How to file a VA radiation exposure (Atomic Veterans) claim — 21 presumptive cancers under 38 CFR 3.309(d) for Hiroshima/Nagasaki + Pacific tests + uranium handling + nuclear cleanup

Step 1: Determine if you/your loved one participated in a "radiation-risk activity" per 38 CFR 3.309(d)

Qualifying radiation-risk activities (the 38 CFR 3.309(d) list): (a) HIROSHIMA/NAGASAKI OCCUPATION FORCES — military personnel present in occupation duties at Hiroshima (entered city limits) or Nagasaki (entered city limits) between August 6, 1945 and July 1, 1946; (b) PACIFIC ATMOSPHERIC NUCLEAR TESTS — Operations Crossroads (Bikini Atoll 1946), Greenhouse (Eniwetok 1951), Ranger (Nevada 1951), Buster-Jangle (Nevada 1951), Tumbler-Snapper (Nevada 1952), Upshot-Knothole (Nevada 1953), Castle (Bikini 1954), Teapot (Nevada 1955), Wigwam (Pacific 1955), Redwing (Bikini 1956), Plumbbob (Nevada 1957), Hardtack I (Pacific 1958), Argus (South Atlantic 1958), Hardtack II (Nevada 1958), Dominic I (Pacific 1962), Dominic II (Nevada 1962); (c) ENIWETOK ATOLL CLEANUP — military personnel involved 1977-1980; (d) URANIUM MINING + PROCESSING — service at Department of Energy facilities Oak Ridge X-10 reactor, Y-12 plant, Paducah, Portsmouth, Hanford, Savannah River; (e) THREE MILE ISLAND nuclear power plant accident response (March 1979) — limited service-connection pathway. Document via: DD-214 ports of departure/return, deployment orders, unit assignments, Operation participation records (DTRA-DOD historical records).

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

Step 2: Verify your condition matches the 21 presumptive cancer list

21 presumptive cancers under 38 CFR 3.309(d) for Atomic Veterans: (1) leukemia (other than chronic lymphocytic leukemia); (2) thyroid cancer; (3) breast cancer; (4) pharyngeal cancer; (5) esophageal cancer; (6) stomach cancer; (7) small intestine cancer; (8) pancreatic cancer; (9) multiple myeloma; (10) lymphomas (except Hodgkin's disease); (11) primary liver cancer; (12) salivary gland cancer; (13) urinary tract cancers; (14) bronchiolo-alveolar carcinoma; (15) bone cancer; (16) brain + central nervous system cancers; (17) colon cancer; (18) lung cancer; (19) ovarian cancer; (20) bile duct cancer; (21) gallbladder cancer. NO MEDICAL NEXUS REQUIRED for radiation-risk-activity veterans + diagnosed presumptive cancer. The framework explicitly presumes radiation causation for these specific cancer types in qualifying veterans.

Step 3: Request DTRA radiation dose reconstruction (for non-presumptive cases)

For cancers NOT on the 21-presumptive list, OR for non-presumptive radiation-related conditions (cardiovascular disease, cataracts, posterior subcapsular cataracts, non-malignant thyroid nodular disease), the Defense Threat Reduction Agency (DTRA) provides dose reconstruction services. DTRA estimates radiation exposure based on service records + duty position + unit assignments during qualifying activities. The dose-reconstructed estimate then supports VA evaluation under 38 CFR 3.311 (radiogenic disease) — a more complex pathway requiring medical nexus opinion. Request DTRA dose reconstruction via: dtra.public.affairs@dtra.mil OR Defense Threat Reduction Agency, ATTN: SCC-VA, 8725 John J. Kingman Road MS 6201, Fort Belvoir VA 22060-6201. Processing 60-180 days. Free service.

Reference: https://www.dtra.mil/Research/Nuclear-Test-Personnel-Review/

Step 4: File VA Form 21-526EZ with explicit Atomic Veteran framing

Submit VA Form 21-526EZ stating "[Cancer], secondary to ionizing radiation exposure during [qualifying activity], radiation-risk activity per 38 CFR 3.309(d)." Include: DD-214 documenting service period + qualifying activity, service records showing duty position, oncologist cancer diagnosis with pathology/biopsy reports, treatment history. For Hiroshima/Nagasaki: official records of occupation duty within city limits dates Aug 6, 1945 - Jul 1, 1946. For Pacific tests: unit records showing presence during named operations. NO MEDICAL NEXUS REQUIRED for the 21-presumptive list. Initial decision typically 4-6 months. CRITICAL: many Atomic Veterans died before the presumptive framework was established (1988 + subsequent expansions). Surviving spouses + adult children may qualify for DIC + survivor benefits for cancer-caused deaths — see Step 5.

Step 5: For surviving family of deceased Atomic Veterans — DIC + Survivors Pension pathway

Surviving spouses + dependent children of deceased Atomic Veterans qualify for DIC if the veteran died from one of the 21 presumptive cancers (radiation-caused death qualifies for service-connected death status). File VA Form 21P-534EZ (Application for DIC, Death Pension, and/or Accrued Benefits) with: marriage certificate, death certificate listing cancer as cause of death, veteran's DD-214 + radiation-risk-activity documentation, oncologist records confirming diagnosis. DIC base rate 2025: $1,653.07/mo for surviving spouse. CHAMPVA healthcare for surviving spouse + dependents (VA Form 10-10D — see /api/v1/howto/apply-champva-healthcare.json). DEA Chapter 35 education benefits for surviving spouse + children — see /api/v1/howto/access-chapter-35-dea-education.json. CRITICAL: many Atomic Veteran families don't realize their spouse/parent's 1980s-2000s cancer death qualifies for retroactive survivor benefits. The presumptive framework applies to deaths regardless of when they occurred, as long as the veteran was an Atomic Veteran + cancer is on the list.