Title 38, Veterans' BenefitsRelease 119-110

§1168 Medical Nexus Examinations for Toxic Exposure Risk Activities

Title 38 › PART II — GENERAL BENEFITS › CHAPTER 11 — COMPENSATION FOR SERVICE-CONNECTED DISABILITY OR DEATH › SUBCHAPTER VI — GENERAL COMPENSATION PROVISIONS › § 1168

Last updated Sep 22, 2026|Official source

Summary

If a veteran files for service-connected disability pay and gives proof of a disability and proof they took part in a toxic exposure risk activity during active service, but that proof does not by itself show the disability is service-related, the Secretary must provide a medical exam and get a medical opinion on whether it is at least as likely as not that the disability is connected to the toxic exposure. The medical reviewer must consider the veteran’s total possible exposures across all deployments and the combined effect of the veteran’s toxic activities. The reviewer does not have to analyze the combined effect of each substance listed in section 1119(b)(2). The term “toxic exposure risk activity” is defined in section 1710(e)(4).

Full Legal Text

Title 38, §1168

Veterans' Benefits, Source: USLM XML via OLRC

(a)Medical Examinations and Medical Opinions.—

(1)Except as provided in subsection (b), if a veteran submits to the Secretary a claim for compensation for a service-connected disability under section 1110 of this title with evidence of a disability and evidence of participation in a toxic exposure risk activity during active military, naval, air, or space service, and such evidence is not sufficient to establish a service connection for the disability, the Secretary shall—

(A)provide the veteran with a medical examination under section 5103A(d) of this title; and

(B)obtain a medical opinion (to be requested by the Secretary in connection with the medical examination under subparagraph (A)) as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity.

(2)When providing the Secretary with a medical opinion under paragraph (1)(B) for a veteran, the health care provider shall consider—

(A)the total potential exposure through all applicable military deployments of the veteran; and

(B)the synergistic, combined effect of all toxic exposure risk activities of the veteran.

(3)The requirement under paragraph (2)(B) shall not be construed as requiring a health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list under section 1119(b)(2) of this title.

(b)Exception.—

Subsection (a) shall not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence.

(c)Toxic Exposure Risk Activity Defined.—

In this section, the term “toxic exposure risk activity” has the meaning given that term in section 1710(e)(4) of this title.

Reference

Citations & Metadata

Citation

38 U.S.C. § 1168

Title 38, Veterans' Benefits

Last Updated

Sep 22, 2026

Release point: 119-110