gland and urinary tract were added in 1992 and bronchiolo-alveolar carcinoma was included in 1999. Finally, in 2002, cancer of the bone, brain, colon, lung, and ovary were added, bringing the total number of cancers considered radiogenic under the presumptive law to 21 (VA, 2002).

The various laws are implemented in Title 38, Code of Federal Regulations, Part 3 (38 CFR Part 3). The regulations authorize the VA to provide medical care and pay compensation benefits to confirmed test participants and dependence and indemnity compensation to certain survivors. A veteran seeking compensation can file a claim with VA. To resolve claims, VA uses one of two processes, depending on the specific type of disease being claimed. Under 38 CFR 3.309, if the veteran was a confirmed participant and has one of the 21 cancers presumed to be radiogenic, the veteran is eligible to receive compensation regardless of dose. Throughout this report, we refer to that situation as “presumptive.”

The second regulation governing the claims process is described in 38 CFR 3.311. It applies to diseases that are not presumed to be caused by radiation exposure but could be linked to radiation if the veteran’s dose was high enough. Alternatively, the veteran can supply evidence that the condition can be caused by radiation, that is, is a radiogenic disease. We refer to that type of claim as “nonpresumptive.” Such a claim is used for veterans with all other forms of cancer and some nonmalignant ailments: tumors of the central nervous system, nonmalignant thyroid disease, posterior subcapsular cataract, and parathyroid adenoma. The process relies on estimating the radiation dose received and evaluating the probability that the disease was caused by the exposure. Under the nonpresumptive regulation, if a veteran’s claim of presence at a nuclear test cannot be verified but the government cannot prove that the veteran was elsewhere at the time, it must be assumed that the veteran was present. The regulation also requires that in assessing a dose, the veteran must be given the benefit of the doubt if information needed to determine the dose is inconclusive or unavailable. The principle of benefit of the doubt is discussed in Section I.C.3.2.

It has happened that a claim was filed under the presumptive regulation but the veteran’s presence at a nuclear test could not be verified, so the veteran was not eligible for compensation under that regulation. In such a case, however, the veteran’s claim can be evaluated under the nonpresumptive regulation.

The laws governing compensation for atomic veterans have continued to change over nearly two decades. There have been advances in the science and tools available for administering the program and for estimating doses. Additional records have also come to light over the years. These changes are reflected in changes to the dose reconstruction process noted by the committee during its review.

I.B.5 Objectives of the NTPR Program

DTRA continues to administer the NTPR program for DOD. VA is responsible for making decisions about awarding claims. The primary function of the

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