Section B – Rating Claims for Disabilities Associated With Mustard Gas or Lewisite Exposure

Updated Apr 29, 2022

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

Change Date

April 14, 2017

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 (WWII). 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.

Note: 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.

If the Veteran had full-body exposure to …	Then SC may be awarded for …
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.

VIII.iii.3.B.1.d. Veterans Eligible for Benefits Based on Exposure to Mustard Gas or Lewisite

Veterans who are eligible for benefits based on exposure to mustard gas or Lewisite include those who

were exposed
- during field or chamber testing
- under battlefield conditions in World War I
were present at the German air raid on the harbor of Bari, Italy, in WWII
engaged in the manufacturing, handling, or destruction of vesicant agents during military service, or
demolished or handled explosive ordinance while serving in Operation Iraqi Freedom.

Notes:

Veterans who participated in mustard gas testing prior to 1968 have been released from vows of secrecy by a March 9, 1993, order of Deputy Defense Secretary William J. Perry. Veterans may discuss the type of agent(s) used, location, and circumstances of exposure, as this information is declassified.
Participation in mustard agent and Lewisite testing can be considered a stressor in determining SC for posttraumatic stress disorder (PTSD).

Reference: For more information on processing claims for PTSD, see M21-1, Part VIII, Subpart iv, 1.A.

VIII.iii.3.B.1.e. 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

developing claims based on mustard gas or Lewisite exposure, see M21-1, Part VIII, Subpart iii, 3.A, and
presumptive SC, see M21-1, Part V, Subpart ii, 2.B.

VIII.iii.3.B.1.f. 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, and
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.

References: For more information on

VBMS-R, see the VBMS Rating User Guide
rating narrative requirements, see M21-1, Part V, Subpart iv, 1.A, and
decision notice requirements, see
- 38 CFR 3.103(f), and
- M21-1, Part VI, Subpart i, 1.B.

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