What this means
m21-1:VIII.iv.5 explains service connection (sc) for chronic diseases. In plain terms, the official guidance says if a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic. It also addresses when deciding any claim for service connection (SC) for a chronic under 38 CFR 3.309(a), it is also necessary to consider SC based on
How this may help with a claim
Use m21-1:VIII.iv.5 when organizing evidence or checking VA's handling of service connection (sc) for chronic diseases. Compare your application, supporting records, and notice with this source-specific point: If a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic. When deciding any claim for service connection (SC) for a chronic under 38 CFR 3.309(a), it is also necessary to consider SC based on Save proof of submission and identify the exact condition, exception, or missing development step before requesting correction or choosing a review option.
What to review in your file
- Check the file against this official condition: action to take if a chronic disease was
- Confirm that the record or notice addresses this source point: If a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic.
- Document how this stated step or exception applies: When deciding any claim for service connection (SC) for a chronic under 38 CFR 3.309(a), it is also necessary to consider SC based on
Important limits
m21-1:VIII.iv.5 explains VA guidance for service connection (sc) for chronic diseases; it does not guarantee an award or replace the statutes, regulations, binding decisions, and review instructions that control an individual claim. Conditions and exceptions still matter, including this source point: If a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic. In claims based on a period of active duty for training (ADT), there is no presumption of SC for chronic diseases under 38 CFR 3.309(a) (see Smith (Valerie Y.) v.
Search terms when useful
Phrases that may help when searching your claim file or this library.
- Service Connection (SC) for Chronic Diseases
- m21-1:VIII.iv.5
- Service Connection Chronic
- Diseases
- Chronic Diseases
- definition chronic disease
- establishing whether disease chronic
- considering
Original VA guidance
The official VA text of this section
Overview
In This Chapter
This chapter contains the topic “ SC for Chronic Diseases.”
1. SC for Chronic Diseases
Introduction
This topic contains information on SC for chronic diseases, including
- definition of a chronic disease
- establishing whether a disease is chronic
- considering
- SC for a chronic disease, and
- presumptive SC
- establishing presumptive SC for chronic diseases, and
- action to take if a chronic disease was
- treated in service, and
- not treated in service.
Change Date
July 29, 2021
VIII.iv.5.1.a. Definition: Chronic Disease
A chronic disease is a disease
- of prolonged duration, producing incapacitating symptoms of varying degree
- that may undergo remission, and
- that is seldom entirely cured with all residuals of damage being completely eradicated.
VIII.iv.5.1.b. Establishing Whether a Disease Is Chronic
If a diagnosis is prefaced with the word “chronic,” that does not necessarily establish the disease as chronic.
Important: Whether a disease is chronic is a matter for a factual determination dependent on the nature of the disease and its manifestations. Some diseases are inherently chronic, such as multiple sclerosis, while others, such as bronchitis, may be either acute or chronic.
VIII.iv.5.1.c. Considering SC for a Chronic Disease
When deciding any claim for service connection (SC) for a chronic under 38 CFR 3.309(a), it is also necessary to consider SC based on
- manifestation of the claimed disease during service, and
- a presumption that the disease, which was first manifested following discharge from service, is nevertheless related to service.
VIII.iv.5.1.d. Considering Presumptive SC
Once a substantially complete claim is of record, the following conditions apply:
- the possibility of entitlement to presumptive SC exists when the Veteran alleges inception within the limiting periods contained in 38 U.S.C. 1112
- the Veteran does not need to establish that the disease in question was definitely diagnosed within the presumptive period, and
- the evidence should show that manifestations of the condition, disabling to the degree of at least 10 percent, became apparent prior to the expiration of the presumptive period shown in 38 CFR 3.307.
VIII.iv.5.1.e. Establishing Presumptive SC for Chronic Diseases
Use the table below to determine the service requirements the Veteran must meet before VA may establish presumptive SC for chronic diseases listed in 38 CFR 3.309(a).
Scroll sideways to see the full table.
| If the Veteran served during … | Then … |
|---|---|
| peacetime before January 1, 1947 | there is no provision for presumptive SC under 38 CFR 3.308(a). |
| peacetime on or after January 1, 1947, or wartime | the Veteran must have had active, continuous service of 90 days or more under 38 CFR 3.307. |
Note: In claims based on a period of active duty for training (ADT), there is no presumption of SC for chronic diseases under 38 CFR 3.309(a) (see Smith (Valerie Y.) v. Shinseki, 24 Vet.App. 40, 44 (2010)) unless SC has been established for a disability based on the period of ADT, as described in M21-1, Part III, Subpart i, 1.A.2.i.
VIII.iv.5.1.f. Action to Take if a Chronic Disease Was Treated in Service
Follow the instructions in the table below when service records show the Veteran was treated for a chronic disease.
Scroll sideways to see the full table.
| If the Veteran... | Then... |
|---|---|
| files a substantially complete claim for the condition | refer the case to the rating activity. |
| did not file a claim for the condition | solicit a claim. |
References: For more information on
- what constitutes a substantially complete claim, see
- M21-1, Part I, Subpart i, 1.A.4.f
- M21-1, Part II, Subpart iii, 1.C.1 and 2, and
- 38 CFR 3.159(a)(3), and
- soliciting claims for chronic, unclaimed disabilities, see M21-1, Part II, Subpart iii, 2.G.2.
VIII.iv.5.1.g. Action to Take if a Chronic Disease Was Not Treated in Service
Even though certain chronic diseases were not treated during service, SC may still be established on a presumptive basis under the provisions of
- 38 U.S.C. 1112, or
- 38 U.S.C. 1137.
Reference: For more information on the diseases for which SC may be established on a presumptive basis and the service requirements that must be met, see 38 CFR 3.307.