The Official Voice of Vietnam Veterans of America, Inc. ®
An organization chartered by the U.S. Congress

January/February 2004

Behind The Scenes Of Service Connection


It is a matter of black-letter law. The U.S. Department of Veterans Affairs (VA) is required to provide disability compensation and health care services to veterans who suffer from disabilities that were incurred in, or aggravated by, their military service. The operative term for eligibility for VA benefits and services as the result of such disorders is "service connection."

For most disorders, service connection requires that evidence must satisfy three basic requirements: (1) something happened in service (e.g., onset or aggravation of a disease or an injury); (2) a current diagnosis of the disorder in question; and (3) a medical professional's opinion that there is a linkage between what happened in service and the current disability (often called a "medical nexus''). For some disorders, the VA recognizes a legal presumption that a medical nexus to service exists.

This presumptive service connection eliminates the need for medical evidence of an etiological connection between military service and current disability. Diseases that are the result of exposure to Agent Orange and other herbicides in Vietnam and Korean War veterans, diseases that are the result of exposure to radiation in World War II veterans, and certain undiagnosed disorders in Gulf War veterans are examples of the principle of presumptive service connection. But how does the VA determine when to apply presumptive service connection?

In many instances, the VA asks the Institute of Medicine. IOM is part of the National Academy of Sciences, a private non-profit organization. The VA contracts with IOM to study the relationship between specified diseases and other conditions and circumstances surrounding military service, most prominently exposure to biological, chemical, and radiological agents. If IOM determines that such a relationship exists, it provides a recommendation that the VA should recognize either direct or presumptive service connection for the disorder in question should apply. The IOM also examines issues involving the health protection of currently deployed military personnel.

In an effort to provide information to the public on military-related health issues, the IOM has launched a new internet website,  The texts of a wide variety of IOM reports are accessible. The website contains information pertaining to veterans of past conflicts and active-duty personnel serving in the war on terrorism and Operation Iraqi Freedom. Deployment health issues involve strategies to protect the health of deployed forces against biological and chemical warfare agents, the adverse effects of vaccines and other drugs, decontamination, and non-battle-related health problems

There are separate sections on the website for issues of concern to veterans of various conflicts. The Gulf War section addresses the effects of various agents to which Gulf War veterans were exposed. The website's discussion concerning Vietnam-era veterans focuses on Agent Orange exposure, exposure to other chemical, biological, and radiological agents involving Projects 112/SHAD, and birth defects in the children of in-country Vietnam veterans. The Korean War section of the website zeros in on the health effects of former prisoners of war; the World War II-era site examines the effects of exposure to Lewisite, mustard gas, radiation, and the effects of abuses as prisoners of war.

According to the website, IOM is engaged in ongoing studies with respect to the acquisition of countermeasures against chemical and biological warfare agents, Agent Orange-related illnesses, the long-term effects of various adverse environmental exposures, military nutrition, weight-management research, and general deployment issues. There is also a list that provides access to selected IOM reports back to 1992.

The more veterans and their families know about the direct and indirect hazards they faced as a result of military service, the better prepared they will be to approach the VA for health care and disability compensation. The new IOM website goes a long way to assist in that education.


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