During the war in Vietnam, swift boats operated in teams of three to five for interdiction of Viet Cong supplies along the 1,500 miles of rivers and canals. Because of Agent Orange exposure, veterans who served on those boats are considered to be at higher risk of DLBCL. U.S. Navy photo
WASHINGTON, DC — Exposure to a wide range of chemicals and radiation has long been known to increase the risk of developing diffuse large B-cell lymphoma (DLBCL). As research has identified new agents associated with increased risk, the U.S. Congress and the VA have responded by facilitating access to healthcare for veterans who were exposed to these agents during their service.
Over more than three decades, the VA has progressively expanded the recognition of certain lymphomas, including DLBCL, as presumptive conditions. Throughout these expansions, the VA has consistently relied on scientific evidence to identify and recognize conditions linked to military service exposures and to provide appropriate care to meet the unique health challenges posed by military service.
Atomic veterans
In 1990, Congress enacted the Radiation-Exposed Veterans Compensation Act, establishing a presumptive service connection for specific cancers linked to ionizing radiation exposure. Non-Hodgkin’s lymphoma (NHL) was among the conditions recognized under this legislation. DLBCL is the most common subtype of NHL. This act primarily benefited “atomic veterans” who participated in atmospheric nuclear tests, occupied Hiroshima or Nagasaki, or were held as prisoners of war in Japan during World War II.1,2
The Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act (PACT Act) of 2021 expanded coverage for DLBCL for several groups of veterans exposed to radiation. The expansion added veterans who had been involved in the cleanup of Enewetak Atoll from January 1, 1977, thorugh December 31, 1980; veterans who helped clean the Air Force B-52 bombers that carried nuclear weapons off the coast of Palomares, Spain, from January 17, 1966, through March 31, 1967; and those who responded to the fire onboard an Air Force B-52 bomber carrying nuclear weapons near Thule Air Force Base in Greenland from January 21, 1968, to September 25, 1968.3
Agent Orange
The Agent Orange Act of 1991 acknowledged a presumptive service connection for NHL related to Agent Orange exposure for veterans who served on land or on the inland waterways of Vietnam between January 9, 1962, and May 7, 1975.4
Agent Orange combined two highly toxic chemicals: 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid. The highly toxic dioxin contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin, a byproduct of Agent Orange production, is widely considered the most carcinogenic component of the herbicide used extensively during the Vietnam War.
The publication of the National Academy of Sciences, formerly the Institutes of Medicine, report, “Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam” definitively established a positive association between herbicide exposure and NHL in 1994.5
in 2022, the PACT ACT also expanded presumptive coverage of DLBCL related to Agent Orange exposure to ‘Blue Water’ veterans who served in Vietnam or its territorial waters from January 9, 1962 to May 7, 1975. Veterans who served on or near the Korean demilitarized zone between September 1, 1967 and August 31, 1971 and active duty and reservist personnel who had regular contact with C-123 aircraft between 1969 and 1986 were also added.
The VA further expanded coverage in 2024 to include veterans who served in Thailand, at any U.S. or Thai base between January 9, 1962 and June 30 1976. It also extended presumptive coverage to veterans who served in Laos from December 1, 1965 to September 30, 1969 and in Cambodia, specifically at Mimot or Krek, Kampong Cham Province from April 16, 1969 to April 30, 1969. Service in certain Pacific regions was also added, specifically, in Guam or American Samoa or their territorial waters from January 9, 1962 to July 30, 1980 or in Johnson Atoll or a ship that called at Johnston Atoll from January 1, 1972 to September 30, 1977.
Burn Pit Exposures
The PACT Act expansion by the VA also added lymphomas of any kind as a presumptive condition for veterans exposed to burn pits, which were commonly used to dispose of waste during conflicts over the last 35 years in the Persian Gult and Southwest Asia. In addition to the chemicals released by the burning materials, JP-8 jet fuel, which contains benzene, was often used as an accelerant for burn pits. Benzene exposure, in particular, is a known risk factor for NHL.
To be eligible for PACT Act compensation for exposure to burn pits or other toxins, veterans must have served at some point since Aug. 2, 1990, on the ground or in the airspace above Bahrain, Iraq, Kuwait, Oman, Qatar, Saudi Arabia, Somalia, United Arab Emirates, the Arabian Sea, the Gulf of Aden, the Gulf of Oman, the neutral zone between Iraq and Saudi Arabia, the Persian Gulf or the Red Sea; or since Sept. 11, 2001, on the ground or in the airspace above Afghanistan, Djibouti, Egypt, Jordan, Lebanon, Syria, Uzbekistan or Yemen.
While the PACT Act covers all lymphomas, a recent study of individuals who served in Afghanistan or Iraq between 2001 and 2022 found that deployment to these locations particularly increased DLBCL and related malignancies. “Prior deployment was associated with more aggressive B-cell lymphoma than military personnel who had never deployed,” noted researchers from Walter Reed National Military Medical Center, Wright Patterson Air Force Base and Brooke Army Medical Center, in their study that included 2,599 active duty servicemembers and retirees diagnosed with NHL during the study period.6
Contaminated Water
All NHLs, including DLBCL, are also presumptive conditions for veterans who served for at least 30 days at either Marine Corps Base Camp Lejeune or Marine Corps Air Station New River between Aug. 1, 1953, and Dec. 31, 1987 under the Camp Lejeune Justice Act of 2022, which is section 804 of the PACT Act. These veterans experienced exposure to water contaminated with benzene, cidhlorethylene, tetrachoroethylene, trichloroethylene, vinyl choloride and other contaminants.
“For decades, these veterans bravely served our country while exposing themselves to hazards like burn pits or Agent Orange — and many got sick as a result,” said former VA Secretary Denis McDonough on the second anniversary of the PACT Act. “We want all of these heroes — and their survivors — to come to VA for the health care and benefits they earned and so rightly deserve.”
These steady expansions reflect the VA’s ongoing commitment to adapting its policies in light of emerging scientific evidence, ensuring that veterans affected by DLBCL receive the support and benefits warranted by their service-related exposures.
- Congressional Research Service. The Radiation Exposure Compensation Act (RECA): Compensation Related to Exposure to Radiation from Atomic Weapons Testing and Uranium Mining. June 14, 2022.
- H.R.1811—Radiation-Exposed Veterans Compensation Act of 1988. Congress.gov. May 20, 1988.
- PACT Act. New York State Department of Veterans’ Services.
- H.R.556—Agent Orange Act of 1991. Congress.gov.
- Institute of Medicine (US) Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam. Washington (DC): National Academies Press (US); 1994.
- Sgrignoli R, Rendo M, Fenderson JL, et al. Impact of military deployment on non-Hodgkin lymphoma subtype. Meeting Abstract: 2024 ASCO Annual Meeting I. JCO. 2024 May;42(16 Suppl). E19070. 2023 Nov;60(5):255-266.