Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a devastating neurological condition that affects motor neurons, causing muscle weakness, paralysis, and eventually, the inability to speak, eat, or breathe independently. Every year, approximately 5,000 to 6,000 people are newly diagnosed with ALS. Many of these diagnoses impact veterans significantly due to their higher incidence rate in developing ALS when compared to civilians. Recognizing this profound impact, the VA ALS System of Care provides some of the most comprehensive support available for veterans battling ALS.
ALS Diagnosis and Military Service
Research has consistently demonstrated that veterans are up to twice as likely as civilians to receive an ALS diagnosis. While the exact cause remains unclear, military service appears to significantly contribute due to unique exposure factors. Military environments combine a variety of collective hazards including pollutants from unregulated industries, particulate matter from desert regions, exhaust from military vehicles and aircraft, emissions from open-air burn pits, and toxic substances prevalent on military bases.
Veterans may also face exposure to highly dangerous substances like lead, pesticides, dioxins, and aerosolized cyanobacteria, particularly during the Gulf War era. Additionally, soldiers often received prophylactic treatments with cholinergic inhibitors intended as protection against nerve gas and insect pests; these inhibitors have since been associated with neurodegenerative diseases, potentially including ALS.
Research has identified numerous exposures strongly associated with ALS. Specifically, treatments involving nasopharyngeal radium, the application or mixing of herbicides or burning agents, ground-level fumigation, proximity to missile explosions, exposure to chemical agent-resistant compound paints, and depleted uranium used in munitions or armor were found to have notably elevated odds ratios (greater than 3), indicating a substantially increased ALS risk.
Given the overwhelming evidence linking ALS to these military-specific exposures, the VA recognizes ALS as presumptively service-connected regardless of a Veteran’s particular circumstances, ensuring comprehensive and rapid support for veterans affected by this devastating disease.
Exposure to Diesel and Jet Exhaust
Research has shown that prolonged exposure to diesel exhaust increases the risk of developing ALS. Truck drivers, mechanics, and other workers in industries with high diesel exhaust exposure have demonstrated higher rates of neurological conditions, including ALS. Military personnel operating in environments with constant exposure to diesel exhaust—such as those working with military transport vehicles, tanks, and aircraft support equipment face similar risks.
Likewise, service members working near jet engines are exposed to jet emissions that contain hazardous pollutants. Studies indicate that Air Force veterans experience higher rates of ALS compared to their counterparts in other military branches. This suggests a correlation between jet exhaust exposure and neurological diseases. Jet emissions release fine particulate matter, carbon monoxide, and volatile organic compounds, which can penetrate deep into the lungs and bloodstream, potentially triggering inflammatory and neurodegenerative processes.
While diesel and jet exhaust exposure are commonly linked to respiratory and cardiovascular diseases, emerging research points to their role in neurological conditions. The presence of oxidative stress, chronic inflammation, and long-term exposure to neurotoxic pollutants in these emissions is suspected to play a significant role in ALS development.
Given the high exposure levels in military settings where personnel frequently work around idling vehicles, aircraft, and confined spaces, veterans should be aware of the potential long-term neurological risks associated with these toxins. Those experiencing early symptoms of ALS, such as muscle weakness, difficulty speaking, or respiratory problems, should seek immediate medical evaluation and document their service-related exposure for VA claims.
ALS and Burn Pits
Burn pits were widely used by the military particularly in Southwest Asia to dispose of waste by open-air burning. These pits typically utilized JP-8 fuel, a kerosene-based accelerant, and burned various types of waste materials such as plastics, metal cans, rubber, paints, solvents, petroleum products, munitions, medical waste, human waste, and wood waste.
The emissions from these burn pits contained hazardous particles and toxic substances including dioxins, furans, particulate matter, volatile organic compounds, and heavy metals. Exposure to burn pit emissions has raised significant health concerns due to their documented associations with respiratory illnesses, cancers, and neurological disorders, notably ALS.
Many veterans deployed in regions with extensive burn pit usage, such as Iraq and Afghanistan, have reported serious chronic health problems, prompting widespread advocacy efforts and legislative actions to ensure affected veterans receive appropriate care and compensation.
ALS and the Gulf War
After the 1990–1991 Persian Gulf War, studies were conducted following reports of unusually high rates of ALS diagnoses among Gulf War veterans, especially for younger veterans typically below the average age for ALS onset.
One extensive study involving nearly 2.5 million active-duty military personnel at the time of the Gulf War found that those deployed to the Gulf region were nearly twice as likely to develop ALS compared to non-deployed personnel. Furthermore, the increased risk was noted across all military branches, although the Army and Air Force personnel demonstrated the greatest risk.
Additional research confirmed significantly higher ALS incidence rates among Gulf War veterans during a specific 10-year window following deployment, potentially highlighting the effects of critical toxic exposures or combinations of multiple risk factors. 85% of Gulf War veterans diagnosed with ALS within this period were younger than 45, considerably lower than the average ALS onset age of 60 in the general population. This data suggests that military exposures in the Gulf War were likely more frequent and intense, accelerating ALS development compared to typical civilian cases.
ALS in Recent Veterans
An increased risk of ALS has been documented among veterans of other conflicts beyond the Gulf War. A 2019 study indicated that veterans deployed to post-9/11 conflicts were diagnosed with ALS at higher rates compared to Gulf War veterans. This suggests that despite advances in protective measures, modern military service continues to expose personnel to environmental hazards that significantly increase the risk of neurological diseases.
The study also highlighted that service members deployed in post-9/11 conflicts faced a greater likelihood of developing ALS compared to their non-deployed counterparts. Factors such as extended exposure to airborne particulates, prolonged use of neurotoxic chemicals, and continued reliance on burn pits in combat zones likely contributed to this heightened risk. This underscores the persistent dangers faced by deployed personnel, reinforcing the need for ongoing research and veteran advocacy.
Given the strong link between ALS and military service, the Department of Veterans Affairs (VA) has classified ALS as a service-connected disease regardless of when the diagnosis was made or what the Veteran was exposed to during service. This classification allows veterans to access comprehensive healthcare benefits and financial assistance without the burden of proving a direct service connection. By streamlining this process, the VA acknowledges the serious impact of ALS on veterans and their families, aiming to provide timely and essential support for those affected.
Presumptive Service Connection for ALS
Since 2008, the VA has recognized ALS as a presumptive service-connected disease, ensuring that veterans diagnosed with ALS receive benefits without needing to establish a direct link between their military service and their condition. Any veteran who served at least 90 continuous days on active duty qualifies for VA disability compensation if later diagnosed with ALS, regardless of where they served. This presumption applies regardless of when the diagnosis occurs—whether immediately after discharge or decades later.
The VA states that ALS does not require manifestation within a specific time frame after service to be considered a service-connected disability. Unlike other presumptive conditions that must appear within a defined post-service period, ALS qualifies for VA benefits regardless of when symptoms develop. This means a veteran could be diagnosed with ALS the day after leaving the military or 20 years later, and the presumption of service connection will still apply.
In addition to direct compensation for veterans, this presumption extends to survivors. If a veteran passes away due to ALS, their spouse and dependents may be eligible for Dependency and Indemnity Compensation (DIC), a monthly benefit provided to surviving family members. This ensures that families of veterans lost to ALS continue to receive financial support.
By streamlining the process through the presumptive service connection, the VA eliminates many bureaucratic hurdles, allowing veterans with ALS and their families to receive essential healthcare, disability benefits, and survivor compensation without prolonged claims battles.
Who Doesn’t Qualify for the ALS Presumption?
Although the VA presumes ALS to be service-connected, certain circumstances may disqualify a veteran from receiving benefits under this presumption. Service connection will not be established if:
- There is affirmative evidence that ALS was not incurred during or aggravated by active military, naval, or air service.
- There is affirmative evidence that ALS resulted from the veteran’s own willful misconduct, such as substance abuse or reckless behavior leading to the disease.
- The veteran did not meet the minimum requirement of 90 continuous days of active military service.
These limitations exist to ensure that benefits are provided specifically to those whose condition can reasonably be linked to military service. However, it is important to note that the burden of proof is on the VA to demonstrate that ALS was not connected to service. In cases where evidence is unclear or insufficient to dispute the presumption, the veteran is generally given the benefit of the doubt.
For veterans who do not qualify under the presumptive ruling but believe their ALS is related to service, alternative avenues for compensation may still be available. A veteran can submit medical evidence and expert opinions to argue a direct service connection outside of the presumption, though this process may require additional documentation and advocacy.
What Is the VA Rating for ALS?
Veterans who qualify for the ALS presumption are automatically granted a 100% disability rating by the VA under Diagnostic Code 8017. Due to ALS’s progressive and incurable nature, this rating is considered permanent and total and cannot be reduced regardless of the disease’s progression. This ensures that veterans diagnosed with ALS receive the highest base level of disability compensation available.
Unlike other conditions, where ratings may fluctuate depending on symptom severity, ALS is recognized as a continually worsening disease, eliminating the need for re-evaluations or future rating adjustments. The automatic 100% rating simplifies the claims process, allowing veterans to focus on their medical care without concern for changes in their benefits.
However, VA regulations also emphasize that Special Monthly Compensation (SMC) should be considered for veterans with ALS. Since the disease causes severe physical limitations, such as paralysis, loss of speech, and respiratory failure, qualifying veterans are often eligible for additional compensation beyond the standard 100% rating. This can provide substantial financial support for those requiring in-home care, assistive devices, and other accommodations essential for daily living.
Getting the Maximum Compensation for ALS
Qualifying veterans diagnosed with ALS are entitled to VA disability compensation, a tax-free monetary benefit provided to veterans whose service-connected conditions impair their ability to work and perform daily activities. Compensation is paid monthly and varies based on the veteran’s marital status and number of dependents.
Veterans with ALS also receive access to the full range of benefits available to disabled veterans, including enrollment in VA health care’s highest priority group. This ensures expedited medical treatment, assistive devices, in-home care, and other critical resources that help improve quality of life. Given the rapid progression of ALS, early access to these benefits is essential.
Special Monthly Compensation (SMC) is an additional benefit for veterans whose service-connected conditions resulted in severe impairment, such as paralysis.
What Is the Special Monthly Compensation for ALS?
Special Monthly Compensation is awarded to veterans whose service-connected disabilities result in severe impairment beyond what is covered by standard disability ratings. Veterans with ALS qualify for SMC due to the disease’s significant impact on mobility, speech, breathing, and overall physical function.
SMC can provide substantial financial assistance, particularly for veterans who:
- Require aid and attendance for daily tasks such as bathing, dressing, and eating.
- Have lost the use of extremities due to paralysis or muscle atrophy.
- Are housebound and unable to leave their residence without assistance.
Since ALS is a degenerative disease, SMC benefits can be increased over time as the veteran’s condition worsens. These benefits may include:
- Adaptive housing grants
- Automobile allowances for vehicle modifications
- Vocational rehabilitation
- Caregiver support programs
- Home-based primary care
Ensuring that the highest level of compensation is secured requires careful documentation of the veteran’s medical status, functional impairments, and the need for long-term care. An experienced VA lawyer can help you get maximum compensation, including SMC.
How Secondary Conditions Can Increase SMC
Secondary conditions are additional health problems that develop as a result of the primary service-connected condition—ALS. They can significantly impact a veteran’s ability to function independently and may contribute to a higher level of Special Monthly Compensation.
Since ALS progressively weakens muscles and disrupts essential bodily functions, it frequently leads to severe complications that entitle veterans to increased financial and caregiving support from the VA. Secondary conditions to ALS include:
- Respiratory complications – Chronic bronchitis and pneumonia due to weakened lung function.
- Sleep apnea – Breathing difficulties during sleep due to muscle weakness.
- Pressure ulcers (bedsores) – Caused by prolonged immobility.
- Dysphagia (difficulty swallowing) – Leading to malnutrition and increased risk of choking.
- Gastroesophageal reflux disease (GERD) – Digestive issues linked to weakened esophageal muscles.
- Bladder and bowel dysfunction – Loss of control due to nerve deterioration.
The severity and presence of secondary conditions will determine whether a veteran qualifies for higher levels of SMC. For instance, if ALS has progressed to the point where it causes respiratory failure requiring mechanical ventilation, the veteran may qualify for SMC Level R or S.
How to Apply for VA Disability for ALS
To begin the VA disability claim process for ALS, veterans must complete and submit VA Form 21-526EZ: Application for Disability Compensation and Related Compensation Benefits. This form is essential for initiating a claim and can be filed online through the VA website or submitted by mail.
While veterans may file claims independently, it is highly recommended to seek assistance from an ALS association or a Veterans Service Organization (VSO). These organizations provide expert guidance to ensure all necessary documentation is included, reducing the risk of delays or denials. Additionally, Hill & Ponton offers a free guide that explains every step of the VA disability application process. Access the guide here.
Keep in mind that applying for VA health care is separate from applying for VA disability compensation. While the Veterans Benefits Administration (VBA) processes disability claims, veterans must also enroll in the Veterans Health Administration (VHA) to access specialized ALS-related medical care, including assistive technology, respiratory support, and in-home care services.
Since ALS is recognized as a life-threatening and terminal condition, the VA prioritizes ALS claims for expedited processing. Veterans diagnosed with ALS should formally request an expedited review when filing their claim.
If you or a loved one has been diagnosed with ALS, don’t navigate the VA claims process alone. At Hill & Ponton, we are dedicated to helping veterans with ALS receive the maximum amount of Special Monthly Compensation. Contact us today for a free case evaluation and let us assist you in securing the benefits you deserve.
Content Reviewed by
Attorney Rachel Cheek
Rachel Cheek is an attorney at Hill & Ponton dedicated to helping veterans secure the benefits they deserve. A University of Florida graduate, she combines her passion for social justice with legal expertise to serve those most in need.
