Peripheral Neuropathy (Early-Onset): VA Presumptive Condition (Agent Orange)

Service required for this presumption

Qualifying service includes service in the Republic of Vietnam between January 9, 1962, and May 7, 1975, or other qualifying herbicide exposure locations. Independently, 38 USC § 1116A covers active military, naval, or air service offshore of the Republic of Vietnam in the area defined by § 1116A(d) during the period beginning on January 9, 1962, and ending on May 7, 1975. Offshore service requires no in-country duty or visitation and no inland-waterway service. Section 1116A(a) makes service connection "subject to section 1113 of this title" and covers "a disease covered by section 1116 of this title becoming manifest as specified in that section". Section 1116A(b) states: A veteran who, during active military, naval, or air service, served offshore of the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. This condition carries a timing requirement that most herbicide presumptions do not. Early-onset peripheral neuropathy must have become manifest to a degree of 10 percent or more within one year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service (38 CFR § 3.307(a)(6)(ii)). For Republic of Vietnam service that last date is the last date the veteran served there within the covered period (38 CFR § 3.307(a)(6)(iii)); the clock does not restart at a later separation date. The requirement limits when the neuropathy appeared, not when a claim may be filed. Each route has its own authority: the Republic of Vietnam route is 38 CFR § 3.307(a)(6)(iii); the Korean DMZ route is 38 USC § 1116B(a)(2), which covers a veteran who served in or near the Korean Demilitarized Zone (DMZ) between September 1, 1967 and August 31, 1971, and names no unit requirement (38 CFR § 3.307(a)(6)(iv) still reads April 1, 1968 and speaks of service in a unit that, as determined by the Department of Defense, operated in or near the DMZ, but 1116B was added by the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23, effective January 1, 2020, and the statute controls); and the Thailand route of January 9, 1962 to June 30, 1976 at any United States or Royal Thai base is 38 USC § 1116(d)(2). The Vietnam ERA of 38 CFR § 3.2(f) is a wider window than this presumption and does not set its bounds.

About this presumption

Early-onset peripheral neuropathy is presumptively service-connected for veterans with qualifying herbicide exposure when it became manifest to a degree of 10 percent or more within one year after the last date of herbicide exposure in service (38 CFR § 3.307(a)(6)(ii)). It does not have to be short-lived, and it does not have to have resolved. VA first added acute and subacute peripheral neuropathy to the presumptive list effective November 7, 1996 (61 FR 57586), and that version covered only a neuropathy that resolved within two years of onset. VA's final rule effective September 6, 2013 (78 FR 54763) replaced "acute and subacute" with "early-onset" and removed the resolution requirement, so VA will not deny the presumption solely because the neuropathy persisted. The one-year requirement governs when the neuropathy appeared, not when a claim is filed. The TCDD-related peripheral neuropathy is typically a sensorimotor polyneuropathy. Peripheral neuropathy that first appeared later cannot use this presumption, but it is not barred from service connection. It can be claimed directly, on evidence that it was incurred in service (38 CFR § 3.303(d)), or as secondary to a service-connected condition that caused it (38 CFR § 3.310). Type 2 diabetes is one such condition for a veteran who has it; it is not a requirement for either route. Both routes need medical evidence of the link that the presumption would otherwise supply. The offshore area of 38 USC § 1116A(d), captured verbatim: Notwithstanding any other provision of law, for purposes of this section, the Secretary shall treat a location as being offshore of Vietnam if the location is not more than 12 nautical miles seaward of a line commencing on the southwestern demarcation line of the waters of Vietnam and Cambodia and intersecting the following points: Points Geographic Names Latitude North Longitude East At Hon Nhan Island, Tho Chu Archipelago Kien Giang Province 9°15.0′ 103°27.0′ At Hon Da Island southeast of Hon Khoai Island Minh Hai Province 8°22.8′ 104°52.4′ At Tai Lon Islet, Con Dao Islet in Con Dao-Vung Toa Special Sector 8°37.8′ 106°37.5′ At Bong Lai Islet, Con Dao Islet 8°38.9′ 106°40.3′ At Bay Canh Islet, Con Dao Islet 8°39.7′ 106°42.1′ At Hon Hai Islet (Phu Qui group of islands) Thuan Hai Province 9°58.0′ 109°5.0′ At Hon Doi Islet, Thuan Hai Province 12°39.0′ 109°28.0′ At Dai Lanh point, Phu Khanh Province 12°53.8′ 109°27.2′ At Ong Can Islet, Phu Khanh Province 13°54.0′ 109°21.0′ At Ly Son Islet, Nghia Binh Province 15°23.1′ 109° 9.0′ At Con Co Island, Binh Tri Thien Province 17°10.0′ 107°20.6′

Evidence still needed

A presumption does not remove the evidence requirement. VA still needs evidence of a current disability, which for this condition means a current diagnosis from a medical provider, and service records that show the qualifying service above. What it removes is the medical opinion connecting the two.

Service records showing the qualifying service and its last date; medical evidence that the neuropathy became manifest to 10 percent or more within one year after the last herbicide exposure in service, such as a nerve conduction study (NCS) and electromyography (EMG) from that period, if available; neurology records; current neurological evaluation documenting residuals. A neuropathy that persisted is still covered if it met the one-year requirement.

Controlling legal authority

38 CFR § 3.309(e); 38 USC § 1116; VA Final Rule, 61 FR 57586 (November 7, 1996); 38 CFR § 3.307(a)(6); 38 USC § 1116A; 38 USC § 1116B

• 38 CFR § 3.309
• 38 CFR § 3.307
• 38 USC § 1116
• 38 USC § 1116A
• 38 USC § 1116B

Related on VeteranHQ

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• VA presumptive conditions, explainedHow presumptive service connection works, and what it does not cover.
• All presumptive conditions by exposureAgent Orange, PACT Act, Camp Lejeune, Gulf War, and ionizing radiation.

Questions About Peripheral Neuropathy (Early-Onset) and Presumptive Service Connection