VA disability claims usually require evidence connecting a current condition to military service. Presumptive conditions are different because the VA recognizes the service connection when the applicable diagnosis and service requirements are met. For veterans with CPD, this can simplify the evidence needed to establish service connection, although medical records and service documentation are still required.
What is Considered to be a Presumptive Illness?
A presumptive illness is a condition the VA recognizes as service connected when specific eligibility requirements are met. Depending on the presumption, those requirements may involve where and when you served, a particular exposure, or when the condition developed after service.
Presumptive conditions include illnesses associated with burn pits and other toxic exposures, Agent Orange, radiation exposure, and Camp Lejeune water contamination.
Examples of Recognized Presumptive Illnesses
The VA recognizes many presumptive conditions based on qualifying military service or exposure. These include conditions covered by the PACT Act, Agent Orange presumptions, radiation exposure rules, and Camp Lejeune water contamination presumptions.
Examples include:
- PACT Act burn pit and toxic exposure conditions: COPD, asthma, chronic bronchitis, chronic rhinitis, chronic sinusitis, emphysema, pulmonary fibrosis, and certain cancers.
- Agent Orange-related conditions: Type 2 diabetes, hypertension, Parkinson’s disease, ischemic heart disease, MGUS, and certain cancers.
- Radiation exposure conditions: Certain cancers, leukemia, lymphoma, and multiple myeloma.
- Camp Lejeune water contamination conditions: Adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, non-Hodgkin’s lymphoma, and Parkinson’s disease.
The VA maintains a broader list of presumptive conditions with the service requirements that apply to each.
Does the PACT Act Presumption Apply to Your COPD?
COPD is one of the respiratory conditions covered by the PACT Act’s burn pit and toxic exposure presumptions. Whether the presumption applies to your claim depends on where and when you served.
Review your service records to determine whether your deployment location and dates fall within the VA’s covered service periods. If they do, your COPD may qualify for presumptive service connection. If they do not, you may still be able to pursue a standard service-connected disability claim, but you would need evidence establishing the connection between your COPD and military service.
Why Don’t Presumptive Illnesses Require Nexus Letters?
Presumptive conditions generally do not require a nexus letter because the VA already presumes a connection between the condition and qualifying military service.
For a standard disability claim, you usually need evidence showing a link between your current condition and an event, injury, illness, or exposure during service. A medical opinion may be used to establish that connection.
With a presumptive claim, that additional proof of causation is not required when you have a qualifying condition and meet the applicable service requirements. You still need evidence showing that you have the condition and that your military service qualifies for the presumption.
What Will You Need Instead?
Instead of a medical nexus letter, you need evidence showing that you have COPD, that your military service meets the requirements for the presumption, and how severe your condition is. Under 38 C.F.R. § 4.97 (Diagnostic Code 6604), the VA rates COPD at 10%, 30%, 60%, or 100%, depending on the severity of the condition.
Evidence may include:
- Service records: Your DD-214, personnel records, or deployment records can help establish that you served in a qualifying location during the applicable timeframe.
- A formal COPD diagnosis: Medical records from a qualified healthcare provider should document your current COPD diagnosis.
- Pulmonary function tests (PFTs): Test results may include FEV-1 (forced expiratory volume in one second), the FEV-1/FVC ratio, and DLCO (diffusing capacity), which the VA uses to evaluate COPD severity.
- Treatment records: Medical records documenting your symptoms, treatment, and any oxygen therapy can provide additional evidence of the severity of your COPD.
Can the VA Still Require a C&P Exam for Presumptive COPD?
While you may not need a nexus letter, this does not mean the VA will not request a Compensation and Pension (C&P) exam.
The VA may schedule an exam if it needs more information about your COPD or its severity before deciding your claim. If your existing medical records provide enough evidence, the VA may be able to review the claim without requiring an additional exam.
A C&P exam may include a review of your medical history and testing used to evaluate the severity of your COPD.
Next Steps to File Your Presumptive COPD Claim
To move forward with a presumptive COPD claim:
- Gather your evidence: Collect medical records documenting your COPD diagnosis and severity, including available PFT results, along with your DD-214 and other records showing where and when you served.
- Protect a potential effective date if needed: If you need more time to gather evidence before filing, submit VA Form 21-0966, Intent to File.
- File your claim: Submit VA Form 21-526EZ for a new disability compensation claim.
- Address a previous denial: If the VA previously denied your COPD claim and it now qualifies as presumptive, submit VA Form 20-0995 for a Supplemental Claim.
Contact us for help filing a COPD claim or challenging a previous denial.
