VA provides special access to health care services to any veteran exposed to ionizing radiation in connection with nuclear device tests or with the American occupation of Hiroshima and Nagasaki, Japan, during the period beginning Sept. 11, 1945, and ending July 1, 1946. Since 1981, these veterans have been eligible for care for all conditions except those that VA affirmatively determines have causes other than radiation exposure. Health care also is available to veterans defined to have service-connected diseases related to radiation exposure they suffered anytime during their military service. VA also pays compensation to veterans and their survivors if the veteran is determined to have a disability due to radiation exposure while in service.
Some 195,000 servicemembers participated in the post-World War II occupation of Hiroshima and Nagasaki, Japan. In addition, approximately 202,000 servicemembers and another 8,000 civilian and contract personnel participated in 235 U.S. atmospheric nuclear tests in the United States and the Pacific and Atlantic oceans prior to the 1963 Limited Test Ban Treaty. The Defense Special Weapons Agency's Nuclear Test Personnel Review program since 1978 has been identifying participants in various tests. Many test participants received no measurable dose of ionizing radiation, with a total of 1,750 nuclear test participants identified as having a dose of 5 rem or higher. (The current federal guideline for U.S. workplace exposure is 5 rem in 12 consecutive months.)
VA may pay compensation for radiogenic diseases under two programs specific to radiation-exposed veterans and their survivors.
- Veterans who participated in nuclear tests by the U.S. or its allies, who served with the U.S. occupation forces in Hiroshima or Nagasaki, Japan, between August 1945 and July 1946, or who were similarly exposed to ionizing radiation while a prisoner of war in Japan, and who develop illnesses specified in the Radiation-Exposed Veterans Compensation Act of 1988 and subsequent legislation.
The 15 types of cancer covered by these laws are:
all forms of leukemia except chronic lymphocytic leukemia; cancer of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland and urinary tract; lymphomas (except Hodgkin's disease); multiple myeloma; and primary liver cancer.
-Veterans who were exposed to ionizing radiation in service and who within specified time periods develop a disease determined to be related to the radiation exposure.
Disability compensation claims of veterans exposed to radiation but who are not covered by the Radiation-Exposed Veterans Compensation Act of 1988 or subsequent presumptive legislation are governed by regulation. Under the regulation, various factors are considered in determining service-connection, including amount of radiation exposure, duration of exposure, and elapsed time between exposure and onset of the disease.
The 22 conditions recognized as radiogenic under the regulation are: all forms of leukemia except chronic lymphocytic leukemia; cancer of the thyroid, breast, lung, bone, live', skin, esophagus, stomach, colon, pancreas, kidney, urine bladder, ovaries, salivary gland, and rectum; posterior subcapsular cataracts; non-malignant thyroid nodular disease; parathyroid adenoma; tumors of the brain and central nervous system; multiple myeloma; and lymphomas other than Hodgkin's disease.
A pending regulation would add the broad category of "any cancer" to the radiogenic list as well as prostate cancer specifically. That proposed regulation followed a review of 53 scientific studies by the Veterans Advisory Committee on Environmental Hazards. VA also will consider evidence that other diseases were caused by radiation exposure.
Rates of compensation depend upon the degree of disability. Additional amounts may be awarded for certain severe disabilities. For deaths in 1993 and after, compensation to survivors is paid based on a flat rate to all eligible claimants. An additional amount may be paid if the veteran had been rated 100-percent disabled for service-connected disabilities, including individual unemployability, for at least eight years prior to death and had been married to the surviving spouse during the same period.
Additional amounts may be payable to the surviving spouse for dependent minor children. Claims for compensation may be filed at the nearest VA regional office. Veterans or their survivors can reach the nearest regional office by calling 1-800-827-1000. The Defense Department maintains a help-line at 800-462-3683 to provide veterans information about their test participation.
Medical Care Authorized
Public Law 97-72, the "Veterans Health Care, Training, and Small Business Loan Act of 1981," authorized VA to provide hospital and nursing home care and limited outpatient services to a veteran who was exposed "while serving on active duty to ionizing radiation from the detonation of a nuclear device in connection with such veteran's participation in the test of such a device or with the American occupation of Hiroshima and Nagasaki, Japan, during the period beginning on Sept. 11, 1945, and ending July 1, l946." The law, however, does not provide for the care of conditions that are found to have resulted from causes other than exposure to ionizing radiation.
Under the Ionizing Radiation Registry program, VA will perform a complete physical examination, including all necessary tests, for each veteran who requests it if He veteran was exposed to ionizing radiation while participating in the nuclear weapons testing program, or if he or she served win the U,S. occupation forces in Hiroshima or Nagasaki. For those whom VA has examined within the prior six months, only those procedures that are medically indicated by current circumstances will be repeated.
Where a registry health examination reveals a condition requiring treatment, the responsible staff physician must determine whether the condition could potentially be associated with ionizing radiation. If a veteran has a disorder that has been associated win exposure to radiation VA will provide hospital and nursing home care in VA facilities. Outpatient care also will be provided at a VA facility to avoid the need to hospitalize the veteran, to prepare the veteran for hospitalization, and to complete care that was initiated during a period of VA hospitalization. These services are provided without regard to the veteran's age, service-connected status, or ability to defray the expense of medical care. Veterans may receive outpatient care at VA facilities or, when VA facilities cannot provide it, VA may arrange for outpatient services to be provided by a private physician
Health -Care Exceptions
Health-care services may not be provided under P.L. 97-72 for conditions that are found, after a medical examination, to have resulted from a cause other than exposure to ionizing radiation.
The following types of conditions are ordinarily considered to be due to a cause over than exposure to low-level ionizing radiation:
- Congenital or developmental conditions (disorders the veteran was born with or that are hereditary;
- Conditions that the veteran had before military service;
- Conditions resulting from an injury;
- Conditions having a specific and well-established cause, e.g., Tuberculosis, gout; and
- Common, well-understood conditions, such as inguinal hernia or acute appendicitis.
If the examining physician believes that a veteran requires care for any of these conditions and presents a complicating circumstance that makes the provision of care under the authority appropriate, he or she may decide to provide it after consulting with the facility chief of staff and the registry physician.