## Facts

- Clyde R. Combee, a World War II veteran, served as a military policeman in Nagasaki, Japan, arriving within weeks after the 1945 atomic bombing and remaining about ten days.
- During that period, he consumed local food and water and qualified as a “radiation-exposed veteran” under the governing statute and VA regulation.
- His service medical records reflected skin treatment in 1946 (including acute dermatitis after an allergic reaction); he later received treatment for eczema beginning in 1958 and claimed radiation exposure aggravated his condition.
- Over time, he was diagnosed with additional blood-related disorders, including leukopenia, thrombocytopenia, and neutropenia; physicians later indicated he suffered from leukopenia and neutropenia.
- VA regulation 38 C.F.R. § 3.311b provided special procedures for claims involving specified “radiogenic diseases,” but neutropenia was not among the listed conditions.
- The VA adjudicatory bodies and the Court of Veterans Appeals treated the regulatory list as exclusive and denied service connection on the ground that a nonlisted disease could not be linked to radiation exposure for compensation purposes.

## Issues

1. Whether section 5 of the Veterans’ Dioxin and Radiation Exposure Compensation Standards Act and 38 C.F.R. § 3.311b bar a veteran from establishing service connection through direct proof of actual causation for a disease not listed as “radiogenic.”
2. Whether the radiogenic-disease list operates as the exclusive route for radiation-based service-connection claims.

## Decision

- The Federal Circuit reversed the Court of Veterans Appeals.
- The court held that section 5 does not eliminate a veteran’s ability to pursue direct service connection by proof of actual causation for an unlisted disease.
- The case was remanded for consideration of Combee’s claim under the correct standard, permitting him to attempt to prove a causal nexus between in-service radiation exposure and neutropenia (or related disorders).

## Legal Principles

- Presumptive or special-procedure regulations for radiation exposure (including radiogenic-disease lists) supplement, rather than replace, traditional direct service-connection methods.
- A claimant may seek service connection by direct evidence of causation even when a claimed disease is not included in a presumptive or listed-disease framework.
- Interpreting an exposure-compensation statute or regulation to foreclose direct-causation proof for unlisted diseases requires clear authorization; absent such language, ordinary service-connection principles remain available.

## Conclusion

The Federal Circuit held that the statutory and regulatory radiation framework does not make the VA’s radiogenic-disease list exclusive; veterans remain entitled to try to prove direct service connection with competent evidence of actual causation for diseases not on the list.


Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994)