What is the Medical Nexus Requirement?
As I wrote in a blog post in 2009, in order to receive service-connected compensation from the Department of Veterans Affairs (VA), a veteran must meet three criteria: the veteran must be suffering from a current disability diagnosed by a medical professional; there must be evidence in the military service records of a disease, injury, or event in service; and the veteran must show a nexus, or link, between the current disability and the in-service disease, injury or event.
What is “Presumptive” Service Connection?
In some cases, the veteran is not required to demonstrate the nexus or link between the current disability and the in-service disease, injury or event. Instead, the VA presumes that specific disabilities diagnosed in certain veterans were caused by their military service. The VA does this because of the unique circumstances of the military service of certain veterans. If one of the medical conditions listed below is diagnosed in a veteran in one of the groups shown on the table, the VA presumes that the circumstances of his/her service caused the medical condition or, in other words, the medical nexus is presumed, and disability compensation can be awarded.
What Conditions are “Presumed” to be Caused by Military Service?
Entitlement to disability compensation benefits is presumed for veterans in the groups identified below who suffer from the medical conditions shown.
Prisoners of War
|Vietnam Veterans |
|Atomic Veterans |
(Exposed to Ionizing Radiation)
|Gulf War Veterans
|(1) Veterans imprisoned for any length of time who are at least 10% disabled and suffer from one of the following medical conditions: |
• any of the anxiety states
• dysthymic disorder
• organic residuals of frostbite
• post-traumatic osteoarthritis
• heart disease or hypertensive vascular disease and their complications
• stroke and its residuals
(2) Veterans imprisoned for at least 30 days, who are at least 10% disabled, and suffer from one of the following medical conditions:
• chronic dysentery
• malnutrition (including optic atrophy)
• any other nutritional deficiency
• irritable bowel syndrome
• peptic ulcer disease
• peripheral neuropathy
• cirrhosis of the liver
|Veterans who served in the Republic of Vietnam between 1/9/62 and 5/7/75 and suffer from one of the following medical conditions: |
• chloracne or other acneform disease similar to chloracne*
• porphyria cutanea tarda*
• soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma or mesothelioma)
• Hodgkin's disease
• multiple myeloma
• respiratory cancers (lung, bronchus, larynx, trachea)
• non-Hodgkin's lymphoma
• prostate cancer
• acute and subacute peripheral neuropathy*
• type 2 diabetes
• chronic lymphocytic leukemia
*Must become manifest to a degree of 10% or more within one year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service.
|Veterans who participated in atmospheric nuclear testing; POWs in Hiroshima or Nagasaki; veterans who served before 2/1/92 at a diffusion plant in Paducah, KY, Portsmouth, OH, or Oak Ridge, TN; or veterans who served before 1/1/74 at Amchitka Island,AK; and suffer from one of the following medical conditions: |
• all forms of leukemia (except for chronic lymphocytic leukemia)
• cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary tract (kidneys, renal pelves, ureters, urinary bladder and urethra), brain, bone, lung, colon, ovary
• bronchiolo-alveolar carcinoma
• multiple myeloma
• lymphomas (other than Hodgkin's disease)
• primary liver cancer (except if cirrhosis or hepatitis B is indicated)
|Veterans who served in the Southwest Asia Theater of Operations during the Gulf War, are at least 10% disabled by 12/31/11, and suffer from one of the following medical conditions:
• chronic fatigue syndrome
• irritable bowel syndrome
• any diagnosed or undiagnosed illness that the Secretary of Veterans Affairs determines warrants a presumption of service connection
Included are medically unexplained chronic multi-symptom illnesses defined by a cluster of signs or symptoms that have existed for 6 months or more. Signs or symptoms of an undiagnosed illness include: fatigue, skin symptoms, headaches, muscle pain, joint pain, neurological symptoms, respiratory symptoms, sleep disturbance, GI symptoms, cardiovascular symptoms, weight loss, menstrual disorders
In addition to the above, veterans with continuous service of 90 days or more who are diagnosed with amyotrophic lateral sclerosis ((ALS)/Lou Gehrig’s disease) at any time after discharge or release from active service are presumed to have established service connection for the disease.