VA Radiation Exposure Presumptive Conditions: Atomic Veterans and PACT Act

Under 38 U.S.C. 1112(c) and 38 CFR 3.309(d), Congress established presumptive service connection for veterans who participated in radiation-risk activities during active military service. These service members, historically designated as Atomic Veterans, do not need to prove the specific dose of radiation received if they participated in a designated operation and developed an enumerated presumptive disease under 38 CFR 3.309(d).

Statutory radiation-risk activities include: onsite participation in atmospheric nuclear weapons tests (1945 to 1962); occupation of Hiroshima or Nagasaki, Japan (August 6, 1945, to July 1, 1946); internment as a prisoner of war in Japan during World War II; and participation in underground nuclear testing at the Nevada Test Site or Amchitka Island, Alaska.

The 2022 PACT Act significantly expanded radiation-risk activities to encompass three additional major response operations: (1) cleanup of Enewetak Atoll in the Marshall Islands from January 1, 1977, to December 31, 1980; (2) cleanup of the Palomares, Spain B-52 nuclear weapons accident from January 17, 1966, to March 31, 1967; and (3) response to the Thule Air Base, Greenland B-52 crash from January 21, 1968, to September 25, 1968.

Under 38 CFR 3.309(d), the VA recognizes specific presumptive conditions for veterans who participated in qualifying radiation-risk activities. These include leukemia (all forms except chronic lymphocytic leukemia), lymphomas (except Hodgkin disease), multiple myeloma, and primary cancers of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, liver (except if cirrhosis or hepatitis B is indicated), salivary gland, urinary tract, bone, brain, colon, and ovary, as well as bronchiolo-alveolar carcinoma and posterior subcapsular cataracts.

If a veteran was exposed to ionizing radiation during military service (such as in nuclear propulsion, medical radiography, or weapons maintenance) but did not participate in a designated statutory radiation-risk activity, the claim cannot proceed under the 38 CFR 3.309(d) presumption. Instead, under 38 CFR 3.311, the claim is evaluated as a radiogenic disease claim requiring a formal radiation dose assessment, often conducted by the Defense Threat Reduction Agency (DTRA), to determine whether the radiation dose was sufficient to produce the diagnosed disease.