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38 CFR 3.309(e) · Presumptive Exposure

Agent Orange Presumptive Conditions

More than 20 diseases are presumptively service-connected for veterans exposed to Agent Orange, which means the VA accepts the connection without a nexus letter. Type 2 diabetes is the most claimed of them: at 20 percent it pays $356.66/month in 2026, and its complications are rated separately on top.

10%Restricted Diet Only$180.42/mo
20%Oral Medication or Insulin, Plus Restricted Diet$356.66/mo
40%Insulin, Diet, and Regulation of Activities$795.84/mo
60%Episodes Requiring Hospitalization or Frequent Care Visits$1,435.02/mo
100%Multiple Daily Insulin Injections With Progressive Decline$3,938.58/mo

Rating Criteria by Level

Agent Orange is an exposure pathway, not a diagnostic code, so there is no single rating scale for it. Each presumptive disease is rated on its own criteria under 38 CFR Part 4. The scale below is for Type 2 diabetes mellitus (diagnostic code 7913, rated under 38 CFR 4.119), the most frequently claimed Agent Orange presumptive condition.

10%Restricted Diet Only
$180.42/mo

Criteria: Type 2 diabetes is manageable by a restricted diet alone, with no oral medication and no insulin.

This is the floor rating under diagnostic code 7913. Any confirmed diabetes diagnosis requiring dietary management is compensable at 10 percent. Many veterans start here and move up as the disease progresses, so a rating increase request is appropriate the moment medication is added.

20%Oral Medication or Insulin, Plus Restricted Diet
$356.66/mo

Criteria: Diabetes requires an oral hypoglycemic agent (such as metformin) and a restricted diet, or insulin and a restricted diet, without any regulation of activities.

This is the most commonly awarded Agent Orange diabetes rating. The vast majority of presumptive diabetes claims land here because most veterans are managed on metformin plus diet. Note that complications of diabetes are rated separately, so this 20 percent is often only the starting point of a much larger combined rating.

Most common rating: metformin plus restricted diet qualifies
40%Insulin, Diet, and Regulation of Activities
$795.84/mo

Criteria: Diabetes requires insulin, a restricted diet, and regulation of activities, meaning a physician has directed avoidance of strenuous occupational and recreational activities.

The regulation of activities requirement is the hard gate at this level, and it is where most 40 percent claims are denied. The Court has held that a physician must actually prescribe activity restriction; self-imposed limits do not count. Ask your endocrinologist to document activity restriction explicitly in your treatment notes if it applies.

60%Episodes Requiring Hospitalization or Frequent Care Visits
$1,435.02/mo

Criteria: Insulin, restricted diet, and regulation of activities, plus episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice-monthly visits to a diabetic care provider, plus complications that would not be compensable if rated separately.

At this level the VA is looking for a documented pattern of acute events. Keep every emergency department record, every after-visit summary, and every glucose log. Complications that carry their own compensable rating (retinopathy, nephropathy, peripheral neuropathy) are rated separately rather than folded into this level.

100%Multiple Daily Insulin Injections With Progressive Decline
$3,938.58/mo

Criteria: More than one daily insulin injection, restricted diet, and regulation of activities, plus episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or separately compensable complications sufficient to be rated 100 percent alone.

The 100 percent schedular rating for diabetes is uncommon and requires every element to be met. Veterans with advanced complications more often reach 100 percent through combined ratings across separately rated complications, or through TDIU when the disease prevents substantially gainful employment.

Presumptive Cancers

Malignancies on the Agent Orange list are rated 100 percent while active and through the treatment period. Six months after treatment concludes, the VA re-examines and rates the residual impairment instead.

Prostate Cancer

Active malignancy rates 100 percent under DC 7528. After treatment, the rating drops to residuals such as voiding dysfunction or erectile dysfunction.

Respiratory Cancers

Lung, bronchus, larynx, and trachea. Active malignancy rates 100 percent, then steps down to residual lung function measured by PFT results.

Non-Hodgkin Lymphoma

100 percent during active disease and for six months after treatment ends, then rated on residuals.

Hodgkin's Disease

100 percent while active and through the treatment period, then re-evaluated on remaining impairment.

Multiple Myeloma

Rated 100 percent during active disease. A plasma cell malignancy that also underpins the MGUS presumptive added in 2021.

Chronic B-Cell Leukemias

Includes chronic lymphocytic leukemia and hairy cell leukemia. Rated 100 percent when active.

Bladder Cancer

Active malignancy rates 100 percent under DC 7528, then residual voiding dysfunction or urinary frequency.

Soft Tissue Sarcomas

A group of connective tissue malignancies. Rated 100 percent during active disease, then on functional residuals.

Presumptive Chronic Conditions

These non-cancer diagnoses carry the same presumption of service connection. Three of them (hypertension, MGUS, and hypothyroidism) were added between 2021 and 2022, which is why so many older denials are now worth reopening.

Type 2 Diabetes Mellitus

DC 7913, rated 10 to 100 percent. The single most claimed Agent Orange presumptive condition.

Ischemic Heart Disease

Rated on METs exercise tolerance from 10 to 100 percent. Includes coronary artery disease and prior myocardial infarction.

Hypertension

Added by the PACT Act in 2022. Rated 10 to 60 percent under DC 7101 based on diastolic and systolic pressure readings.

Parkinson's Disease and Parkinsonism

Rated on the affected extremities and functional impairment. Parkinsonism was added as a separate presumptive in 2021.

Early Onset Peripheral Neuropathy

Must have appeared within one year of exposure. Rated 10 to 40 percent per affected extremity.

AL Amyloidosis

A protein deposition disease rated on the organ systems it damages, most often the heart and kidneys.

Hypothyroidism

Added as a presumptive in 2021. Rated 10 to 100 percent under DC 7903 based on symptom severity.

MGUS

Monoclonal gammopathy of undetermined significance, added by the PACT Act in 2022. Rated on hematologic findings and any progression.

Chloracne

Must appear within one year of exposure. Rated 0 to 30 percent on the extent of skin involvement.

Porphyria Cutanea Tarda

Must appear within one year of exposure. Rated on skin involvement and liver findings.

How to Establish an Agent Orange Claim

A presumptive claim removes the nexus requirement, but it does not remove the other two elements. You still need qualifying service and a current diagnosis. There are three routes to a grant:

Presumptive Service Connection

Prove you served in a qualifying location during the qualifying window, and show a current diagnosis from the 38 CFR 3.309(e) list. The VA then presumes both exposure and causation. No nexus letter is needed.

Direct Connection With Proven Exposure

If your diagnosis is not on the list, or your service location is not covered, you can still win by documenting actual herbicide exposure (unit histories, buddy statements, base storage records) and obtaining a medical nexus opinion tying that exposure to your condition.

Secondary to a Presumptive Condition

Once a presumptive is granted, everything it causes becomes claimable. Diabetes drives peripheral neuropathy, retinopathy, and kidney disease. Ischemic heart disease drives sleep apnea claims and activity-limitation secondaries. Each secondary carries its own rating.

What Happens at Your C&P Exam

The exam for a presumptive claim is about severity, not causation. The examiner is not deciding whether Agent Orange caused your disease; that question is already settled by regulation. Expect the examiner to:

  • Confirm the diagnosis and review lab work (A1C, lipid panel, pathology reports, imaging)
  • Document your exact treatment regimen: diet only, oral medication, insulin, and injection frequency
  • Ask specifically whether a physician has restricted your activities, which is the gate for 40 percent and above
  • Count hospitalizations and diabetic care visits over the past 12 months
  • Screen for complications that must be rated separately, including peripheral neuropathy, retinopathy, nephropathy, and erectile dysfunction
  • Record cardiac findings and METs tolerance if ischemic heart disease is also claimed

Bring your DD-214 or deployment orders proving the qualifying location, a current medication list, and any note in which your doctor restricted your activities. The regulation of activities language is the single most common reason a 40 percent diabetes claim gets denied at 20 percent instead.

Secondary Conditions to Agent Orange Presumptives

The presumptive itself is often the smaller part of the award. Complications flowing from a service-connected presumptive are rated separately and combine into your total.

Peripheral Neuropathy

Diabetic nerve damage in the feet and hands. Rated 10 to 40 percent per extremity, so bilateral involvement can add substantially to a combined rating.

Diabetic Retinopathy

Rated on visual acuity and field loss. Advanced cases can reach very high ratings on the vision schedule.

Diabetic Nephropathy

Kidney damage rated on the genitourinary schedule from 0 to 100 percent, with dialysis at the top of the scale.

Hypertension

Now presumptive in its own right after the PACT Act, and also commonly secondary to diabetes and kidney disease. Rated 10 to 60 percent under DC 7101.

Erectile Dysfunction

A recognized diabetic complication. Usually rated 0 percent but qualifies for Special Monthly Compensation (SMC-K), a separate flat monthly payment.

Depression

Chronic disease management and functional decline commonly support a secondary mental health claim. Rated 0 to 100 percent on the mental disorders scale.

SourcesLast reviewed: July 2026

Agent Orange VA Rating FAQ

What does presumptive mean for an Agent Orange claim?
Presumptive means the VA accepts the link between your service and your diagnosis without requiring a nexus letter. If you served in a qualifying location during a qualifying period and you have a diagnosis on the 38 CFR 3.309(e) list, the VA presumes exposure and presumes the connection. You still have to prove the diagnosis and you are still rated on severity.
What is the VA rating for Type 2 diabetes from Agent Orange?
Type 2 diabetes is rated under diagnostic code 7913 at 10, 20, 40, 60, or 100 percent. Oral hypoglycemic medication plus a restricted diet is 20 percent, which pays $356.66 per month at 2026 rates. Insulin plus restricted diet plus regulation of activities is 40 percent, paying $795.84 per month.
Is high blood pressure an Agent Orange presumptive condition?
Yes. The PACT Act of 2022 added hypertension and MGUS to the Agent Orange presumptive list. Hypertension is rated under diagnostic code 7101 from 10 to 60 percent based on your diastolic and systolic readings.
Which locations qualify for Agent Orange presumptive exposure?
Vietnam and its inland waterways (January 9, 1962 to May 7, 1975), the Korean DMZ (September 1, 1967 to August 31, 1971), Thailand air bases, Laos, certain Cambodian provinces, Guam and American Samoa (1962 to 1980), Johnston Atoll (1972 to 1977), and C-123 aircraft crews (1969 to 1986). Several of these were added by the PACT Act in 2022.
Can I file again if my Agent Orange claim was denied years ago?
Yes. If your condition or your service location was added to the presumptive list after your denial, that counts as a liberalizing law change and you can file a supplemental claim. Veterans denied for hypertension, or denied for Thailand or Guam service before 2022, are the largest group affected by the PACT Act.
Do I still need a nexus letter for a presumptive condition?
No. That is the entire value of a presumptive. What you do need is proof of the qualifying service (DD-214, unit records, flight or deployment orders) and a current diagnosis from a qualified provider. If either of those is weak, the presumption never gets applied.
What if my condition is not on the presumptive list?
You can still win on a direct basis. You would need evidence of actual herbicide exposure and a medical nexus opinion connecting that exposure to your diagnosis. This is a harder path, but it is available for any condition, including bladder conditions, other cancers, and secondary conditions caused by a presumptive diagnosis.
Do surviving family members qualify for Agent Orange benefits?
Yes. If a veteran died from a presumptive condition, surviving spouses and dependents may qualify for Dependency and Indemnity Compensation. Children of Vietnam veterans with spina bifida have a separate benefit program that does not depend on the veteran having filed a claim.