participation is confirmed, DTRA provides the VARO with a report of the dose assessment. The report includes an external photon dose with upper bound and an external neutron dose if applicable, internal doses to the target organs corresponding to the radiogenic diseases identified in the VA claim, and skin dose and eye dose if applicable. Those doses account for all emissions of alpha, beta, gamma, and neutron radiation from all sources to which the veteran was exposed. A copy of the DTRA response is provided to the claimant.

The VARO sends the claim and DTRA dose assessment to the Compensation and Pension (C and P) Service of the Veterans Benefits Administration in Washington, DC, for an advisory opinion. The C and P Service asks the Office of Public Health and Environmental Hazards (OPHEH) of the Veterans Health Administration for a medical opinion of the likelihood that the veteran’s radiation exposure caused his radiogenic disease(s). For each disease, OPHEH considers the upper bound dose to the target organ, age or approximate age at exposure and at diagnosis, family and employment history, and exposure to other toxicants and carcinogens before and after military service.

Thereafter, using DTRA-reported upper-bound doses, OPHEH applies probability of causation methods, such as those based on radioepidemiological tables issued by the National Institutes of Health (NIH) (see Section III.E). Those methods are supplemented by information from other scientific or medical sources and consideration of other factors to evaluate whether it is at least as likely as not that the claimed disease(s) resulted from the reported radiation doses. OPHEH returns the case to the C and P Service with its medical opinion on the claim.

The C and P Service reviews the medical opinion from OPHEH and all the evidence of record and issues an advisory opinion to the VARO. The C and P Service notes whether, according to the regulations, the veteran’s disability from the specific diseases is the result of his military service activities.

The VARO informs the claimant about the outcome of the claim. If the claim is granted, the VARO pays compensation based on the current degree of disability resulting from the covered diseases.

Whenever a claim is denied by VA, and the veteran or other claimant believes that VA did not make a good decision because it did not review all the evidence or did not apply the law correctly, the claimant has the right to appeal a decision made by a VARO or medical center. Claimants may appeal a complete or partial denial of a claim or the amount of benefit granted.

III.C CLAIMS FILED UNDER PRESUMPTIVE REGULATION

To initiate a claim under the presumptive regulation (38 CFR 3.309), a person must file a claim for disability compensation with the VARO serving his geographic area. A VA claim under this regulation does not require the claimant to obtain prior confirmation of participation from DTRA. The claimant must furnish medical evidence of a radiogenic disease listed in 38 CFR 3.309(d). The



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