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How to file a VA claim for radiation exposure — the 21 presumptive cancers of 38 CFR 3.309(d), the radiation-risk activities, and 3.311 claims

Under 38 CFR 3.309(d), a veteran who participated in a "radiation-risk activity" is presumed service-connected for 21 listed cancers; no proof of cause is needed beyond the service and the diagnosis. The activities include onsite participation in an atmospheric nuclear test, the occupation of Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946, internment as a prisoner of war in Japan, 250 days at the Paducah, Portsmouth or Oak Ridge K-25 gaseous diffusion plants before February 1, 1992, the Amchitka Island underground tests before 1974, Department of Energy Special Exposure Cohort-equivalent duties, and — added by the PACT Act — the Enewetak Atoll cleanup (1977–1980), the Palomares, Spain response (January 17, 1966 – March 31, 1967) and the Thule, Greenland response (January 21 – September 25, 1968). Other conditions that may be caused by radiation are decided case by case under 38 CFR 3.311 with a radiation dose estimate.

Time required: PT2H (claim and records) + VA development, including a dose estimate for 3.311 claims Outcome: A presumptive service-connected rating for a listed cancer, or a 3.311 decision on another radiogenic disease; DIC for survivors when a listed cancer caused the death
If you're in crisis: Call 988 + Press 1 for the Veterans Crisis Line — 24/7, free, confidential. Spanish operators available 24/7. Text 838255. Filing claims can wait; your safety cannot.

What you'll need

  • VA Form 21-526EZ
  • Service records showing the radiation-risk activity: unit, dates and location (test operation, occupation duty, plant assignment, cleanup or response effort)
  • Medical records with the cancer diagnosis and pathology
  • For survivors: VA Form 21P-534EZ, the death certificate and the veteran's service records
  • A free accredited representative (CVSO or VSO)

Step-by-step

Step 1: Confirm the radiation-risk activity

The regulation names these activities: onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima or Nagasaki by U.S. forces from August 6, 1945 to July 1, 1946; internment as a prisoner of war in Japan with comparable exposure; at least 250 days before February 1, 1992 on the grounds of the gaseous diffusion plants at Paducah, Kentucky, Portsmouth, Ohio or the K-25 area at Oak Ridge, Tennessee, with dosimetry monitoring or comparable exposure; service before January 1, 1974 on Amchitka Island, Alaska in duties related to the Long Shot, Milrow or Cannikin underground tests; service that would qualify a Department of Energy employee for the Special Exposure Cohort; the Enewetak Atoll cleanup from January 1, 1977 to December 31, 1980; onsite response to the B-52 accident near Palomares, Spain from January 17, 1966 to March 31, 1967; and onsite response to the B-52 fire and crash near Thule Air Force Base, Greenland from January 21 to September 25, 1968. Reserve members on active or inactive duty for training are covered.

Reference: https://www.law.cornell.edu/cfr/text/38/3.309

Step 2: Check the 21 presumptive cancers

Leukemia (other than chronic lymphocytic leukemia); cancers of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary tract (kidneys, renal pelves, ureters, bladder and urethra), bone, brain, colon, lung and ovary; multiple myeloma; lymphomas (except Hodgkin's disease); primary liver cancer (except where cirrhosis or hepatitis B is indicated); and bronchiolo-alveolar carcinoma. These are presumed service-connected in a radiation-exposed veteran at any time after service.

Reference: https://www.law.cornell.edu/cfr/text/38/3.309

Step 3: Other radiogenic diseases — 38 CFR 3.311

If your cancer is not on the list, or you were exposed in service in another way (for example occupational exposure to X-rays or nuclear weapons), VA decides the claim under 38 CFR 3.311. VA obtains a radiation dose estimate — for test participants and occupation veterans from the Defense Threat Reduction Agency's Nuclear Test Personnel Review program, otherwise from service records — and a medical opinion on whether the dose could have caused the disease. The 3.311 list of radiogenic diseases includes additional cancers such as skin, prostate, kidney and rectal cancer, posterior subcapsular cataracts, non-malignant thyroid nodular disease and parathyroid adenoma, and VA will consider any other cancer with supporting medical evidence.

Reference: https://www.law.cornell.edu/cfr/text/38/3.311

Step 4: File the claim

File VA Form 21-526EZ online, by mail, in person or through a free accredited representative. Submit medical records showing the diagnosis and service records showing the radiation-risk activity; if you do not have the service records, VA requests them, and your unit, dates and location help it find them. If VA denied the claim before and the activity or condition is now covered — for example Enewetak, Palomares or Thule service after the PACT Act — file a Supplemental Claim (VA Form 20-0995).

Reference: https://www.va.gov/disability/eligibility/hazardous-materials-exposure/ionizing-radiation/

Step 5: Survivors, and the Ionizing Radiation Registry

If a radiation-exposed veteran died of a listed cancer, the surviving spouse and dependent children can claim Dependency and Indemnity Compensation on VA Form 21P-534EZ with the death certificate and the veteran's service records (base DIC rate $1,699.36 a month effective December 1, 2025); CHAMPVA health care and Chapter 35 education benefits may follow. Living veterans with a qualifying exposure can also ask their VA medical center for a free Ionizing Radiation Registry health exam.

Reference: https://www.va.gov/family-and-caregiver-benefits/survivor-compensation/dependency-indemnity-compensation/

Critical tips

  • A presumptive condition needs no medical opinion on cause — the service and the diagnosis are enough.
  • The PACT Act added Enewetak, Palomares and Thule in 2022; veterans of those efforts denied before then should file a Supplemental Claim.
  • Service records for nuclear test operations are often held with unit records rather than the personnel file; name the operation (for example Castle, Redwing or Dominic) and your ship or unit.
  • A county veterans service officer can file the claim for free: warriorsfund.org/find-cvso.
  • In crisis: dial 988 then press 1, or text 838255.
Free claim help is the highest-leverage starting point. County Veterans Service Officers (CVSOs), VFW, American Legion, DAV, and AMVETS offer FREE claim help, typically through VA-accredited representatives (accreditation is per person; ask whether the person helping you is VA-accredited). Find a free CVSO → · Support Wounded Warriors EIN 86-1336741 →

Related resources

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