Developing Claims Based On Exposure to Burn Pits and Other Toxins, Including Fine Particulate Matter (BPOT)

In This Section

Introduction

• identifying a claim for qualifying disabilities due to BPOT exposure
• establishing covered Veteran status
• developing for evidence of qualifying disabilities
• considering the 1119 corporate flash
• handling discrepancies with the 1119 corporate flash, and
• documenting BPOT exposure.

Change Date

VIII.ii.2.B.1.a. Identifying a Claim for Qualifying Disabilities Due to BPOT Exposure

• identify symptoms of a general medical condition, such as shortness of breath or respiratory issues rather than explicitly listing a diagnosis, or
• describe respiratory cancer in other terms, such as cancer of the throat or neck.

• If a claim is unclear, claims processors should review the medical evidence to determine if a qualifying diagnosis exists, or follow the procedures in M21-1, Part III, Subpart i, 2.D.1.c to clarify the claim.
• If the Veteran claims a disability that is not recognized as a BPOT presumptive, process the claim under direct SC guidelines in accordance with the toxic exposure risk activity procedures outlined in the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 Implementation Standard Operating Procedure (SOP).
• The claimant must identify the disability(ies) that resulted from BPOT exposure. If the claimant only alleges exposure without identifying a symptom or disability, follow the procedures for handling an incomplete application in M21-1, Part II, Subpart iii, 1.C.2.b and c.

VIII.ii.2.B.1.b. Establishing Covered Veteran Status

• the Veteran’s corporate record for the Toxic Exposure – Sec.1119 Covered Veteran flash
• available service records, and
• Individual Longitudinal Exposure Record (ILER).

VIII.ii.2.B.1.c. Developing for Evidence of Qualifying Disabilities

VIII.ii.2.B.1.d. Considering the 1119 Corporate Flash

• automatically establish a corporate flash, Toxic Exposure – Sec.1119 Covered Veteran, and
• update the PACT ACT DEPLOYMENTS tab (on the MILITARY SERVICE screen) in the Veterans Benefits Management System (VBMS) Core to reflect details provided by VADIR that were used to verify the Veteran’s 38 U.S.C. 1119-qualifying service.

VIII.ii.2.B.1.e. Handling Discrepancies With the 1119 Corporate Flash

VIII.ii.2.B.1.f. Documenting BPOT Exposure

• uploading the Individual Deployment History from ILER, or
• annotating other service records that establish service in a qualifying location.

Introduction

• when to request an examination or medical opinion
• medical opinions to determine aggravation of a pre-existing disability, and
• examination guidelines for BPOT presumptive disabilities.

Change Date

VIII.ii.2.B.2.a. When to Request an Examination or Medical Opinion

VIII.ii.2.B.2.b. Medical Opinions to Determine Aggravation of a Pre-Existing Disability

VIII.ii.2.B.2.c. Examination Guidelines for BPOT Presumptive Disabilities

• Any condition that requires an invasive diagnostic procedure, such as a biopsy, is considered outside of the scope of VA examination practice. In these cases, follow guidance in M21-1, Part IV, Subpart i, 2.A.1.d regarding scope of practice relative to examinations.
• Bronchiolitis is extremely difficult to diagnose and generally requires a lung biopsy.
• If there is question as to whether the Veteran is diagnosed with a presumptive condition that generally requires a biopsy, but there is no biopsy report, request a medical opinion.
  • Do not request a biopsy or for the Veteran to be sedated and/or undergo an invasive procedure.
  • Identify any evidence for the examiner supporting why the biopsy was not conducted.
  • If the evidence of record is unclear as to whether the Veteran is diagnosed with one of the presumptive cancers, or whether the cancer is considered the primary site of the cancer, request a medical opinion to help determine the originating site of the cancer.
  References: For more information on
  • history of BPOT exposure policies, see M21-1, Part VIII, Subpart ii, 2.A.1.a, and
  • considering presumptive SC for metastatic cancer, see M21-1, Part V, Subpart ii, 2.B.1.b.