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Appendix F
Tables: Summary of Presumptive Disability Decision-Making Legislative History



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Appendix F Tables: Summary of Presumptive Disability Decision-Making Legislative History F-1

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F-2 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS TABLE F-1 Summary of PDDM Legislative History (by Date) Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information Within 2 years On or after April 6, Disease contracted August 9, Veterans’ Bureau. Chronic Diseases: after separation 1917 during active 1921 Public Law 67-47. • Neuropsychiatric disease from active military service 1921. 67th Cong., [later called psychoses] military or Or 1st Sess. Ch. 57, • Tuberculosis, pulmonary naval service Discharged or Sec. 18, 42 Stat. (active) [March 4, 1923 resigned active 147, 153 Act expanded the Characteristic service on or before presumption to include all manifestations of November 11, 1918 forms of active the disease to 10 tuberculosis] percent or more Internal Chronic Within 1 year after November 12, November Chronic Constitutional Memorandum constitutional the date of 1921, stated 12, 1921 Diseases: implementing disease contracted separation from connection to • Anemia (primary) Veterans’ Bureau during active service active military • Arteriosclerosis Regulation No. 11 military service service • Beriberi • Diabetes insipidus And • Diabetes mellitus Office Constitutional December 2, • Endocrinopathies Memorandum No. diseases were 1921 • Gout 36 defined on • Hemochromatosis December 2, 1921 • Hemoglobinuria (paroxysmal) • Hemophilia • Hodgkin’s disease • Leukemia (all types) • Ochronosis • Pellagra • Polycythemia (erythremia) • Purpura • Rickets • Scurvy

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APPENDIX F F-3 Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information By January 1, Between April 6, Disease contracted June 7, 1924 World War Chronic Diseases: 1925 1917, and July 2, during active Veterans’ Act, • Dysentery (amebic) 1921 military or naval 1924. Public Law (tropical disease added Characteristic service 68-242. 68th as chronic disease) manifestations of Or Cong., 1st Sess. • Encephalitis lethargica the disease to 10 Discharged or Title II. • Neuropsychiatric disease percent or more resigned prior to Compensation and • Paralysis agitans July 2, 1921 Treatment. • Tuberculous (active) Ch. 320, Sec. 200, Or 43 Stat. 607, 615 Discharged or resigned on or before November 11, 1918, or on or after July 2, 1921 Amends list of Characteristic Disease contracted During World War 1925 Veterans’ Bureau Constitutional Diseases: constitutional manifestation during military or I Schedule for • Arthritis (deformans and diseases within 1 year from naval services in Rating Disabilities chronic) date of separation the World War I (based upon the • Carcinoma, sarcoma, and from active service WW Veterans other tumors Or Act, 1924) • Cardiovascular-renal If medical disease, including evidence hypertension affirmatively • Endocarditis, chronic establishes • Leprosy (tropical disease conclusive service added as a chronic connection after 1 disease) year of separation • Myocarditis, chronic • Nephritis, chronic forms (was not carried forward, • cholecystitis, chronic, proceeding to gall-stone formation

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F-4 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information • nephrolithiasis • valvulitis, chronic) Establishes November 2, Veterans’ Bureau Manifest within 6 • Ulcers (gastric or service 1928 Schedule of months from duodenal) connection for Disability discharge from ulcers Ratings, military service Extension 6 and shown present within 1 year after discharge Amends list of April 12, Executive Order Chronic Diseases Tuberculosis: chronic diseases Manifest to a 1933 6089. Instruction • Epilepsies and presumption degree of 10 No. 2, • Organic diseases of the of tuberculosis percent within 1 Implementing nervous system Carried forward year of discharge; Vet. Reg. No. 1. prior second-year April 12, 1933 presumptions of diagnoses chronic diseases presumptive if at 6 except rickets, months for obesity, acidosis, minimal cases, 9 months for beriberi, chronic moderately cholecystitis, advanced cases, diabetes and 12 months for insipidus, gout, far advanced cases hemophilia, hemochromat- osis, hemoglobinuria, nephrolithiasis, ochronosis, pellagra, purpura, scurvy, polycythemia (erythremia), and chronic valvulitis

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APPENDIX F F-5 Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information August 14, Executive Order Amends list of Chronic Diseases: 1935 6089. Instruction chronic diseases • Osteitis deformans No. 2-A, (Paget’s disease) Implementing Vet. Reg. No. 1. August 14, 1935 December VA Circular No. Disease contracted Within 1 year after Tropical Diseases: 28, 1945 8, section I during active separation of • Malaria active service military service Relapses of Within 1 year after January 3, Disability ratings Disease contracted Service in the Tropical Diseases: malaria (after the separation of tropics or a place 1947 for malaria and during wartime • Dysentery (amebic, 1 year separation) active wartime having a high chronic diseases service bacillary) need others, under service incidence of the characteristically • Filariasis (Bancroft’s oath to establish disease under tropical in origin. type) frequency of consideration Veterans • Leishmaniasis (including relapse over a Administration kala-azar) period of time Technical Bulletin • Malaria relating back to 8-6. Washington, • Schistosomiasis the 1-year period DC: VA • Trypanosomiasis following • Yaws discharge At least 6 months Chronic Diseases: Disease contracted June 24, Act of June 24, of service and during active 1948 1948. Public Law • Anemia (primary) honorably service 80-748. 80th • Arteriosclerosis discharged Cong., 2d Sess. • Arthritis Within 1 year after Ch. 612, Sec. 1, • Bronchiectasis separation from 62 Stat. 581 • Calculi of the kidney, active service or at bladder, or gall bladder a time when • Cardiovascular-renal standard and disease (hypertension, accepted treatises myocarditis, Buerger’s indicate that the disease, Raynaud’s incubation period disease)

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F-6 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information thereof • Cirrhosis of the liver commenced during • Coccidioidomycosis active service • Diabetes mellitus • Encephalitis lethargica residuals • Endocarditis • Endocrinopathies • Epilepsies • Hodgkin’s disease • Leukemia (nephritis) • Organic diseases of the nervous system (tumors of the brain, cord, peripheral nerves) • Osteitis (deformans) • Osteomalacia • Peptic ulcers (gastric or duodenal) • Scleroderma • Tuberculosis (active) • Tumors (malignant) Tropical Diseases: • Black water fever • Cholera • Dracontiasis • Dysentery • Filariasis • Leishmaniasis • Leprosy • Loiasis • Malaria • Onchocerciasis

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APPENDIX F F-7 Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information • Oroya fever • Pinta • Plague • Schistosomiasis • Yaws • Yellow fever February 9, Pensions, Disease contracted Wartime service Within 1 year after Chronic Diseases: Factual Basis: 1949 bonuses, and separation from Established by during military prior to January 1, • Anemia (primary) veterans’ relief. active wartime medical evidence, service 1947, to July 25, • Arteriosclerosis Part 3: Veterans’ service competent lay 1947 • Arthritis claims; evidence, or both • Atrophy, progressive Within 1 year after miscellaneous Tropical Diseases: muscular the date prior to amendments. Service in the Pulmonary • Brain hemorrhage which a disability tropics or a place Federal Register Tuberculosis: • Brain thrombosis must have been 14(26):568-578. having a high Specific • Bronchiectasis incurred incidence of the Former 39 CFR assumptions for • Calculi of the kidney, disease under Sec. 3.80; Sec. diagnosis in bladder, or gall bladder consideration 3.86(a), 3.95 second year after Chronic Disease: • Cardiovascular-renal Manifestations service disease (hypertension) sufficient to Ulcer (peptic): • Cirrhosis of the liver identify the disease Within 6 months • Coccidioidomycosis entity and from date of active • Diabetes mellitus sufficient service or within 6 • Encephalitis lethargica observations to months of July 25, residuals establish 1947; or if more • Endocarditis chronicity at the than 6 months, then • Endocrinopathies time evidence of continuity of • Epilepsies characteristic Tropical Disease: • Hodgkin’s disease When shown to symptoms during • Leprosy exist at a time the first 6 months • Leukemia (nephritis) when standard and after termination of • Myasthenia gravis accepted treatises active service • Myelitis indicate that the • Myocarditis

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F-8 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information incubation period • Nephritis of the diseases • Organic diseases of the commenced during nervous system active service • Osteitis (deformans) • Osteomalacia Characteristic • Palsy, bulbar manifestations of • Paralysis agitans the disease to 10 • Peptic ulcers (gastric or percent or more, duodenal) except pulmonary • Psychoses tuberculosis • Raynaud’s disease • Scleroderma • Sclerosis (amyotrophic lateral, multiple) • Syringomyelia • Thromboangiitis Obliterans (Buerger’s disease) • Tuberculosis (active) • Tumors (malignant) of the brain or spinal cord or peripheral nerves Tropical Diseases: • Black water fever • Cholera • Dracontiasis • Dysentery • Filariasis • Leishmaniasis • Leprosy • Loiasis • Malaria

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APPENDIX F F-9 Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information • Onchocerciasis • Oroya fever • Pinta • Plague • Schistosomiasis • Yaws • Yellow fever October 12, Pensions, Military service Amends list of Chronic Diseases: 1949 bonuses, and Pupura idiopathic chronic diseases veterans’ relief. (hemorrhagic) Part 3: Veterans’ claims; miscellaneous amendments. Federal Register 14(197):6174- 6180. Former 38 CFR Sec. 3.86(a) August 31, Pensions, Disease contracted See Veterans See Veterans Added to list of Chronic Disease: 1950 bonuses, and Sarcoidosis during military Regulation 1 (38 Regulation 1 (38 chronic and veterans’ relief. service USC Ch. 12) USC Ch. 12) tropical diseases Part 3: Veterans’ Tropical Disease: claims; Amebiasis miscellaneous amendments. Federal Register 15(169):5902- 5910. Former 38 CFR Summarizes Veteran who Disease contracted June 17, Veterans’ Benefits Tropical Chronic and Tropical previous rules and engaged in combat during active 1957 Act of 1957. Diseases: Diseases: legislation and Serves 6 months or with the enemy in military, naval, or Same diseases as above three Public Law 85-56. amends more and contracts active service with air service entries (1949 and 1950 Sec. 301. 85th

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F-10 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information tropical or disease dates/location of Cong., 1st Sess. entries) a military, naval, or because of therapy service and Sec. 301(3 and 4). air organization of in connection with presumption 71 Stat. 83, 95 the U.S. during a tropical disease period of war, campaign, or Within 1 year after expedition separation from active service or Period of service when standard and after November 11, accepted treatises 1918, and before indicate incubation July 2, 1921, if period served after April 5, 1917, and before November 12, 1918 Psychosis: WWII or Korean Period after service within 2 December 31, years after 1946, and before discharge or July 26, 1947, if release and before period began before July 26, 1949 January 1, 1947 (WWII) or February 1, 1957 (Korean) Lays out criteria Disease contracted February 24, Disease subject to Chronic and Tropical for presumption during active 1961 presumptive Diseases: wartime service Same as June 17, 1957 military, naval, or service connection for air service connection. chronic or Federal Register tropical disease 26(36):1581-1582 Factual Basis: May be established by medical evidence,

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APPENDIX F F-11 Legislation or Etiology of Location/Date of Presumptive Additional Date Regulation Presumptive Disease Disease Service Period Information competent lay evidence or both Service Detained or Held by Imperial August 12, Public Law 91- Active military, Former Prisoner of War connection interned for not Japanese 1970 376. Sec. 3. 91st naval, or air Associated Diseases: presumption for less than 6 months Government or the Cong., 2d Sess., service and was • Avitaminosis former prisoners German 1970. Sec 3. 84 held prisoner of • Beriberi (including of war Characteristic Government during Stat. 787, 788 war beriberi heart disease) manifestations of World War II, • Chronic dysentery the disease (except Government of • Helminthiasis psychosis) to 10 North Korea during • Malnutrition (including percent or more the Korean conflict, optic atrophy associated after service or the Government with malnutrition) of North Vietnam, • Other nutritional or the Viet Cong Psychosis: deficiency during the Vietnam Characteristic • Pellagra era manifestations of • Psychosis the disease to 10 percent or more within 2 years after separation from service Service of 90 days Active service December 1, Pensions, Chronic Diseases: Diseases Associated with Manifest to a or more during a 1970 bonuses, and Former Prisoners of War degree of 10 war period on or veterans’ relief. Former Prisons percent or more after January 31, Part 3: Chronic and Tropical of War: within 1 year for 1955 Held by an enemy Adjudication. Diseases Hansen’s disease government or its Subpart A: (leprosy) and agents during Pension, tuberculosis WWII, Korean compensation, within 3 years; conflict, or the and dependency multiple sclerosis Vietnam era, and indemnity within 7 years suffered from compensation. from date of dietary Federal Register separation from deficiencies, 35(232):18280-

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F-122 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information the Arabian Sea, active service in • Neurologic signs or the Red Sea, and the Southwest symptoms the airspace Asia theater of • Neuropsychological above these operations during signs or symptoms locations the Persian Gulf • Signs or symptoms War involving skin Compensation for February 3, Final rule for • Signs or symptoms certain 1995 undiagnosed involving the undiagnosed illnesses during respiratory system illnesses. Final service in the (upper or lower) rule. Federal Persian Gulf War • Sleep disturbances Register 60(23):6660- 6666. 38 CFR Part 3 Interim rule to April 29, Compensation for Persian Gulf War Interim rule expand the period 1997 certain service extending the within diseases must undiagnosed period of disease manifest illnesses. Interim to manifest from rule with request “two years after for comments. the date on which the veteran last Federal Register 62(82):23138- performed active 23139. military, naval, or 38 CFR Part 3 air service in the Southwest Asia theater of operations during the Persian Gulf War” to “December 31, 2001” Compensation for March 6, Extend the Final rule for certain 1998 presumptive extending the

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APPENDIX F F-123 Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information undiagnosed period (to presumptive period illnesses. Final December 31, for Persian Gulf rule. Federal 2001) in such a veterans manner that no Register 63(44):11122- Persian Gulf 11123. veterans with 38 CFR Part 3 qualifying disabilities would be denied compensation (no specific dates) Extension of December Military service Veterans Persian Gulf Persian Gulf Chronic • presumptive period 27, 2001 Vietnam Veteran Education and Exposure Exposure: multisymptom for respiratory Active duty in the active service Benefits Additional illness: cancers and Diseases: “On Armed Forces in Expansion Act of chronic fatigue additional diseases September 30, the Southwest 2001. Public Law Persian Gulf syndrome, associated with 2011” Asia theater of 107-103. 107th Exposure: fibromyalgia, and herbicide exposure operations during Persian Gulf War Cong., 1st Sess. irritable bowel and Persian Gulf the Persian Gulf service active syndrome exposure War military, naval, or air service Amended list of diseases associated with military service, Persian Gulf War Extension of Undiagnosed Veteran who Persian Gulf War November 9, Extension of the presumptive period illness manifest to served on active active military, naval, 2001 presumptive for compensation a degree of 10 duty in the or air service period for for Gulf War percent or more Southwest Asia compensation for veteran’s through theater during the Gulf War undiagnosed December 31, Persian Gulf War veterans’ illnesses 2006 undiagnosed illnesses. Interim

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F-124 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information final rule with request for comments. Federal Register 66(218):56614- 56615. 38 CFR Part 3 Extension of the December Southwest Asia Through Extends the period presumptive 27, 2002 theater of December 31, within which period for operations during 2006 disabilities must compensation for the Persian Gulf become manifest for Gulf War War entitlement for veterans’ compensation undiagnosed illnesses. Final rule. Federal Register 67(249):78979- 78980. 38 CFR Part 3 June 10, Amends what a Compensation 2003 “qualifying chronic and pension disability” includes provisions of the Veterans Education and Benefits Expansion Act of 2001. Final Rule. Federal Register 68(111):34539- 34543. 38 CFR Parts 3 and 13

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APPENDIX F F-125 Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information Through Extends the period Extension of the December Southwest Asia December 31, within which presumptive 18, 2006 theater of 2011 disabilities must period for operations during become manifest for compensation for the Persian Gulf entitlement for Gulf War War compensation veterans. Interim final rule. Federal Register 7(242):75669- 75672. 38 CFR Part 3 Approved Active duty in the Southwest Asia Medical or 38 USC § 1117 February 27, Armed Forces during theater during the scientific 2006 the Persian Gulf War Persian Gulf War evidence and historical treatment of manifestation periods that have been established Within a period Service in the 38 USC § 1118 Approved Association with (if any) that is Armed Forces in February 27, exposure to a prescribed in a the Southwest 2006 biological, chemical, regulation Asia theater of or other toxic agent, operations during environmental or the Persian Gulf wartime hazard, or War preventive medicine or vaccine Chronic disabilities Manifest either 38 CFR 3.317 Southwest Asia for a period of 6 during active theater during the months or more or military, naval, or Persian Gulf War intermittent air service or to a episodes of degree of 10 Southwest Asia improvement and percent or more theater includes

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F-126 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information not later than worsening over a 6- Iraq, Kuwait, December 31, month period Saudi Arabia, 2006 neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, United Arab Emirates, Oman, Gulf of Aden, Gulf of Oman, Persian Gulf, Arabian Sea, Red Sea, and air space above these locations Veteran who October 21, Establishes service Persian Gulf War Language for the served on active 1998 connection for Veterans Act of National Academy of duty in the illnesses associated 1998. Public Law Sciences report for Southwest Asia with the Persian Gulf 105-277. 105th presumption of service theater during the War Cong., 2d Sess., connection for illnesses Persian Gulf War Sec. 1601, 1602, associated with service in Diseases having an 1603 the Persian Gulf War association with exposure to a biological, chemical, or other toxic agent, environmental or wartime hazard, or preventive medicine or vaccine Diseases Associated with Radiation-Risk Activity Diseases specific August 8, Radiation-risk activity Total of at least Amends list of • Cancer of the bone to radiation- 2001 250 days before diseases associated • Cancer of the brain exposed veterans. Ionizing radiation February 1, 1992 with radiation-risk

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APPENDIX F F-127 Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information activities and (Paducah, KY; Proposed rule. • Cancer of the colon date/location of Portsmouth, OH; Military service Federal Register • Cancer of the lung service K25 at Oak 66(153):41483- • Cancer of the ovary Ridge, TN) 41485. 38 CFR Part 3 Diseases specific January 25, Radiation-risk activity Service before Amends definition to radiation- 2002 Definition: January 1, 1974 of radiation-risk exposed veterans. Participation in a test (Amchitka Island, activity Final rule. involving atmospheric AL) and detonation of a nuclear performance of Federal Register device; duty related to 67(17):3612- occupation of Long Shot, 3616. Hiroshima or Milrow, or 38 CFR Part 3 Nagasaki, Japan Cannikin (August 6, 1945, to underground July 1, 1946); or nuclear tests internment as a prisoner of war in Japan or service on active duty in Japan following such internment during WWII with opportunity for exposure to ionizing radiation Amended December Radiation-risk activity Veterans Benefits “radiation-risk 10, 2004 Improvement Act activity” to include Ionizing of 2004. Public service in a capacity Law 108-454. if performed as an Military service 108th Cong., 2d employee of the Sess., Sec. 306. DOE would qualify 118 Stat. 3598 inclusion as a

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F-128 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information member of the Special Exposure Cohort Diseases or Death NOT Associated with Military Service April 6, 2001 Active military, naval, Veterans’ use of Disease attributable to Claims based on or air service tobacco products are use of tobacco products the effects of NOT considered to tobacco products. be service Final rule. connected Federal Register 66(67):18195- 18198. 38 CFR Part 3 Miscellaneous 38 USC § 101 Approved Definitions: February 27, Veteran 2006 Spanish-American War World War I World War II Korean conflict Armed Forces Veteran of any war Service-connected Non-service-connected Active duty Active duty for training Inactive duty training Active military, naval, or air service Former prisoner of war Reserve Vietnam era Persian Gulf war

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APPENDIX F F-129 Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information Death 38 USC § 108 Approved 7-year absence February 27, 2006 38 USC § 501 Approved Secretary has authority to February 27, prescribe rules and 2006 regulations to carry out laws administered by the VA 38 USC § 1110 Approved Entitlement to February 27, compensation for 2006 disability resulting from diseases contracted in line of duty in the active military, naval, or air service, during a period of war 38 USC § 1111 Approved Presumption of sound February 27, condition at the time of 2006 examination, acceptance, and enrollment into service Aggravation to a 38 USC § 1153 Approved Increase in disability preexisting injury or February 27, during active military, disease 2006 naval, or air service, unless the increase is due to the natural progress of the disease Veteran’s service 38 USC § 1521 Approved Active military, naval, Service requirements for non- February 27, or air service requirements: service-connected 2006 • 90 days or disability more during a period of war • Period of war

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F-130 IMPROVING THE PRESUMPTIVE DISABILITY DECISION-MAKING PROCESS FOR VETERANS Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information and was discharged or released for a service- connected disability • 90 consecutive days or more and began or ended during a period of war • Aggregate of 90 days or more in two or more separate periods of service during more than one period of war Secretary may Guidelines for 38 CFR 1.18 Former prisoners of May give a establish a establishing presumptions war minimum presumption of of service connection for duration of service connection former prisoners of war detention or for a disease when internment for there is at least application of the limited/suggestive presumption evidence that an increased risk of Defines such disease is “evidence” associated with

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APPENDIX F F-131 Legislation or Location/Date of Presumptive Additional Presumptive Disease Regulation Date Etiology of Disease Service Period Information service involving detention or internment as a prisoner of war and an association between the two is biologically plausible 38 CFR 3.310 Service-connected Secondary condition amputation of one established as service lower extremity at or connection of the original above the knee or condition service-connected • Cardiovascular amputations of both disease for service- lower extremities at or connected above the ankles amputation

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