M21-1 Manual / Part V, Subpart ii, Chapter 2, Section E

Service Connection (SC) for Congenital, Developmental, or Hereditary Disorders

M21-1, Part V, Subpart ii, Chapter 2, Section E

Overview

In This Section

This section contains the topic “Determining SC for Congenital, Developmental, or Hereditary Disorders.”

1. Determining SC for Congenital, Developmental, or Hereditary Disorders

Introduction

This topic contains information on determining SC for congenital, developmental, or hereditary disorders, including

definition of
- congenital or developmental defects, and
- congenital, developmental, or hereditary disease
establishing SC for congenital, developmental, or hereditary disorders
requesting medical opinions in claims for SC for congenital, developmental, or hereditary disorders
considering the
- development of symptoms of hereditary disease in service, and
- aggravation of a hereditary disease in service.

Change Date

December 21, 2023

V.ii.2.E.1.a. Definition: Congenital or Developmental Defects

Congenital or developmental defects refer to normally static, structural, or inherent body abnormalities which are typically present at birth and are generally incapable of improvement or deterioration. These include but are not limited to
vertebral anomalies such as block (fused) vertebrae
atrial septal defect
pectus excavatum
mental deficiency
absent, displaced, or supernumerary parts
personality disorder, and
undescended testicles.
Note: The presumption of soundness does not apply to congenital defects because such defects are not diseases or injuries within the meaning of the statutes governing the presumption. References: For more information on
the prohibition of service connection (SC) for congenital or developmental defects, see
38 CFR 4.9, and
38 CFR 3.303(c), and
the inapplicability of the presumption of soundness to congenital or developmental defects, see Terry v. Principi, 340 F.3d 1378, 1385-86 (Fed. Cir. 2003).

V.ii.2.E.1.b. Definition: Congenital, Developmental, or Hereditary Disease

Congenital, developmental, or hereditary diseases refer to diseases that are recognized to be congenital, developmental, or familial in origin. A congenital, developmental, or hereditary disease may appear in adulthood and is capable of improvement or deterioration. Examples of congenital or hereditary diseases include but are not limited to
polycystic kidney disease
sickle cell disease
retinitis pigmentosa, and
Huntington’s chorea.
References: For more information on handling claims for SC based on
sickle cell disease, see M21-1, Part V, Subpart iii, 9.1, and
retinitis pigmentosa, see M21-1, Part V, Subpart iii, 2.A.3.e.

V.ii.2.E.1.c. Establishing SC for Congenital, Developmental, or Hereditary Disorders

Congenital or developmental defects, refractive error of the eye, personality disorders, and mental deficiency are not considered diseases or injuries under 38 CFR 3.303(c). Since they are not diseases or injuries, they are not generally subject to SC.However, establish SC, if warranted, for
diseases of congenital, developmental, or familial, hereditary origin that
first manifest themselves during service, or
pre-exist service and progress at an abnormally high rate during service
a hereditary or familial disease that first became manifest to a compensable degree within the presumptive period following discharge from service pursuant to 38 CFR 3.309(a), provided the rebuttable presumption provisions of 38 CFR 3.307 are satisfied, and
disabilities resulting from an overlying injury or disease of a congenital defect.
Notes:
VAOPGCPREC 11-1999 held that M21-1 provisions created in 1964 did not preclude awarding SC for in-service aggravation of pre-existing retinitis pigmentosa. Therefore, subsequent Department of Veterans Affairs General Counsel Precedent Opinions and M21-1 changes cannot be considered liberalizing changes.
A degenerative condition is not a type of congenital defect.
Important: Genetic test results showing a predisposition to a disease are not sufficient to rebut an evidentiary presumption (of soundness or that a chronic condition arose during a presumptive period). Similarly, such a test result is insufficient to sever SC or to reduce the evaluation of a service-connected disability. References: For more information on
claims for SC involving congenital and developmental defects and diseases of familial or hereditary origin, see
Winn v. Brown, 8 Vet.App. 510, 516 (1996)
Cousin v. Wilkie, 905 F.3d 1316 (Fed. Cir. 2018)
VAOPGCPREC 1-1990, March 16, 1990
VAOPGCPREC 67-1990, July 18, 1990, and
VAOPGCPREC 82-1990, July 18, 1990
congenital and developmental defects and refractive error of the eyes, see M21-1, Part V, Subpart iii, 2.A
severance of SC, see M21-1, Part X, Subpart ii, 5.B
rebuttal of presumptions of SC under 38 CFR 3.307(d), see M21-1, Part V, Subpart ii, 2.B.1.d-f, and
the difference between an abnormal laboratory finding and a diagnosis, see M21-1, Part V, Subpart ii, 3.C.1.a.

V.ii.2.E.1.d. Requesting Medical Opinions in Claims for SC for Congenital, Developmental, or Hereditary Disorders

When considering SC for a condition of congenital or developmental origin, determine whether the condition is a disease process or is simply a defect or abnormality. In many instances, it may be necessary to request a medical opinion regarding the proper classification of a medical condition at issue. Particularly, the examiner should be asked whether the condition is capable of improvement or deterioration. Although the outcome of such an opinion request is probative in determining whether a congenital or development condition is a disease or a defect, and consequently whether it is subject to SC, the opinion is not wholly determinative and must be considered in the context of the remainder of the evidentiary record. Reference: For more information on requesting medical opinions in claims for SC for congenital or developmental conditions, see Quirin v. Shinseki, 22 Vet.App. 390 (2009).

V.ii.2.E.1.e. Considering the Development of Symptoms of Hereditary Disease in Service

Consider diseases of hereditary origin to be incurred in service if the pathological signs or symptoms developed after entry into active service. Even if the Veteran is almost certain to eventually develop a disease, a genetic or other familial predisposition does not constitute having the disease. Only when the evidence shows actual manifestation of symptoms or signs of pathology followed by a diagnosis, may the Veteran be said to have developed the disease. Notes:
At what point the Veteran starts to manifest signs or symptoms is a factual, medical determination that must be based upon
the medical evidence of record in each case, and
sound medical judgment.
The only prerequisite for the application of the presumption of soundness is that the Veteran’s entry examination be clear of any noted diseases or disabilities. When the presumption of soundness applies, it can only be rebutted with clear and unmistakable evidence that the injury or disease existed prior to and was not aggravated by service.
References: For more information on
the presumption of soundness, see M21-1, Part V, Subpart ii, 2.A.2, and
genetic test results and determinations regarding presumptions, see M21-1, Part V, Subpart ii, 2.E.1.c.

V.ii.2.E.1.f. Considering the Aggravation of a Hereditary Disease in Service

A hereditary disease that manifests some symptoms before entry into active service may be found to have been aggravated during service if it progresses during service at a rate greater than normally expected according to accepted medical authority. Note: This is a factual, medical determination that must be based upon the evidence of record and sound medical judgment.

Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part V, Subpart ii, Chapter 2, Section E (U.S. government work, reproduced for reference). Browse all sections →