Department of Veterans Affairs § 3.310

Epithelioid leiomyosarcoma (malignant § 3.310 Disabilities that are proxi- leiomyoblastoma) mately due to, or aggravated by, Rhabdomyosarcoma service-connected disease or injury. Ectomesenchymoma Angiosarcoma (hemangiosarcoma and (a) General. Except as provided in lymphangiosarcoma) § 3.300(c), disability which is proxi- Proliferating (systemic) mately due to or the result of a serv- angioendotheliomatosis ice-connected disease or injury shall be Malignant glomus tumor service connected. When service con- Malignant hemangiopericytoma nection is thus established for a sec- Synovial sarcoma (malignant synovioma) Malignant giant cell tumor of tendon sheath ondary condition, the secondary condi- Malignant schwannoma, including malig- tion shall be considered a part of the nant schwannoma with rhabdomyoblastic original condition. differentiation (malignant Triton tumor), (b) Aggravation of nonservice-connected glandular and epithelioid malignant disabilities. Any increase in severity of schwannomas a nonservice-connected disease or in- Malignant mesenchymoma jury that is proximately due to or the Malignant granular cell tumor result of a service-connected disease or Alveolar soft part sarcoma Epithelioid sarcoma injury, and not due to the natural Clear cell sarcoma of tendons and progress of the nonservice-connected aponeuroses disease, will be service connected. How- Extraskeletal Ewing’s sarcoma ever, VA will not concede that a non- Congenital and infantile fibrosarcoma service-connected disease or injury was Malignant ganglioneuroma aggravated by a service-connected dis- NOTE 2: For purposes of this section, the ease or injury unless the baseline level term ischemic heart disease does not include hypertension or peripheral manifestations of of severity of the nonservice-connected arteriosclerosis such as peripheral vascular disease or injury is established by med- disease or stroke, or any other condition ical evidence created before the onset that does not qualify within the generally of aggravation or by the earliest med- accepted medical definition of Ischemic ical evidence created at any time be- heart disease. tween the onset of aggravation and the (f) Disease associated with exposure to receipt of medical evidence estab- contaminants in the water supply at lishing the current level of severity of Camp Lejeune. If a veteran, or former the nonservice-connected disease or in- reservist or member of the National jury. The rating activity will deter- Guard, was exposed to contaminants in mine the baseline and current levels of the water supply at Camp Lejeune dur- severity under the Schedule for Rating ing military service and the exposure Disabilities (38 CFR part 4) and deter- meets the requirements of § 3.307(a)(7), mine the extent of aggravation by de- the following diseases shall be service- ducting the baseline level of severity, connected even though there is no as well as any increase in severity due record of such disease during service, to the natural progress of the disease, subject to the rebuttable presumption from the current level. provisions of § 3.307(d). (1) Kidney cancer. (Authority: 38 U.S.C. 1110 and 1131) (2) Liver cancer. (c) Cardiovascular disease. Ischemic (3) Non-Hodgkin’s lymphoma. heart disease or other cardiovascular (4) Adult leukemia. disease developing in a veteran who has (5) Multiple myeloma. (6) Parkinson’s disease. a service-connected amputation of one (7) Aplastic anemia and other lower extremity at or above the knee myelodysplastic syndromes. or service-connected amputations of (8) Bladder cancer. both lower extremities at or above the ankles, shall be held to be the proxi- (Authority: 38 U.S.C. 501(a) and 1112(b)) mate result of the service-connected [41 FR 55873, Dec. 23, 1976] amputation or amputations. (d) Traumatic brain injury. (1) In a vet- EDITORIAL NOTE: For FEDERAL REGISTER ci- tations affecting § 3.309, see the List of CFR eran who has a service-connected trau- Sections Affected, which appears in the matic brain injury, the following shall Finding Aids section of the printed volume be held to be the proximate result of and at www.fdsys.gov. the service-connected traumatic brain

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injury (TBI), in the absence of clear tary changes if manifest within 12 evidence to the contrary: months of moderate or severe TBI. (i) Parkinsonism, including Parkin- (2) Neither the severity levels nor the son’s disease, following moderate or se- time limits in paragraph (d)(1) of this vere TBI; section preclude a finding of service (ii) Unprovoked seizures following connection for conditions shown by moderate or severe TBI; evidence to be proximately due to serv- (iii) Dementias of the following ice-connected TBI. If a claim does not types: presenile dementia of the Alz- meet the requirements of paragraph heimer type, frontotemporal dementia, (d)(1) with respect to the time of mani- and dementia with Lewy bodies, if festation or the severity of the TBI, or manifest within 15 years following both, VA will develop and decide the moderate or severe TBI; claim under generally applicable prin- (iv) Depression if manifest within 3 ciples of service connection without re- years of moderate or severe TBI, or gard to paragraph (d)(1). within 12 months of mild TBI; or (3)(i) For purposes of this section VA (v) Diseases of hormone deficiency will use the following table for deter- that result from hypothalamo-pitui- mining the severity of a TBI:

Mild Moderate Severe

Normal structural imaging ...... Normal or abnormal structural imaging ... Normal or abnormal structural imaging. LOC = 0–30 min ...... LOC > 30 min and < 24 hours ...... LOC > 24 hrs.

AOC = a moment up to 24 hrs ...... AOC > 24 hours. Severity based on other criteria.

PTA = 0–1 day ...... PTA > 1 and < 7 days ...... PTA > 7 days. GCS = 13–15 ...... GCS = 9–12 ...... GCS = 3–8.

NOTE: The factors considered are: § 3.311 Claims based on exposure to Structural imaging of the brain. ionizing radiation. LOC—Loss of consciousness. (a) Determinations of exposure and AOC—Alteration of consciousness/mental dose—(1) Dose assessment. In all claims state. PTA—Post-traumatic amnesia. in which it is established that a GCS—Glasgow Coma Scale. (For purposes radiogenic disease first became mani- of injury stratification, the Glasgow Coma fest after service and was not manifest Scale is measured at or after 24 hours.) to a compensable degree within any ap- (ii) The determination of the severity plicable presumptive period as speci- level under this paragraph is based on fied in § 3.307 or § 3.309, and it is con- the TBI symptoms at the time of in- tended the disease is a result of expo- jury or shortly thereafter, rather than sure to ionizing radiation in service, an the current level of functioning. VA assessment will be made as to the size will not require that the TBI meet all and nature of the radiation dose or the criteria listed under a certain se- doses. When dose estimates provided verity level in order to classify the TBI pursuant to paragraph (a)(2) of this sec- at that severity level. If a TBI meets tion are reported as a range of doses to the criteria in more than one category which a veteran may have been ex- of severity, then VA will rank the TBI posed, exposure at the highest level of at the highest level in which a cri- the dose range reported will be pre- terion is met, except where the quali- sumed. fying criterion is the same at both lev- els. (Authority: 38 U.S.C. 501) (Authority: 38 U.S.C. 501, 1110 and 1131) (2) Request for dose information. Where necessary pursuant to paragraph (a)(1) [44 FR 50340, Aug. 28, 1979, as amended at 66 of this section, dose information will FR 18198, Apr. 6, 2001; 71 FR 52747, Sept. 7, be requested as follows: 2006; 78 FR 76208, Dec. 17, 2013] (i) Atmospheric nuclear weapons test participation claims. In claims based

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