Radiation claims run on two separate tracks in the VA's regulations, and knowing which one applies explains a lot about how a claim is developed. This guide covers both, as the VA publishes them.
Track one: the presumptive list
38 CFR 3.309(d) presumes service connection for a list of cancers in veterans who took part in a radiation-risk activity. The VA's radiation exposure page describes the qualifying activities, which include atmospheric nuclear testing, the post-war occupation of Hiroshima and Nagasaki, and service at specified nuclear materials plants.
For veterans in this group, the listed cancers do not require a medical opinion linking the disease to service.
Track two: dose estimates under 38 CFR 3.311
38 CFR 3.311 handles radiogenic diseases outside the presumptive list. The VA obtains a radiation dose estimate for the veteran and refers the claim for review, including a medical opinion on whether the disease resulted from the exposure.
This track is evidence-driven rather than list-driven, which is why the medical record and the timing of the diagnosis matter more here.
The presumptive framework behind both
The service and timing requirements that govern presumptions generally live in 38 CFR 3.307. For how presumptions fit next to direct and secondary connection, see our presumptive conditions overview and our service connection guide.
Where veterans start
Every case is different, and there is no obligation at any step. When veterans want to understand what their records actually support, these are the two most common starting points:
- Medical records review
A licensed physician reviews your records for a $250 flat fee and identifies which conditions the available evidence may support. The fee is refunded in full if nothing supportable is identified.
- Nexus letter
When the records support one, a licensed provider writes the medical opinion that addresses the link between your condition and your service.
Documenting a radiation-risk activity
Because the presumption in 38 CFR 3.309(d) depends on participation in a specifically defined radiation-risk activity, the service record has to show that participation. This can include unit records, orders assigning a veteran to a nuclear test group, occupation forces records for Hiroshima or Nagasaki, or personnel records tied to a listed gaseous diffusion plant. The VA's radiation exposure page lists the recognized activities and the records the VA typically relies on to confirm them.
When service records do not clearly show participation, the VA may request additional information from the Department of Defense or other federal sources before deciding whether the radiation-risk activity is established.
How the dose-estimate process works
For claims under 38 CFR 3.311, the VA requests a radiation dose estimate, generally from the Department of Defense or another federal agency with records of the veteran's exposure. That estimate is then sent, along with the veteran's medical history, for review of whether the dose was sufficient to have caused the claimed disease.
This process takes longer than a listed presumptive claim because it depends on records from outside the VA and on a medical opinion prepared specifically for the claim. Veterans pursuing a claim under this track should expect the dose-estimate and referral process to add time to the standard claims timeline.
Choosing between the two tracks
A veteran does not choose which track applies - it depends on whether the diagnosed disease appears on the list in 38 CFR 3.309(d). When it does, the radiation-risk activity alone establishes the presumption. When it does not, the claim proceeds under 38 CFR 3.311 regardless of how strong the veteran's exposure history is.
Veterans who are unsure which category their diagnosis falls into can review the list in 38 CFR 3.309(d) directly or ask an accredited representative to help identify which process applies before filing.
This guide is educational. It summarizes the VA's own published rules and links to the exact sources it relies on. It is not legal or claims advice, and it is not a substitute for an accredited representative, who can advise you about your specific claim. Accredited help is free - search the VA's accreditation database to find a Veterans Service Organization, accredited agent, or attorney.
Frequently asked questions
What is a radiation-risk activity?
38 CFR 3.309(d) defines it to include participation in atmospheric nuclear tests, the occupation of Hiroshima or Nagasaki, service at certain gaseous diffusion plants, and prisoner-of-war service in Japan during that occupation period.
What if my cancer is not on the presumptive list?
38 CFR 3.311 creates a separate path: the VA develops a radiation dose estimate and refers the claim for a medical opinion on whether the exposure likely caused the disease.
Are all cancers covered?
No. 38 CFR 3.309(d) lists specific cancers. Other radiogenic diseases are handled through the dose-estimate process in 38 CFR 3.311.