Rating Criteria by Level
There is no single diagnostic code for radiation exposure. Each presumptive cancer is rated under the code for the organ system it affects, using the schedule at 38 CFR Part 4. What every malignancy shares is the lifecycle below: 100 percent while the cancer is active, then a mandatory examination, then a rating built from whatever the disease and its treatment left behind.
Criteria: An active, untreated, or currently treated malignant neoplasm. The 100 percent evaluation continues through active treatment and for six months following the last surgery, chemotherapy, radiotherapy, or other therapeutic procedure.
Every malignant neoplasm diagnostic code carries this same rule, whether the cancer is respiratory (DC 6819), digestive (DC 7343), genitourinary (DC 7528), or hematologic (DC 7703). The six-month clock starts at the last treatment, not at the diagnosis. When the clock runs out the VA must schedule a mandatory VA examination before it can reduce the rating, and the reduction cannot take effect without proper due process notice.
Automatic 100 percent: active treatment plus six months
Criteria: Residuals of the cancer or its treatment that meet a 60 percent level under the applicable body-system code, such as significant renal dysfunction after a nephrectomy, or continuous immunosuppressive therapy following a transplant.
This is the most common outcome for veterans whose treatment removed or permanently damaged an organ. The residual is rated under the code for the organ system, not under a cancer code. Document every lasting deficit at the reexamination: lab values, imaging, and functional limits carry far more weight than a narrative statement.
Criteria: Ongoing residuals at a moderate level, such as hypothyroidism following a thyroidectomy with fatigue and cold intolerance, or persistent gastrointestinal symptoms after a partial gastrectomy.
Thyroid cancer is one of the most frequently granted radiation presumptives, and nearly every case leaves lifelong hypothyroidism requiring hormone replacement. That residual is rated under DC 7903 and should be claimed explicitly rather than assumed to carry over from the cancer rating.
Criteria: Mild but measurable residuals, such as a tender or painful surgical scar, mild anemia following treatment, or limited symptoms controlled by continuous medication.
A 10 percent residual is easy to overlook and easy to win. Surgical scars from a mastectomy, thyroidectomy, or laparotomy are separately compensable when painful or unstable, and they are rated in addition to whatever the organ system rating is, not instead of it.
Criteria: The cancer is in remission and no compensable residuals remain after the mandatory post-treatment examination.
A 0 percent rating pays nothing, but it is still a service connection and it is worth keeping. It preserves the effective date, it entitles you to VA health care for the condition, and if the cancer recurs or a late treatment effect appears years later you file for an increase rather than fighting the service-connection question all over again.
The 21 Presumptive Diseases Under 3.309(d)
These diagnoses are presumptively service-connected for any veteran who took part in a radiation-risk activity. No dose estimate and no medical nexus opinion is needed:
- Leukemia, all forms except chronic lymphocytic leukemia
- Multiple myeloma, and lymphomas other than Hodgkin disease
- Cancer of the thyroid, breast, pharynx, and salivary gland
- Cancer of the esophagus, stomach, small intestine, colon, and pancreas
- Cancer of the bile ducts and gall bladder
- Primary liver cancer, unless cirrhosis or hepatitis B is indicated
- Cancer of the lung, and bronchiolo-alveolar carcinoma
- Cancer of the bone, brain, ovary, and urinary tract
Note the two most common misses: prostate cancer and skin cancer are not on the 3.309(d) presumptive list. Both are covered under the 3.311 radiogenic pathway described below, which requires a dose estimate but is very much still winnable.
How to Service-Connect a Radiation Claim
Radiation claims run on three separate tracks, and choosing the right one at filing is the difference between a six-month grant and a three-year appeal:
Presumptive Under 3.309(d)
You participated in a listed radiation-risk activity and you have one of the 21 listed diseases. Qualifying service includes onsite participation in atmospheric nuclear tests, occupation of Hiroshima or Nagasaki from August 6, 1945 to July 1, 1946, POW internment in Japan, 250 or more days at the Paducah, Portsmouth, or K-25 Oak Ridge gaseous diffusion plants before February 1, 1992, and Amchitka Island underground testing. The PACT Act added the Enewetak Atoll cleanup, Palomares Spain, and Thule Greenland. See the related PACT Act conditions page for the full 2022 expansion.
Radiogenic Disease Under 3.311
Your cancer is not on the presumptive list, or your exposure was occupational (nuclear reactor work, radiology, weapons maintenance, depleted uranium). The VA requests a dose estimate from the Defense Threat Reduction Agency and refers the case for a causation opinion. Submit any film badge or dosimetry records you kept, plus a private nexus letter, before the referral rather than after.
Direct Service Connection
Neither pathway applies, but your service treatment records document the exposure event and a physician links your diagnosis to it. This track has no location or diagnosis list at all, so it is the fallback for one-off incidents such as a reactor accident or a mishandled radioactive source aboard ship.
What Happens at Your C&P Exam
Radiation claims generate two different exams: one at the initial claim, and a mandatory one when the 100 percent treatment rating is about to end. Expect the examiner to:
- Confirm the diagnosis with pathology reports and staging documentation
- Record the date of the last surgery, chemotherapy, or radiation session, which sets the six-month clock
- Assess whether the cancer is in remission, stable, or recurrent
- Catalog every treatment residual by organ system, including scars, fatigue, and hormone deficiency
- Screen for treatment-induced peripheral neuropathy and cognitive complaints
- Provide a causation opinion if you filed under the 3.311 radiogenic pathway
The reexamination is where ratings are lost. Bring a written list of every lasting symptom, your current medication list, and your most recent labs. If the examiner does not ask about a residual, raise it yourself and make sure it lands in the report.
Secondary Conditions to Radiation-Related Cancers
Treatment residuals are rated separately from the cancer and combine into your total. These are the claims most often left on the table:
Peripheral NeuropathyPlatinum and taxane chemotherapy agents cause lasting nerve damage in the hands and feet. Rated 10 to 40 percent per affected extremity.
HypothyroidismNear universal after thyroidectomy or neck radiation. Rated under DC 7903 at 10 to 100 percent depending on symptom burden.
Depression and AnxietyCancer diagnosis and treatment frequently trigger a compensable mental health condition. Rated 0 to 100 percent on the general mental disorders formula.
Surgical ScarsPainful or unstable scars from mastectomy, thyroidectomy, or laparotomy are separately compensable at 10 to 30 percent.
Hearing Loss and TinnitusCisplatin is directly ototoxic. See hearing loss and tinnitus for the rating criteria.
Renal DysfunctionFollows nephrectomy or nephrotoxic chemotherapy. Rated on the renal dysfunction formula from 0 to 100 percent.
Rating pages for the most commonly paired secondaries: depression, anxiety, hearing loss, tinnitus, and peripheral neuropathy.
SourcesLast reviewed: August 2026
Radiation Exposure VA Rating FAQ
What cancers are presumptive for radiation exposure?
38 CFR 3.309(d) lists 21 diseases: all leukemias except chronic lymphocytic leukemia, multiple myeloma, lymphomas other than Hodgkin disease, and cancers of the thyroid, breast, pharynx, esophagus, stomach, small intestine, pancreas, bile ducts, gall bladder, salivary gland, urinary tract, brain, bone, lung, colon, and ovary. Primary liver cancer qualifies unless cirrhosis or hepatitis B is indicated, and bronchiolo-alveolar carcinoma is separately listed.
Who counts as a radiation-exposed veteran?
A veteran who took part in a radiation-risk activity under 38 CFR 3.309(d)(3): onsite participation in atmospheric nuclear tests, occupation of Hiroshima or Nagasaki between August 6, 1945 and July 1, 1946, POW internment in Japan, at least 250 days at the Paducah, Portsmouth, or K-25 Oak Ridge gaseous diffusion plants before February 1, 1992, or underground testing at Amchitka Island. The PACT Act added the Enewetak Atoll cleanup, Palomares Spain, and Thule Greenland in 2022.
What is the VA rating for an active radiation-related cancer?
Any active malignancy is rated 100 percent during treatment and for six months after the final surgery, chemotherapy, or radiation session. That pays $3,938.58 per month for a veteran alone at 2026 rates. The VA must then schedule a reexamination before rating the residuals.
What if my cancer is not on the presumptive list?
Use 38 CFR 3.311, the radiogenic disease pathway. It covers any cancer plus posterior subcapsular cataracts, non-malignant thyroid nodular disease, parathyroid adenoma, and brain and central nervous system tumors. It is not presumptive: the VA develops a dose estimate and refers the case to the Under Secretary for Benefits for a causation opinion, so a private nexus letter and any dosimetry records you kept are worth submitting up front.
Does the VA still pay after my cancer goes into remission?
Only if residuals remain, and they usually do. A thyroidectomy leaves hypothyroidism, a nephrectomy leaves renal impairment, and chemotherapy commonly leaves peripheral neuropathy. Each residual is rated under its own body-system code and the ratings combine.
Can I refile if my radiation claim was denied before the PACT Act?
Yes. The PACT Act added radiation-risk locations in 2022, and the VA treats that as a liberalizing law change. File a supplemental claim rather than an appeal, and cite the new location language directly.
How is Radiation Exposure Compensation Act money different from VA compensation?
The Radiation Exposure Compensation Act (RECA) is a Department of Justice program that pays a one-time lump sum. VA disability compensation is a separate monthly benefit administered by the VA. A veteran can receive both, though the VA may offset monthly payments against a RECA award until the lump sum is recouped.
Do I need to prove how much radiation I received?
Not for a presumptive claim under 3.309(d). If your service falls within a listed radiation-risk activity and your diagnosis is on the list of 21, no dose estimate is required. Dose reconstruction only applies to the 3.311 radiogenic pathway, where the Defense Threat Reduction Agency prepares the estimate.