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Conditions Lung Cancer

Lung Cancer VA Rating

Written and reviewed by Landon · Updated October 10, 2026

Lung cancer is rated under 38 CFR § 4.97 DC 6819. The rating starts at 100 percent during active treatment and drops to a residuals-based rating six months after treatment ends. The fight is rarely about whether the cancer is real. It's about whether the veteran fits one of the presumptive lanes (Agent Orange, PACT Act burn pit, ionizing radiation), and what the residuals look like once treatment is done.

Board of Veterans' Appeals: 27.3% granted across 2,483 decided Board rulings on Lung Cancer, 2021 to 2026. What this number means

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Answers grounded in VA rules and Board decisions. Free to start.

How VA rates Lung Cancer

DC 6819: Malignant Neoplasms. Respiratory

DC 6819 rating criteria and monthly pay
RatingWhat VA looks forMonthly pay (2026, veteran alone)Calculator
100%Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths$3,938.58Try it

The 100 percent rating continues beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure; six months after treatment stops, a mandatory VA examination determines the rating, and any change is subject to 38 CFR § 3.105(e). If there has been no local recurrence or metastasis, residuals are rated. Respiratory cancer of any type is on the PACT Act list in 38 U.S.C. 1120(b) for covered veterans, and lung, bronchus, larynx, and trachea cancers are on the Agent Orange list in 38 CFR 3.309(e).

Monthly pay is the basic amount for a veteran alone at that overall rating. Separate ratings combine under VA rules; the payments do not add together. Combine your ratings in the calculator or read the VA compensation rates (opens in a new tab).

Criteria checked against 38 CFR Part 4 (eCFR) as of 2026-07-01. 38 CFR § 4.97 explained (official text (opens in a new tab)).

VA forms for Lung Cancer

A Disability Benefits Questionnaire (DBQ) is a VA form your clinician uses to document your condition and its effects.

On this page
  1. TL;DR
  2. Lung cancer VA rating criteria (DC 6819)
  3. Is lung cancer presumptive for Agent Orange?
  4. PACT Act lung cancer: respiratory cancer of any type under § 1120
  5. Can VA deny lung cancer because you smoked? (38 USC § 1103)
  6. Is lung cancer presumptive for radiation exposure?
  7. Lung cancer residuals after the six-month exam
  8. What Wins Lung Cancer Claims at the Board
  9. Why VA denies lung cancer claims
  10. Questions veterans ask about lung cancer
    1. Is lung cancer presumptive for Agent Orange?
    2. Is lung cancer covered by the PACT Act?
    3. What is the VA rating for lung cancer after treatment?
    4. Can VA deny lung cancer because I smoked?
    5. Is lung cancer presumptive for Camp Lejeune?
    6. Is lung cancer presumptive for radiation exposure?
  11. Bottom Line

Lung cancer sits in a strange spot in the VA rating system. The diagnosis itself is almost never the contested question. Either there's a pathology report or there isn't. What gets contested is the path to service connection (which presumptive lane applies, or whether a direct nexus opinion holds up against the smoking history) and what the rating looks like six months after treatment ends.

I pulled Claim Raven's Board data for lung cancer. Across 2,483 decided Board rulings on lung cancer from 2021 to 2026, 27.3% were granted, 28.4% denied and 44.3% remanded. A ruling is one issue the Board decided in one decision; one decision often rules on several issues. The grant rate sits 2.6 points above the Board-wide 24.7%, and part of the reason is structural: lung cancer has two strong presumptive lanes (Agent Orange for veterans with qualifying herbicide-covered service and the 38 USC §§ 1119 and 1120 toxic-exposure framework) that remove the nexus question for veterans who meet every requirement. Ionizing radiation provides a separate presumption under 38 CFR § 3.309(d) or a development procedure under § 3.311 for a smaller group. When no presumption applies, the claim becomes a fight over whether the evidence connects a non-tobacco in-service exposure to the cancer.

This page walks through the DC 6819 rating mechanics, the exact presumptive and radiation pathways, the tobacco-use bar under 38 USC § 1103, the six-month re-evaluation, and the patterns that separate granted lung cancer claims from denied ones at the Board.


TL;DR

  • Lung cancer is rated under 38 CFR § 4.97 Diagnostic Code 6819. The rating is 100 percent during active treatment, with a mandatory VA examination six months after treatment ends, after which the rating drops to whatever the residuals support.
  • Across 2,483 decided Board rulings on lung cancer from 2021 to 2026, 27.3% were granted, 28.4% denied and 44.3% remanded. The grant rate is 2.6 points above the Board-wide 24.7%, and remand is the most common outcome.
  • The Agent Orange presumption under 38 CFR § 3.309(e) covers lung cancer (and respiratory cancers generally) for Vietnam-era veterans with qualifying service. This lane removes the nexus question entirely.
  • The broad toxic-exposure presumption comes from 38 USC §§ 1119 and 1120. Section 1120 covers respiratory cancer of any type for a covered veteran. Section 3.320 is a separate, narrower regulation covering nine named rare respiratory-cancer histologies and narrower service criteria.
  • The tobacco bar at 38 USC § 1103 prevents service connection based on in-service tobacco use. Section 1103(b) expressly preserves the Agent Orange and radiation presumptions. The PACT Act presumption in § 1120 is not named there; it is subject to the rebuttal rules in § 1113 instead.
  • The residuals rating after the six-month re-evaluation is where most rating disputes happen. Post-surgical residuals after lobectomy or pneumonectomy rate under DC 6844 and the restrictive lung disease formula; radiation scarring and fibrosis rate under DC 6830 and the interstitial lung disease formula.
  • The 100 percent active-treatment rating returns automatically on recurrence or metastasis. Veterans whose cancer comes back move from a residuals rating back to 100 percent for the new active-treatment phase.

Lung cancer VA rating criteria (DC 6819)

Lung cancer is rated under 38 CFR § 4.97, Diagnostic Code 6819, "Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths." The diagnostic code covers malignant tumors of any part of the respiratory system, such as the lung, bronchus and trachea.

The full regulatory text is short.

"Neoplasms, malignant, any specified part of respiratory system exclusive of skin growths: 100. NOTE: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals."

This is the same temporal structure used for malignant neoplasms across the rating schedule. It has three moving pieces.

The 100 percent floor during active treatment is automatic. As long as the veteran is undergoing surgical, radiation, chemotherapy, or other antineoplastic treatment for the lung cancer, the rating is 100 percent. There's no severity threshold to clear. Diagnosis plus active treatment plus service connection equals 100 percent.

The six-month re-evaluation is mandatory and falls on VA. The regulation requires VA to determine the rating by examination six months after the last day of active treatment. The 100 percent rating stays in place until then, and any reduction after the exam has to follow 38 CFR § 3.105(e): a written proposal with the reasons and 60 days for you to send evidence. Veterans don't have to chase the re-examination. In practice, the re-exam request usually shows up on its own.

The residuals rating is whatever the predominant residual supports. Most lung cancer treatment leaves measurable residuals: reduced pulmonary function from surgical removal of lung tissue, radiation-induced lung scarring (pulmonary fibrosis), or persistent cough and dyspnea from treatment effects. The residuals rate under whichever diagnostic code captures the dominant impairment. A lobectomy patient with reduced FEV-1 rates under the pulmonary function tables. A radiation patient with radiation-induced pneumonitis or fibrosis rates under DC 6830, which uses the General Rating Formula for Interstitial Lung Disease. A veteran with no measurable residuals (rare but possible after early-stage resection) can drop to 0 percent.

The temporal structure has one more feature worth flagging: recurrence resets the clock. If the cancer recurs or metastasizes, the 100 percent rating returns for the new active-treatment phase, and a new six-month re-evaluation runs after that round of treatment ends.


Is lung cancer presumptive for Agent Orange?

Yes, with qualifying service. The Agent Orange presumptive list at 38 CFR § 3.309(e) includes respiratory cancers (cancer of the lung, bronchus, larynx, or trachea). The relevant statutory authority is 38 USC § 1116. Respiratory cancers were added to the presumptive list in a June 1994 VA rule, and they have remained on the list since.

The qualifying service definition has expanded multiple times since the original rule.

  • Boots-on-ground Vietnam service was the original qualifying category. Veterans with documented in-country service in Vietnam between January 9, 1962 and May 7, 1975 qualify.
  • Blue Water Navy service was added by the Blue Water Navy Vietnam Veterans Act of 2019 (38 USC § 1116A). Veterans who served offshore of Vietnam, within 12 nautical miles of a baseline set out in the statute, during the same period now qualify under the same framework.
  • Thailand service at any United States or Royal Thai base between January 9, 1962 and June 30, 1976 now qualifies by statute (38 USC § 1116(d), added by the PACT Act), without regard to where on the base the veteran was located or what job the veteran performed.
  • Laos, Cambodia, Guam, American Samoa and Johnston Atoll were added by the same PACT Act subsection: Laos from December 1, 1965 to September 30, 1969; Mimot or Krek in Cambodia from April 16 to April 30, 1969; Guam or American Samoa or their territorial waters from January 9, 1962 to July 31, 1980; and Johnston Atoll, or a ship that called there, from January 1, 1972 to September 30, 1977.
  • Korean DMZ service in or near the DMZ between September 1, 1967 and August 31, 1971 also qualifies (38 USC § 1116B).

For any veteran with qualifying service who develops lung cancer, the Agent Orange presumption operates the same way: the nexus is presumed. The veteran does not need a medical opinion connecting the cancer to herbicide exposure. The regulation does the connecting.

This is part of why the lung cancer grant rate runs a little above the Board-wide rate. More than half of the lung cancer service connection rulings had a presumption in play, and those were granted somewhat more often than lung cancer service connection rulings overall; the Board section below shows the claim theory breakdown. For veterans in a qualifying-service window, the only contested questions are usually whether the qualifying service is adequately documented and whether the cancer fits the regulatory definition.

The qualifying-service question gets litigated more than the cancer question. A Blue Water Navy veteran whose ship's logs are missing or whose deck logs don't clearly place the ship within 12 nautical miles may end up fighting the qualifying-service question for years. A veteran who served in Thailand may still need personnel or unit records placing them at a United States or Royal Thai base during the covered period.


PACT Act lung cancer: respiratory cancer of any type under § 1120

The PACT Act created the broad toxic-exposure disease presumption in 38 USC §§ 1119 and 1120. Section 1119 defines covered service and presumed toxic exposure. Section 1120 supplies the disease presumption and lists "respiratory cancer of any type." Section 1119 alone is not the disease authority.

For this statutory lane, § 1119's covered-service locations and dates are these.

  • Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, the United Arab Emirates, and the airspace above them on or after August 2, 1990
  • Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Yemen, Uzbekistan, and the airspace above them on or after September 11, 2001

For a covered veteran, § 1120 covers lung cancer regardless of histologic type. Non-small cell lung cancer, small cell lung cancer, adenocarcinoma, squamous cell carcinoma, and large-cell carcinoma all fall within the statute's "respiratory cancer of any type" language.

Section 3.320 should not be used as the authority for that all-histology statement. It is a separate, narrower regulation covering squamous cell carcinoma of the larynx; squamous cell carcinoma, adenocarcinoma, and salivary-gland-type tumors of the trachea; and adenosquamous carcinoma, large-cell carcinoma, salivary-gland-type tumors, sarcomatoid carcinoma, and typical or atypical carcinoid of the lung. It also uses narrower qualifying-service rules: the Southwest Asia theater during the Persian Gulf War, or Afghanistan, Syria, Djibouti, or Uzbekistan on or after September 19, 2001.

The PACT Act framework is significant for the lung cancer claim pipeline because it captures a population of veterans who were previously fighting direct service connection against airborne hazard exposure (burn pits, oil well fires, particulate matter from the desert environment) without a presumption to fall back on. Before 2022, a Gulf War veteran with lung cancer typically had to produce a medical opinion linking the cancer to specific in-service exposures. The opinion fights were ugly, and most of these claims either lost or remanded for further development.

After 2022, the same veteran files under the PACT Act presumption and skips the opinion fight entirely. The lung cancer claim docket from 2022 forward looks structurally different from the pre-PACT Act docket for this reason.


Can VA deny lung cancer because you smoked? (38 USC § 1103)

In the decisions I read, the most common reason a direct-service-connection lung cancer claim gets denied is smoking. The medical literature is unambiguous that tobacco use is the leading risk factor for lung cancer. C&P examiners and Board members both know this. So when a veteran files a direct claim for lung cancer based on in-service exposures (asbestos, diesel exhaust, industrial chemicals), the smoking history usually shows up as the dominant alternative explanation.

The legal framework governing tobacco-use claims is 38 USC § 1103. Subsection (a) of the statute reads as follows.

"Notwithstanding any other provision of law, a veteran's disability or death shall not be considered to have resulted from personal injury suffered or disease contracted in the line of duty in the active military, naval, air, or space service for purposes of this title on the basis that it resulted from injury or disease attributable to the use of tobacco products by the veteran during the veteran's service."

Translated: VA cannot grant service connection for a disability that is "attributable to the use of tobacco products" during military service. A veteran cannot win a lung cancer claim on the theory that "I started smoking in the Army and that smoking caused my cancer."

Subsection (b) limits the bar. It says subsection (a) does not preclude service connection for a disease otherwise shown to have been incurred or aggravated in service, or one that became manifest to the required degree during a presumptive period under § 1112 or § 1116. That leaves these lanes open.

  • The Agent Orange and radiation presumptions. Section 1116 is the Agent Orange presumption, and § 1112 includes the presumption for radiation-exposed veterans. Section 1103(b) names both, so a smoking history does not defeat a claim that meets one of them, although the ordinary rebuttal rules still apply. The PACT Act presumption in § 1120 is not named in § 1103(b); § 1120 is made subject to the rebuttal rules in § 1113 instead, so the statute settles the tobacco question less clearly for that lane.
  • Direct claims based on non-tobacco in-service exposures. A veteran who can show direct exposure to asbestos, radioactive material, or other carcinogenic substances during service can win on a direct theory, with a medical opinion attributing the cancer to that exposure rather than to tobacco use.

In practice, lung cancer claims fall into three patterns.

  1. The presumptive claim: The veteran satisfies the service and disease requirements for Agent Orange, §§ 1119 and 1120, or ionizing radiation. Section 1103(b) preserves the Agent Orange and radiation presumptions by name.
  1. The direct claim with strong non-tobacco evidence: The veteran has documented in-service exposure to a known carcinogen (asbestos in shipboard environments, ionizing radiation from atomic testing, specific industrial chemicals) and a medical opinion explicitly attributing the cancer to that exposure rather than to tobacco use. These claims can win when the opinion is strong.
  1. The direct claim that hangs on tobacco: The veteran started smoking in service and the entire causation theory runs through that. These claims lose under § 1103.

Where a presumption applies, it settles the link to service, and at the Board, claims argued under a presumption were granted a little more often than direct claims; the Board section below shows both. Direct claims based on non-tobacco exposures can be won, but they need documented exposure and a medical opinion. Direct claims based on smoking lose.


Is lung cancer presumptive for radiation exposure?

The third presumptive lane for lung cancer is ionizing radiation. The relevant regulations are 38 CFR § 3.309(d) (radiation-exposed veterans) and 38 CFR § 3.311 (radiogenic diseases).

There are two distinct frameworks here, and they cover different populations.

38 CFR § 3.309(d), radiation-exposed veterans. This regulation provides automatic presumptive service connection for a defined list of cancers for veterans who participated in "radiation-risk activities." The covered activities include atmospheric nuclear weapons testing, post-Hiroshima/Nagasaki occupation, internment as a POW in Japan, and service at specific gaseous diffusion plants (Paducah, Portsmouth, Oak Ridge K-25). Lung cancer is on the presumptive list for radiation-exposed veterans under this regulation. The presumption operates the same way as Agent Orange: qualifying service plus the listed cancer equals presumed service connection.

38 CFR § 3.311, radiogenic diseases. This is a more procedural framework for veterans with documented exposure to ionizing radiation during service who don't fit the § 3.309(d) categories. The regulation requires VA to develop the case by obtaining a radiation dose estimate (from the Department of Defense for nuclear test and Hiroshima or Nagasaki occupation claims, and from VA's Under Secretary for Health for other exposures), then forwarding the case to VA's Under Secretary for Benefits for review. The Under Secretary considers whether the cancer is "at least as likely as not" related to the exposure based on the dose estimate and the latency period. This is a case-by-case adjudication, not a true presumption, but it provides a procedural pathway for veterans with documented radiation exposure that doesn't fit § 3.309(d).

Lung cancer is explicitly listed as a radiogenic disease under § 3.311(b)(2). For veterans with documented in-service radiation exposure that doesn't qualify for the § 3.309(d) presumption, the § 3.311 procedure is the right framework.

The radiation lanes cover a much smaller population than Agent Orange or PACT Act. Most lung cancer claims granted on a presumptive basis run through one of the chemical exposure lanes, not the radiation lane. But for the veterans who fit it, the radiation pathway is real and worth pursuing.


Lung cancer residuals after the six-month exam

The 100 percent active-treatment rating under DC 6819 ends six months after the last day of active treatment, subject to the mandatory VA re-examination. What happens at that re-examination determines the residuals rating going forward.

The residuals are rated under whichever diagnostic code captures the predominant impairment. The most common patterns are these.

Pulmonary function deficits after lobectomy or pneumonectomy. Surgical removal of lung tissue reduces the volume of lung available for gas exchange. The residual impairment is measured by pulmonary function testing (PFT), with FEV-1, FEV-1/FVC, and DLCO values mapping to the rating tiers in the General Rating Formula for Restrictive Lung Disease, which covers DCs 6840 through 6845. Post-surgical residuals after lobectomy or pneumonectomy are rated under DC 6844 with that formula. A pneumonectomy patient with severe restrictive impairment can rate 60 percent or higher. A lobectomy patient with modest residual deficit may rate at 10 to 30 percent.

Radiation pneumonitis and pulmonary fibrosis. Radiation therapy to the chest can cause scarring of lung tissue (radiation pneumonitis acutely, pulmonary fibrosis chronically). The residual rates under DC 6830 (radiation-induced pulmonary pneumonitis and fibrosis), which uses the General Rating Formula for Interstitial Lung Disease, with PFT criteria similar to the post-surgical framework. The fibrosis can progress over time, and re-evaluations after the initial six-month re-exam may capture worsening that supports an increased rating.

Persistent cough, dyspnea, and reduced exercise tolerance. Some veterans have functional symptoms after treatment that don't show up dramatically on PFT but produce real limitation in daily activities. The rating in these cases tends to land in the lower tiers (10 to 30 percent) and may require documentation of symptom severity beyond what PFT alone captures.

Recurrence or metastasis. If the cancer recurs or metastasizes, the 100 percent active-treatment rating returns automatically for the new treatment phase. A patient who completes treatment, drops to a residuals rating at month six, and then has a recurrence at month eighteen would move back to 100 percent for the duration of the new active treatment.

The rating disputes at the Board after the six-month re-evaluation tend to follow the pattern I've seen across other cancer claims: the dispute is rarely about whether the residuals exist, it's about whether they meet the threshold for the next-higher tier under the applicable PFT framework. Under the restrictive lung disease formula, a veteran with FEV-1 of 65 percent predicted sits at 30 percent, and a veteran with FEV-1 of 50 percent predicted sits at 60 percent. The gap between those tiers turns on a single PFT number, and PFT numbers can move from exam to exam.

When the rating dispute is about residuals, the path to a higher tier usually involves these pieces.

  • A current PFT with technically valid spirometry (proper technique, three reproducible efforts, post-bronchodilator values)
  • A C&P examination that explicitly addresses the predominant residual and applies the right diagnostic code (DC 6844 for post-surgical residuals, DC 6825 for interstitial lung disease, etc.)
  • Documentation of any constitutional or functional symptoms that aren't fully captured by PFT alone

What Wins Lung Cancer Claims at the Board

A few patterns I see consistently in granted lung cancer cases at the BVA.

Qualifying service for a presumptive lane, well-documented. DD-214 and unit records that clearly establish herbicide-covered service, service covered by § 1119, or qualifying radiation-risk activity. The documentation question is usually the contested one for presumptive claims, not the cancer question.

Pathology confirmation of malignancy. A biopsy report or surgical pathology report confirming the malignant diagnosis is essentially required. CT or imaging findings alone are not enough. The malignancy needs to be tissue-confirmed for the DC 6819 rating to apply.

A clear treatment timeline. The 100 percent active-treatment rating depends on documentation that treatment is ongoing or has ended. Surgical records, radiation oncology notes, chemotherapy administration records, and immunotherapy infusion records all qualify. The end-of-treatment date is the start of the six-month clock for the re-evaluation.

For direct claims, a medical opinion that explicitly addresses the non-tobacco exposure pathway. When the presumptive lanes don't apply and the claim depends on direct service connection, the medical opinion has to engage with the specific in-service exposure (asbestos, ionizing radiation, specific carcinogens) and explain why that exposure is the more likely cause than tobacco use. Generic opinions that just say "as likely as not related to service" don't survive the § 1103 framework when the file shows a significant smoking history. Among rulings the Board granted or denied, those with a private medical opinion in the record were granted more often than lung cancer rulings overall. That is an association, not proof of cause.

A C&P examination at the six-month mark that engages with the right diagnostic code. Residuals examinations that produce specific PFT values, identify the predominant residual, and apply the correct DC tend to support defensible residuals ratings. Generic exams that just describe the cancer history without addressing current impairment tend to produce low ratings that get appealed.


Why VA denies lung cancer claims

Across 2,483 decided Board rulings on lung cancer from 2021 to 2026, 27.3% were granted, 28.4% denied and 44.3% remanded, a grant rate 2.6 points above the Board-wide 24.7%. When the Board denied lung cancer service connection, it most often found no link to service, and less often no qualifying in-service event or exposure. The patterns behind those findings repeat.

Smoking as the cause. The examiner attributes the cancer to tobacco, and the claim rests on in-service smoking, which § 1103 bars.

Qualifying service not documented. A presumption fails because the records do not place the veteran in a covered location or covered radiation-risk activity during the covered period.

The wrong authority for the histology. A claim built on § 3.320 fails for a lung cancer type that section does not list, when the broader § 1120 presumption was the right one, or the veteran's service does not meet § 1119.

A direct claim with no exposure evidence. The opinion says "as likely as not" without documenting asbestos, radiation or another in-service carcinogen, or without addressing the smoking history.

Residual ratings without valid testing. For rating appeals, a PFT with poor technique or no post-bronchodilator values leaves the next tier unproven.

When the Board sends a lung cancer claim back instead of deciding it, the most common reason is an inadequate VA exam or opinion, followed by records VA still had to get. The Board section below shows how often each denial and remand reason came up and what the Board did with medical opinions.


Questions veterans ask about lung cancer

Is lung cancer presumptive for Agent Orange?

Yes. Respiratory cancers, including lung cancer, are on the herbicide list in 38 CFR § 3.309(e). With qualifying service in Vietnam, its offshore waters, Thailand bases, Laos, Cambodia, Guam, American Samoa, Johnston Atoll or the Korean DMZ during the covered dates, the link to service is presumed.

Is lung cancer covered by the PACT Act?

Yes, for a covered veteran under 38 USC § 1119. Section 1120 lists respiratory cancer of any type, so every lung cancer histology qualifies with service in the listed countries on or after August 2, 1990 or September 11, 2001.

What is the VA rating for lung cancer after treatment?

Lung cancer is rated 100 percent during treatment under DC 6819. Six months after treatment ends, VA examines you and rates the residuals, usually under the restrictive or interstitial lung disease formulas, unless the cancer has come back.

Can VA deny lung cancer because I smoked?

VA cannot grant service connection on the theory that smoking during service caused the cancer (38 USC § 1103). The statute preserves the Agent Orange and radiation presumptions, and a direct claim built on a non-tobacco exposure such as asbestos can still win with a medical opinion that addresses the smoking history.

Is lung cancer presumptive for Camp Lejeune?

No. Lung cancer is not on the Camp Lejeune list in 38 CFR § 3.309(f). A Camp Lejeune veteran can still claim it directly with a medical opinion linking it to the contaminated water.

Is lung cancer presumptive for radiation exposure?

Yes, for radiation-exposed veterans who took part in a radiation-risk activity listed in 38 CFR § 3.309(d), such as atmospheric nuclear testing. Other veterans with documented in-service radiation exposure go through the case-by-case dose review in § 3.311.


Bottom Line

Lung cancer is rated under 38 CFR § 4.97 Diagnostic Code 6819. The rating starts at 100 percent during active treatment and continues for six months after treatment ends, after which a mandatory VA re-examination establishes the residuals rating. Across 2,483 decided Board rulings from 2021 to 2026, the grant rate is 27.3 percent, a little above the Board-wide 24.7 percent, and remand is the most common outcome. The principal presumptive lanes are Agent Orange under 38 CFR § 3.309(e), respiratory cancer of any type under 38 USC §§ 1119 and 1120, and ionizing radiation under 38 CFR § 3.309(d); § 3.311 supplies a case-development procedure rather than an automatic presumption. Section 3.320 is a narrower alternative for nine named rare respiratory cancers and should not be cited as the all-histology authority. The tobacco bar at 38 USC § 1103 prevents claims based on in-service smoking, and § 1103(b) preserves the Agent Orange and radiation presumptions. The residuals rating after the six-month re-evaluation depends on what's left after treatment: pulmonary function deficits from lung tissue removal, fibrosis from radiation, or persistent functional symptoms. Recurrence resets the rating to 100 percent for the new active-treatment phase.


Methodology and Limitations

  • Data source: 38 CFR § 4.97 DC 6819 (malignant respiratory neoplasms), 38 CFR § 4.97 DC 6840 to 6845 (residuals frameworks), 38 CFR § 3.309(d) and § 3.311 (ionizing radiation), 38 CFR § 3.309(e) and 38 USC § 1116 (Agent Orange), 38 USC §§ 1119 and 1120 (broad toxic-exposure respiratory-cancer presumption), 38 CFR § 3.320 (narrower particulate-matter disease list), 38 USC § 1103 (tobacco-use bar), and Claim Raven's read of 511,036 Board decisions from 2021 to 2026, which contain 1,378,030 rulings, including 2,730 rulings on lung cancer.
  • Sample size: 2,483 decided Board rulings on lung cancer, with outcomes split 27.3% granted (679), 28.4% denied (705) and 44.3% remanded (1,099). Another 247 rulings were dismissed or withdrawn and are left out of the grant rate. Breakdowns by claim theory, appeal type, medical opinion and denial and remand reasons appear in the Board section below, computed from the same data. The read records that a presumption was raised, not which one, and it does not code residuals ratings, so those patterns are described in directional terms from the regulations and the decisions. The private-opinion comparison covers only rulings the Board granted or denied and is an association, not a cause.
  • Limitations: The dataset captures BVA-level decisions. Lung cancer claims granted at the regional office without appeal are not in the sample, and those claims are likely structurally easier (presumptive lane applies, qualifying service obvious) than the appealed claims that reach the Board. The presumptive frameworks have changed multiple times since the original 1994 Agent Orange rule, and older BVA decisions may reflect earlier versions of the qualifying-service definitions. The PACT Act framework is relatively new (2022) and the docket of PACT Act burn-pit lung cancer claims is still maturing at the Board level. These observations describe BVA patterns and are not predictions of individual outcomes. Claim Raven is data analysis, not legal, medical, or VA-accredited advice. If you need help with a lung cancer claim, work with an accredited representative.

What Board appeals show for Lung Cancer

These are outcomes at the Board of Veterans' Appeals, not first-time claims, and not your personal odds. They show where appeals on this issue tend to land.

How appeals on this issue ended

27.3%

granted across 2,483 decided Board rulings on Lung Cancer, 2021 to 2026.

  • Granted679 27.3%
  • Denied705 28.4%
  • Sent back1,099 44.3%

"Sent back" means remanded: the Board returned the claim to VA for more work instead of deciding it.

When the Board discussed a private medical opinion

Granted or denied rulings where the Board's decision discussed a private medical opinion (289)65.7%

All Lung Cancer granted or denied rulings (1,384)49.1%

Both rows leave out remands, because the Board weighs this evidence only when it grants or denies. Association, not cause; the Board may simply discuss stronger evidence more.

The full evidence breakdown, with grant rates for every evidence type and language from actual Board decisions, is in Raven Insights, included with every paid plan.

Why the Board denied lung cancer claims

In 316 service connection rulings the Board denied, 2021 to 2026, it found this part of the claim not shown:

  • A link between lung cancer and service (nexus)78.2%
  • An event, injury or exposure in service39.6%
  • A current diagnosis21.2%

A denial can fail more than one part, so the shares can add up to more than 100%.

Why the Board sent lung cancer claims back

Of 1,099 lung cancer rulings the Board remanded, 2021 to 2026:

  • The VA exam or opinion was not adequate53.2%
  • VA still had records to get41.7%
  • VA had not given an exam21.1%
  • The exam was out of date or the condition had worsened3.1%

A remand can ask for records and a new exam at once, so these overlap.

What happened after a remand

Legacy appeals the Board remanded and then decided again on the same docket, with the second decision in 2010 to 2026.

  • Granted when the Board decided it again27.8% of 367

Associations, not causes. Appeals under the 2019 system start a new docket each time, so they cannot be followed this way.

Results by what the appeal asked for

Board rulings on lung cancer, 2021 to 2026, by the question the Board decided. The share is granted out of every decided ruling, remands included.

  • Service connection25.7% of 1,352
  • Cause of death (DIC)28.6% of 455
  • A higher rating21.5% of 368
  • An earlier effective date37.2% of 121

What the Board did with medical opinions

Service connection rulings on lung cancer the Board granted or denied, 2021 to 2026, by the medical opinion it relied on. The share is granted.

  • It relied on a favorable medical opinion100.0% of 184
  • It relied on an opinion against the claim2.1% of 194
  • It weighed no medical opinion55.1% of 236

All granted or denied lung cancer service connection rulings: 52.4% of 664.

Remands are left out on both sides, because the Board weighs medical opinions only when it grants or denies. Associations, not causes.

Direct, secondary and presumptive claims

Service connection rulings on lung cancer, 2021 to 2026, by how the claim was argued. The share is granted out of every decided ruling, remands included.

  • Direct: it began in service26.8% of 1,142
  • Secondary: caused or worsened by a service-connected condition20.0% of 210
  • Presumptive: the law presumes the link29.1% of 776

All lung cancer service connection rulings: 25.7% of 1,352.

A presumptive claim is also counted as direct or secondary.

How lung cancer appeals have gone since 1992

Every Board ruling on lung cancer since 1992, by when it was decided. The share is granted out of every decided ruling.

  • 1992 to 20028.3% of 373
  • 2003 to February 201914.3% of 1,380
  • February 2019 to August 2022 (new appeals system)22.9% of 1,015
  • Since August 2022 (PACT Act)32.3% of 1,144

These rows come from a simpler reading of every decision's order since 1992, so they are a different measure from the 2021 to 2026 figures elsewhere on this page. Issues with unclear outcomes, or with both a decision and a remand, are left out.

What the Board cites in lung cancer decisions

Board decisions from 2019 to 2026 on lung cancer alone, and the rules and cases they cite far more often than other decisions on the same kind of issue. Each share is the part of these decisions that cite it at least once, against the same share across all decisions on that issue.

Service connection 587 decisions

  • 38 CFR § 3.307 Presumptive service connection: chronic, tropical and prisoner-of-war diseases, herbicide and Camp Lejeune exposure39.4% vs 19.5%
  • Combee v. Brown 34 F.3d 103917.7% vs 4.7%
  • 38 CFR § 3.1010 Substitution under 38 U.S.C. 5121A following death of a claimant9.2% vs 1.8%
  • 38 CFR § 3.311 Claims based on exposure to ionizing radiation5.5% vs 0.5%
  • Landicho v. Brown 7 Vet. App. 423.4% vs 0.7%
  • Smith v. Brown 10 Vet. App. 3303.4% vs 0.7%

A higher rating 170 decisions

Read from the decision text. A citation shows what the Board discussed, not which side it helped, and Board decisions are not precedential.

Do you need a nexus letter for Lung Cancer?

A nexus opinion may matter when VA disputes whether this condition is connected to service or to an already service-connected condition.

  • If service connection is already established, the dispute may be about rating severity rather than nexus.
  • If a presumptive rule covers the condition and service, a separate nexus opinion may not be required.
  • If the current diagnosis, event, or medical explanation is missing, locate that evidence before asking a clinician for an opinion.

Do you need a nexus letter for this condition? View Raven Nexus.

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