Radiogenic Disease Dose-Based Pathway

How §3.311 works

Section 3.311 is not an automatic presumption like §3.309(d). It is a procedural pathway: when a radiogenic disease first becomes manifest after service and was not manifest to a compensable degree within the presumptive periods of §3.307 or §3.309, and it is contended the disease resulted from in-service radiation exposure, the VA performs a dose assessment and refers the claim to the Under Secretary for Benefits for further consideration.

Three threshold requirements. Under §3.311(b)(1), a claim is referred for further consideration only if all three are met:

1. The veteran was exposed to ionizing radiation (atmospheric testing, Hiroshima/Nagasaki occupation Sept 1945 – Jul 1946, or other activities as claimed);
2. The veteran subsequently developed a radiogenic disease (listed below, or otherwise supported by competent scientific or medical evidence);
3. The disease first became manifest within the manifestation period specified for that disease.

Radiogenic diseases (§3.311(b)(2))

"Radiogenic disease" means a disease that may be induced by ionizing radiation. The regulation lists the following:

• All forms of leukemia except chronic lymphatic (lymphocytic) leukemia
• Thyroid cancer
• Breast cancer
• Lung cancer
• Bone cancer
• Liver cancer
• Skin cancer
• Esophageal cancer
• Stomach cancer
• Colon cancer
• Pancreatic cancer
• Kidney cancer
• Urinary bladder cancer
• Salivary gland cancer
• Multiple myeloma
• Posterior subcapsular cataracts
• Non-malignant thyroid nodular disease
• Ovarian cancer
• Parathyroid adenoma
• Tumors of the brain and central nervous system
• Cancer of the rectum
• Lymphomas other than Hodgkin's disease
• Prostate cancer
• Any other cancer

Manifestation periods (§3.311(b)(5))

The disease must first become manifest within the period specified below. If it manifests outside that window, §3.311 does not apply.

Dose assessment process

Once a claim meets the three threshold requirements, the VA develops a dose estimate:

• Atmospheric nuclear test participation claims. Dose data is requested from the Department of Defense in all cases.
• Hiroshima/Nagasaki occupation claims (prior to July 1, 1946). Dose data is requested from the Department of Defense in all cases.
• Other exposure claims. Records concerning the veteran's exposure are requested, including the DD Form 1141 (Record of Occupational Exposure to Ionizing Radiation), if maintained, and service medical records. Records are forwarded to the Under Secretary for Health, who prepares a dose estimate based on available methodologies.

Independent expert referral. When a material difference exists between a credible-source estimate submitted by or on behalf of the claimant and official military dose data, ordinarily, one estimate at least double the other, the estimates are referred to an independent expert selected by the Director of the National Institutes of Health. "Highest-in-range" rule applies: when dose estimates are reported as a range, exposure at the highest level of the reported dose range is presumed.

Factors for consideration (§3.311(e))

In deciding whether a veteran's disease resulted from in-service radiation exposure, the regulation directs consideration of:

1. The probable dose, in terms of dose type, rate, and duration as a factor in inducing the disease, taking into account any known limitations in the dosimetry devices employed.
2. The relative sensitivity of the involved tissue to induction, by ionizing radiation, of the specific pathology.
3. The veteran's gender and pertinent family history.
4. The veteran's age at time of exposure.
5. The time-lapse between exposure and onset of the disease.
6. The extent to which exposure to radiation, or other carcinogens, outside of service may have contributed to development of the disease.

Willful misconduct / supervening cause. Service connection will not be established under §3.311 if the disease is due to the veteran's own willful misconduct, or if there is affirmative evidence that a supervening, nonservice-related condition or event is more likely the cause.

Other pathways if §3.311 does not apply

• §3.309(d) automatic presumption. If the veteran participated in one of the eight listed "radiation-risk activities" and has one of the 21 listed diseases, that presumption applies instead of the dose-based process here. See the §3.309(d) reference page →
• Direct service connection. A veteran may always attempt direct service connection by showing a current diagnosis, an in-service event or exposure, and a medical nexus linking the two. See the three elements of service connection →

Source and currency

Authority: 38 U.S.C. 501; Pub. L. 98-542. Originally codified at 50 FR 34459 (Aug. 26, 1985), as amended through 67 FR 6871 (Feb. 14, 2002).

Regulation text: 38 CFR §3.311 on eCFR.gov (official text, always current).

Data on this page: Reproduced from the eCFR Title 38 snapshot dated 2026-04-20. The eCFR link above is authoritative if it differs.