examination with medical opinion requested in accordance with may provide the required nexus. e. Establishing Consider whether direct SC may be established under , even if SC is claimed Direct SC for a disease diagnosed service has ended. SC may be awarded for a after Under 38 CFR disease diagnosed after discharge when all the evidence establishes that the 3.303(d) disease was incurred in service. The means that a Veteran will be considered to f. Definition: presumption of soundness Presumption of have been in sound condition (the claimed disability did not exist) when Soundness examined, accepted, and enrolled for service. The presumption of soundness does apply when the Exceptions: not evidence shows defects, infirmities, or disorders noted at entrance into service (such as conditions noted on the entrance examination), or the injury or disease clearly and unmistakably existed prior to service and was not aggravated by service. Notes: The presumption of soundness applies only when the Veteran underwent a physical examination at the time of entry into service on which the claim is based. Only the conditions that are recorded in the enlistment examination report are to be considered as noted. A history of pre-service conditions recorded at the time of the entrance examination is not a notation of the condition. It is just one factor that must be considered on the question of presumption of soundness. The presumption of soundness is also applicable when the Veteran underwent a physical examination upon entrance into service, but the report of examination is unavailable. In such a situation, the presumption of soundness will stand. Once the presumption of soundness arises it is only overcome when the record contains clear and unmistakable evidence showing that the disease or injury existed prior to service was not and aggravated by service. For more information on the presumption of soundness and Reference: aggravation, see M21-1, Part IV, Subpart ii, 2.B.4.a 370 F.3d 1089, 1096 (Fed. Cir. 2004) , , 25 Vet.App. 231 (2012), and , 26 Vet.App. 48 (2012).
examination with medical opinion requested in accordance with may provide the required nexus. e. Establishing Direct SC Under 38 CFR 3.303(d) Consider whether direct SC may be established under , even if SC is claimed for a disease diagnosed after service has ended. SC may be awarded for a disease diagnosed after discharge when all the evidence establishes that the disease was incurred in service. f. Definition: Presumption of Soundness The presumption of soundness means that a Veteran will be considered to have been in sound condition (the claimed disability did not exist) when examined, accepted, and enrolled for service. Exceptions: The presumption of soundness does not apply when the evidence shows defects, infirmities, or disorders noted at entrance into service (such as conditions noted on the entrance examination), or the injury or disease clearly and unmistakably existed prior to service and was not aggravated by service. Notes: The presumption of soundness applies only when the Veteran underwent a physical examination at the time of entry into service on which the claim is based. Only the conditions that are recorded in the enlistment examination report are to be considered as noted. A history of pre-service conditions recorded at the time of the entrance examination is not a notation of the condition. It is just one factor that must be considered on the question of presumption of soundness. The presumption of soundness is also applicable when the Veteran underwent a physical examination upon entrance into service, but the report of examination is unavailable. In such a situation, the presumption of soundness will stand. Once the presumption of soundness arises it is only overcome when the record contains clear and unmistakable evidence showing that the disease or injury existed prior to service and was not aggravated by service. Reference: For more information on the presumption of soundness and aggravation, see M21-1, Part IV, Subpart ii, 2.B.4.a , 370 F.3d 1089, 1096 (Fed. Cir. 2004) , 25 Vet.App. 231 (2012), and , 26 Vet.App. 48 (2012).