records establish service in a qualifying location
38 CFR 3.156(c).M21-1, Part VIII, Subpart i, 1.C.4.b-d
none of the above special provisions applyM21-1, Part V, Subpart ii, 4.A.

VIII.i.1.C.4.b. Effective Dates Based on Herbicide Exposure and CFR 3.156(c)

If a claim based on exposure to herbicides was previously denied because available service records did not establish the Veteran had qualifying service, decision makers must review any newly available service records to determine if new evidence of qualifying service exists. Reconsider the claim under 38 CFR 3.156(c) if newly received service records result in
  • presumption of herbicide exposure based on location of service, or
  • concession of herbicide exposure on a factual basis.
As stated in 38 CFR 3.156(c)(3), if the evidence now justifies the establishment of SC, the effective date will be the later of
  • the date entitlement arose, or
  • the date VA received the previously decided claim.
Notes:
  • The date entitlement arose may be either the
    • date the claimed disease was diagnosed (or symptoms became manifest according to medical evidence), or
    • the date the claimed presumptive disease was finalized as part of the presumptive list of herbicide exposure-related diseases in 38 CFR 3.309(e) or 38 U.S.C. 1116.
  • Decision makers must also consider other applicable effective date provisions as outlined in M21-1, Part VIII, Subpart i, 1.C.4.a.
Reference: For more information on developing claims based on herbicide exposure, see M21-1, Part VIII, Subpart i, 1.B.

VIII.i.1.C.4.c. Determining Applicability of 38 CFR 3.156(c) or 38 CFR 3.114 for Exposure to Herbicides in Korea

Effective dates based on a grant of SC for a disability associated with exposure to herbicides in the Korean demilitarized zone (DMZ) can be affected by liberalizing changes and/or receipt of additional service department records. Two liberalizing changes to the provisions of 38 CFR 3.307(a)(6)(iv) (as discussed more thoroughly in M21-1, Part VIII, Subpart i, 1.B.4.b) have been made to revise the applicable dates for the concession of exposure to herbicides for Veterans who served in specific designated units operating in or near the Korean DMZ. When a claim for SC associated with exposure to herbicides in Korea was previously denied, but entitlement to the benefit is now established based onReferences: For more information on

VIII.i.1.C.4.d. Examples of Determining an Effective Date in a Claim Based on Herbicide Exposure in Korea

Facts: The Veteran previously claimed and was denied SC for prostate cancer due to herbicide exposure in Korea. The Veteran was notified of the denial on July 18, 2010. The service records at that time showed that the Veteran served in a designated unit in the Korean DMZ, but the dates of service were in October to November 1970. The Veteran has submitted a supplemental claim for SC for prostate cancer due to herbicide exposure in Korea. Analysis: The liberalizing law change of February 24, 2011, expanded the applicable dates for presumption of exposure for Veterans who served in a designated unit in the Korean DMZ to include dates of service through August 31, 1971. Since the Veteran’s service in 1970 falls within the designated time period, SC is now warranted. Given that SC is warranted based on the liberalizing law change expanding the applicable time period associated with Korean service, apply 38 CFR 3.114 to assign an effective date one year prior to the date of receipt of the supplemental claim if all other criteria for applicability of this regulation are otherwise satisfied. Facts: The Veteran previously claimed and was denied SC for lung cancer due to herbicide exposure in Korea. The claim was received on March 12, 2015, and the Veteran was notified of the denial on August 22, 2015. The Veteran claimed to have been assigned on temporary duty orders to a designated unit in the DMZ during the spring of 1969. Development attempts were made for records of the Veteran’s assignments, and no evidence was received to verify the claimed service. In 2019, the Veteran submitted a supplemental claim with new and relevant evidence. Development for that claim revealed recently declassified records confirming that the Veteran was sent on temporary duty orders to a designated unit in the Korean DMZ in 1969. Analysis: Receipt of additional service records confirming service in a designated unit in the Korean DMZ in 1969 is sufficient to allow presumption of herbicide exposure under 38 CFR 3.307(a)(6)(iv). Assuming all other criteria are met, the prior denial of SC must be reconsidered and revised under 38 CFR 3.156(c). SC for lung cancer is warranted effective March 12, 2015.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart i, Chapter 1, Section C (U.S. government work, reproduced for reference). Browse all sections →