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Presumption of Service Connection for Chronic Diseases

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There are certain chronic diseases that a veteran may be presumptively entitled to if the disease manifests to a certain degree within a specified timeframe after the veteran’s period of service.  The VA has acknowledged that if a veteran develops characteristic manifestations of a chronic disease within one year following discharge from service, it is more likely than not that the veteran had the condition in service.  Therefore, for the presumption to apply, the veteran does not need to have service treatment records showing he was treated for the condition.  There are 41 chronic diseases that are eligible for presumption of service connection and are listed in 38 U.S.C.S. § 1101(3). Among the most common include:

  • primary anemia
  • arteriosclerosis
  • arthritis
  • cirrhosis of the liver
  • hypertension
  • gall stones or kidney stones
  • diabetes mellitus
  • epilepsies
  • lupus
  • organic diseases of the nervous system
  • Raynaud’s disease
  • Sarcoidosis
  • multiple sclerosis
  • active tuberculosis
  • gastric ulcers or duodenal ulcers

The symptoms associated with the disease must manifest to a degree of 10 percent or more within one year from the date of separation from service in order for the presumption to apply.  However, there are three exceptions.  Tuberculosis and leprosy have extended manifestation periods of three years, and multiple sclerosis, seven years.  The condition must meet the 10 percent threshold of impairment based on the VA disability ratings of diseases.

The trail of symptoms must be followed by a definitive diagnosis within a reasonable timeframe.  This presumption helps veterans who may or may not have had symptoms in service because they do not have to show proof that the condition began in service.  It also helps those that failed to seek immediate medical attention for their symptoms, for one reason or another, until a couple of years after separation from service.

If a veteran develops symptoms associated with one of the chronic diseases listed in the Statute, and is diagnosed within the presumptive period, they are granted presumptive service connected disability benefits.  However, there are situations where the veteran has a current disability that was not diagnosed within the presumptive period, what then?

After discharge, a lot of veteran’s attribute many symptoms to the re-acclimation to civilian life.  In this transition, they experience change in foods and eating habits, adjustment to sleep patterns, and even abrupt change in weather.  All of these changes can wreck havoc on the intestinal system, nervous system, and immunological system.  Luckily, for most, these symptoms abate and they are back on track living a fruitful life.  For others, however, as time goes by, the symptoms may wax and wane until they become chronic, and ultimately end up with a definite diagnosis of a disease.  Proof of symptoms can be confirmed by acceptable medical evidence, but it can also be confirmed by lay evidence.

For example, the 10 percent rating threshold for primary iron-deficiency or primary pernicious anemia, that is, anemia that has not developed secondary to an existing or known cause, is: Hemoglobin 10gm/100ml or less with findings such as weakness, easy fatigability or headaches.  In this case, lab work is necessary to show the hemoglobin value.  However, a lay person can easily describe characteristics of the condition in the veteran such as lethargy, inability to complete a task due to fatigue, excessive sleep, pale façade, or frequent complaints of headaches.

Another example is Raynaud’s disease.  Raynaud’s disease causes your fingers and toes to feel numb and cold in response to cold temperature and stress.  It can also affect the nose, lips, ears, and even nipples.  Raynaud’s disease can arise secondary to an underlying medical condition. It can also occur on its own. The Statue does not specify whether presumption applies to primary or secondary Raynaud’s disease; therefore, you should be encouraged to apply regardless of the origin.  The 10 percent rating threshold is met when an individual experiences “characteristic attacks occurring one to three times a week.”

Raynaud’s disease causes the affected areas of the skin to turn white.  Then, they often turn blue and feel cold to the touch.  Once circulation returns, the areas turn red and swollen.  These are visual characteristics of the disease that can be witnessed and validated by a lay person.  For these situations, where the chronic disease causes identifying markers, the veteran should obtain written statements from co-workers, friends, neighbors, and relatives that can describe the symptoms observed during the presumptive time period.  The use of lay statements can help fortify your claim for compensation based on the theory of presumptive service connection and it is a powerful tool to have on your side.

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