New VA Presumptive Service Connections - Blood, Bladder, and Genitourinary Cancers

On January 8, 2025, the the Department of Veterans Affairs (VA) announced new presumptive service connection for acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, and myelofibrosis due to exposure to Fine Particulate Mater (PM2.5.) This comes after the VA published an interim final rule (IFR) on January 1, 2025 establishing presumptive service connection for urinary bladder, ureter, and related genitourinary (GU) cancers.

What is Fine Particulate Matter?

Environmental Protection Agency (2023). Particulate Matter Basics.

Fine particulate matter (PM2.5) refers to tiny particles suspended in the air, each measuring 2.5 micrometers or smaller in diameter. These microscopic particles are a diverse mix of solid particles and liquid droplets, originating from various sources such as vehicle emissions, industrial processes, waste burning, and natural sources such as geologic dusts and regional pollutants. The small size of PM2.5 allows them to penetrate deep into the respiratory system when inhaled. The health effects of fine particulate matter are a growing concern, as scientific studies have linked exposure to PM2.5 with a range of adverse health outcomes. These may include respiratory and cardiovascular issues, exacerbation of pre-existing conditions such as asthma and heart disease, and even associations with long-term health problems such as decreased lung function and increased mortality.

The ability of PM2.5 to bypass the body's natural defenses and reach the deeper parts of the lungs and bloodstream underscores the potential risks it poses to human health. Veterans that qualify for these presumptions were likely exposed to dust, sandstorms, military burn pits, and other environmental hazards containing fine particulate matter that exceeded healthy levels. The EPA maintains National Ambient Air Quality Standards (NAAQS) which currently define a healthy exposure to PM2.5 of up to 35 ug/m3 for a 24-hour exposure and up to 9 ug/m3 for a chronic 1-year exposure.

Presumptive Conditions

Particulate matter presumptions by the VA refer to the acknowledgment that certain health conditions are presumed to be service-connected for veterans exposed to fine particulate matter at a specific location and time frame during their military service. This step lowers the burden of proof for these Veterans, meaning that they do not need to prove that their service caused their condition to receive benefits for it. Instead, VA automatically assumes service connection for the condition and provides benefits accordingly. The presumptions for urinary bladder, ureter, and related genitourinary cancers went into effect on January 2, 2025, and the presumptions for acute and chronic leukemias, multiple myelomas, myelodysplastic syndromes, and myelofibrosis will be effective on January 10, 2025.

Chronic Diseases (at any time following separation from a qualifying period of military service)

• Asthma

• Rhinitis

• Sinusitis, to include rhinosinusitis

Cancers (at any time following separation from a qualifying period of military service)

• Squamous cell carcinoma of the larynx

• Squamous cell carcinoma of the trachea

• Adenocarcinoma of the trachea

• Salivary gland-type tumors of the trachea

• Adenosquamous carcinoma of the lung

• Large cell carcinoma of the lung

• Salivary gland-type tumors of the lung

• Sarcomatoid carcinoma of the lung

• Typical and atypical carcinoid of the lung

• Urinary bladder cancer, including over-lapping sites of the bladder (NEW)

• Ureter cancer, including the ureteric orifice, and urachus (NEW)

• Acute leukemias (NEW)

• Chronic leukimas (NEW)

• Multiple myelomas, including monoclonal gammopathy of undetermined significance (MGUS) (NEW)

• Myelodysplastic syndromes (MDS) (NEW)

• Myelofibrosis (NEW)

Eligibility Criteria

To be eligible for the new particulate matter presumptions, veterans must have had a qualifying period of service - active military, naval, or air, or space service while assigned to a duty station in, including the airspace above:

On or after September 19, 2001

• Afghanistan

• Djibouti

• Egypt

• Jordan

• Lebanon

• Syria

• Yemen

• Uzbekistan

On or after August 2, 1990

• The Southwest Asia theater of operations

  • Iraq

  • Kuwait

  • Saudi Arabia

  • The neutral zone between Iraq and Saudi Arabia

  • Bahrain

  • Qatar

  • The United Arab Emirates

  • Oman

  • Gulf of Aden

  • Gulf of Oman

  • Persian Gulf

  • Arabian Sea

  • Red Sea

• Somalia

Exceptions

A disease listed above shall not be presumed service connected if there is affirmative evidence that:

1. The disease was not incurred or aggravated during active military, naval, air, or space service; or

2. The disease was caused by a supervening condition or event that occured between the Veteran’s most recent departure from active military, naval, air, or space service and the onset of the disease; or

3. The disease is the result of the Veteran’s own willful misconduct