M21-1 Manual / Part VIII, Subpart iii, Chapter 3, Section B
Rating Claims for Disabilities Associated With Mustard Gas or Lewisite Exposure
M21-1, Part VIII, Subpart iii, Chapter 3, Section B
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Overview
In This Section | | This section contains the topic, “Rating Claims for Disabilities Associated With Mustard Gas or Lewisite Exposure.” |
1. Rating Claims for Disabilities Associated With Mustard Gas or Lewisite Exposure
Introduction | | This topic contains information on rating claims based on mustard gas or Lewisite exposure, including- presumptive service connection (SC) based on exposure to mustard gas or Lewisite
- history of presumptive SC under 38 CFR 3.316
- disabilities for which SC may be awarded by presumption under 38 CFR 3.316(a)
- what to consider when rating mustard gas or Lewisite claims, and
- rating decision requirements in mustard gas or Lewisite claims.
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Change Date | | April 13, 2026 |
VIII.iii.3.B.1.a. Presumptive SC Based on Exposure to Mustard Gas or Lewisite | | Under 38 CFR 3.316, presumptive service connection (SC) can be established when there is- in-service full-body exposure to a vesicant agent (mustard gas or Lewisite), and
- a diagnosis of a condition associated with the type of verified exposure as listed in 38 CFR 3.316(a).
The presumption removes the need to prove a nexus between the current diagnosis and the in-service exposure. Therefore, when the evidence is sufficient for the presumption to arise, SC is established (assuming that generally applicable requirements such as Veteran status based on a qualifying discharge have been met) unless other evidence rebuts the presumption. Reference: For more information on the definitions of full-body exposure, mustard gas, and Lewisite, see M21-1, Part VIII, Subpart iii, 3.A.1.a. |
VIII.iii.3.B.1.b. History of Presumptive SC Under 38 CFR 3.316 | | The Department of Veterans Affairs initially began recognizing certain disabilities when it published 38 CFR 3.316 on July 31, 1992. This regulation established a presumption of SC based upon mustard agent or Lewisite exposure, provided that the Veteran was subjected to full-body exposure during field or chamber experiments to test protective clothing or equipment during World War II. These Veterans must have subsequently developed a chronic form of one of the following: laryngitis, bronchitis, emphysema, asthma, or diseases of the eye including conjunctivitis, keratitis, or corneal opacities. The current version of 38 CFR 3.316, which became effective January 6, 1993, expanded the list of recognized disabilities and the methods of exposure. |
VIII.iii.3.B.1.c. Disabilities for Which SC May Be Awarded by Presumption Under 38 CFR 3.316(a) | | Use the table below to identify the disabilities for which SC may be awarded by presumption under 38 CFR 3.316(a) based on full-body exposure during active military service.| If the Veteran had full-body exposure to … | Then SC may be awarded for … |
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| nitrogen or sulfur mustard gas | - chronic conjunctivitis
- keratitis
- corneal opacities
- scar formation at the exposure site
- nasopharyngeal cancer
- laryngeal cancer
- lung cancer (except mesothelioma), and/or
- squamous cell carcinoma of the skin.
| | nitrogen or sulfur mustard gas or Lewisite | chronic forms of- laryngitis
- bronchitis
- emphysema
- asthma, and/or
- chronic obstructive pulmonary disease (COPD).
| | nitrogen mustard gas | acute non-lymphocytic leukemia. |
Notes: - SC will not be awarded if the claimed condition is due to the Veteran’s own willful misconduct or there is affirmative evidence that establishes a non-service-related supervening condition or event as the cause of the claimed condition.
- Consider claims for non-presumptive disabilities under the toxic exposure risk activity (TERA), direct SC provisions.
Reference: For more information on TERA, see the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 Implementation Standard Operating Procedure (SOP). |
VIII.iii.3.B.1.d. What to Consider When Rating Mustard Gas or Lewisite Claims | | When rating mustard gas claims, consider that the- acute effects of exposure to mustard gas or Lewisite may be evident in the service treatment records
- delayed effects of exposure may appear even though no acute effects were noted in service, and
- Veteran may have been exposed to mustard gas or Lewisite outside of service.
References: For more information on |
VIII.iii.3.B.1.e. Rating Decision Requirements in Mustard Gas or Lewisite Claims | | In order to clearly identify issues awarded or denied as due to mustard gas or Lewisite exposure, decision makers must complete the following steps in the Veterans Benefits Management System - Rating (VBMS-R):- select the appropriate Mustard Gas special issue and the relevant special issue basis specific to the nature of exposure claimed or shown
- if denying the claim, select the relevant decision rationale in VBMS-R to ensure the decision notice fully informs the claimant of the reason for the decision, and
- if deciding the claim under TERA provisions, follow the TERA rating guidance outlined in the PACT Act Implementation SOP.
References: For more information on |
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Source: VA M21-1 Adjudication Procedures Manual, M21-1, Part VIII, Subpart iii, Chapter 3, Section B (U.S. government work, reproduced for reference). Browse all sections →