Amyotrophic lateral sclerosis — also known as Lou Gehrig's disease — is a progressive neurodegenerative disease that attacks the motor neurons in the brain and spinal cord that control voluntary muscle movement. As motor neurons deteriorate and die, the brain loses its ability to initiate and control muscle movement. The result is progressive muscle weakness that eventually affects speaking, swallowing, and breathing.
ALS typically progresses in one of two patterns. Limb onset ALS (more common) begins with weakness or stiffness in the arms or legs. Bulbar onset ALS begins with speech or swallowing difficulties and progresses to limb involvement. In both cases, cognitive function is generally preserved while motor function deteriorates — which makes the disease particularly devastating for veterans who remain fully aware of their physical decline.
The average life expectancy following an ALS diagnosis is 2–5 years, though approximately 10% of patients survive 10 years or more. Stephen Hawking, who lived 55 years with ALS, is a well-known exception. For most veterans with ALS, however, the disease progresses rapidly — making early and aggressive benefit filing critical.
Research consistently finds that military veterans have a higher incidence of ALS compared to the general population. Studies published in peer-reviewed journals including Neurology and ALS and Frontotemporal Degeneration have found veterans face 1.5–2x the ALS risk of age-matched civilians. The exact cause remains under investigation, but proposed mechanisms include:
Because the science has not identified a single definitive cause — and because veterans face such elevated risk across exposure categories — Congress and VA determined in 2008 that requiring individual veterans to prove causation was both scientifically unfair and administratively burdensome. The presumptive rule was the result.
Under 38 CFR § 3.318, VA presumes that ALS diagnosed in a veteran is related to their military service, provided the veteran meets the basic service eligibility requirement. This regulation, effective September 23, 2008, was one of the broadest presumptive expansions in VA history because it applied to all veterans regardless of era, MOS, or specific exposure history.
A veteran is eligible for the ALS presumptive if they: (1) served on active duty, active duty for training, or inactive duty training for 90 days or more in the aggregate; (2) have a current diagnosis of ALS from a physician; and (3) have no disqualifying discharge. That's it. No exposure proof. No nexus letter. No medical opinion linking ALS to service.
The 90-day aggregate service requirement means the days do not need to be continuous. A veteran who served 45 days, separated, and then served another 45 days on a different enlistment meets the 90-day threshold. For most veterans, who served at least one 2+ year enlistment, this requirement is easily satisfied.
There is no time limit between separation from service and ALS diagnosis. A veteran diagnosed with ALS 40 years after honorable discharge is still eligible for the presumptive. This is important because ALS's latency period — the time between potential exposure and disease onset — can span decades.
The presumptive applies across all eras of service: World War II veterans, Korea, Vietnam, Gulf War, OEF/OIF/OND, and post-9/11 veterans. If you served 90 days and you have ALS, you qualify.
VA rates ALS under Diagnostic Code 8017 in 38 CFR Part 4 — the Schedule for Rating Disabilities. DC 8017 covers "amyotrophic lateral sclerosis" and by regulation assigns an automatic 100% schedular rating.
The 100% rating is not based on measuring specific functional deficits — it is categorical. The diagnosis itself triggers the 100% rating. VA does not rate ALS at 10%, 30%, or 70% based on progression; it is always 100% from the effective date of the claim.
| Benefit | Monthly Amount (2026) | Who Gets It |
|---|---|---|
| 100% VA Disability (single veteran, no dependents) | $3,737.85 | Veteran |
| 100% VA Disability (with spouse) | $4,072.28 | Veteran |
| SMC-L (aid and attendance) | $4,871.16 | Veteran (in addition to 100%) |
| DIC base rate (surviving spouse) | $1,562.74 | Surviving spouse after veteran's death |
The effective date for the 100% rating is the date VA receives the claim — or the date of discharge if the veteran files within one year of separation. This makes filing immediately upon diagnosis critically important, as back pay accumulates from the effective date.
Total Disability Individual Unemployability (TDIU) is a benefit that allows veterans with less than 100% schedular rating to receive 100% pay if their service-connected conditions prevent gainful employment. Since ALS is already 100% schedular, TDIU is not necessary — though veterans may wish to ensure TDIU is also on file as a protective measure if there are any rating issues.
Special Monthly Compensation (SMC) is additional compensation beyond the standard rating amounts, provided to veterans who need more support due to the severity of their service-connected conditions. For ALS veterans, the most critical SMC level is SMC-L — the "aid and attendance" rate.
SMC-L applies when a veteran requires the regular aid and attendance of another person to perform daily activities, including bathing, feeding, dressing, or attending to hygiene. It also applies if the veteran is bedridden, has a significantly impaired visual acuity, or is in a nursing home due to service-connected disability.
Because ALS progressively destroys motor function, virtually every ALS veteran will eventually require the regular aid and attendance of another person. VA policy effectively treats ALS as presumptively qualifying for SMC-L as the disease progresses. Veterans should file for SMC-L at diagnosis or as soon as care needs begin — do not wait until the condition is advanced. The SMC-L rate in 2026 is $4,871.16/month, replacing (not adding to) the 100% rate.
Beyond SMC-L, veterans with ALS may also qualify for higher SMC tiers as the disease progresses:
As ALS progresses and the veteran requires mechanical ventilation or continuous skilled nursing support, SMC-T becomes the applicable rate. This is significantly higher than SMC-L. Ensuring your claims file is updated as your condition progresses is essential to receiving the full benefit.
Dependency and Indemnity Compensation (DIC) is a monthly benefit paid to eligible survivors of veterans who die from service-connected conditions. Because ALS is 100% service-connected for all eligible veterans, the surviving spouse, dependent children, and parents of a veteran who dies from ALS are entitled to DIC.
| DIC Benefit Component | Monthly Amount (2026) |
|---|---|
| Base DIC rate (surviving spouse) | $1,562.74 |
| Additional: veteran rated 100% for 8+ continuous years before death | +$340.99 |
| Additional: surviving spouse with dependent child under 18 | +$340.99 |
| Additional: surviving spouse needs aid and attendance | +$420.32 |
| Additional: surviving spouse is housebound | +$151.98 |
A surviving spouse who qualifies for DIC and also has dependent children can receive over $2,000/month in combined DIC benefits. These amounts are tax-free and increase annually with cost-of-living adjustments.
The surviving spouse should file for DIC using VA Form 21P-534EZ as soon as possible after the veteran's death. The effective date for DIC is the date VA receives the claim, so delay means lost benefits.
Filing an ALS claim requires moving quickly because of the disease's progression and because back pay starts from the date of claim — not the date of diagnosis.
The primary form for VA disability claims is VA Form 21-526EZ, the Application for Disability Compensation and Related Compensation Benefits. You can file online at va.gov, by mail, or through a VA-accredited representative.
On the form, list "Amyotrophic Lateral Sclerosis (ALS) — presumptive under 38 CFR § 3.318" as the claimed condition. This flags the claim for the correct presumptive pathway from the start.
File for Special Monthly Compensation (SMC) at the same time as your initial disability claim. Request SMC based on aid and attendance requirements. Attach a statement from your physician or caregiver documenting your current care needs.
VA has a terminal illness processing protocol. Annotate your claim envelope or online submission with "TERMINAL ILLNESS — ALS" and include a physician's statement confirming the terminal prognosis. This triggers faster processing at the VA regional office.
Track your claim at va.gov/claim-or-appeal-status. If you haven't received a rating decision within 4–6 weeks for a terminal illness claim, contact your VSO or attorney to escalate.
Because ALS is a presumptive condition, the evidentiary requirements are simpler than for most VA claims — but you still need to submit the right documents to avoid delays.
DD-214 or service record confirming 90+ days active duty · Neurologist's diagnosis of ALS (ideally including clinical criteria: EMG findings, upper and lower motor neuron involvement) · Personal statement confirming current care needs (for SMC) · Caregiver/family statement about aid and attendance needs (for SMC)
What you do NOT need:
The presumption eliminates the need for causation evidence entirely. The only medical evidence needed is the ALS diagnosis itself. This is fundamentally different from non-presumptive VA claims where the nexus letter is the centerpiece of the claim.
VA recognizes that veterans with terminal illnesses cannot wait 12–18 months for a rating decision. The agency has established expedited processing protocols for terminal illness claims, including ALS.
Under the terminal illness protocol:
For the fast-track to work, the claim file must be complete when submitted. A Fully Developed Claim (FDC) with all required documentation submitted upfront gives VA everything it needs to decide immediately without waiting for additional development. This is why having an experienced representative — VSO or accredited attorney — submit the claim is valuable: they know exactly what constitutes a complete package for an ALS presumptive claim.
Veterans who have been diagnosed with ALS and not yet filed should file immediately. Do not wait until the disease has progressed further. The effective date for back pay is the date of filing, not the date of diagnosis — so a veteran who waits six months before filing loses six months of benefits, which at $3,700–$4,800/month represents $22,000–$29,000 in forfeited back pay.
VA-accredited attorneys who specialize in veterans benefits can be particularly valuable for ALS claims — not because the initial claim is complicated (the presumptive makes it straightforward) but because maximizing the total package requires legal knowledge across multiple benefit systems:
The difference between SMC-L and SMC-T is thousands of dollars per month. An experienced attorney knows the progression criteria for each SMC tier and can ensure the veteran's claims file is updated as their condition warrants higher compensation. This requires knowing when and how to file for SMC increases — not waiting for VA to initiate it.
If a veteran filed for a condition years ago that was denied or rated incorrectly — or if ALS was already present but not yet diagnosed formally — an attorney can argue for an earlier effective date based on informal claims, earlier medical records, or application of the benefit of the doubt standard.
Attorneys can help veterans and their spouses prepare DIC paperwork in advance so that when the veteran passes, the surviving spouse can file immediately with complete documentation. This prevents the loss of months of DIC payments while a surviving spouse navigates grief and unfamiliar paperwork.
ALS qualifies for Social Security's Compassionate Allowances program, which fast-tracks SSDI approval. An attorney experienced in veterans law can refer to and coordinate with SSDI counsel, ensuring the veteran receives both VA and Social Security benefits simultaneously.
If you have been diagnosed with ALS and have questions about your VA benefits or want representation for your claim, claim.vet's attorney marketplace connects ALS veterans with accredited attorneys who handle terminal illness claims. You can also take our quick qualification quiz to understand what benefits you may be entitled to.
The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act of 2022 expanded VA's presumptive conditions to cover many more cancers and conditions for veterans with toxic exposures. ALS was included in the PACT Act's expanded list — but for most veterans, the earlier 38 CFR § 3.318 presumptive is more advantageous.
Here's why: The PACT Act presumptive for ALS requires toxic exposure documentation (burn pit registry, specific deployment locations, etc.). The § 3.318 presumptive requires only 90 days of service with no exposure requirement at all. For ALS specifically, § 3.318 is the broader and more powerful presumptive for the vast majority of veterans.
However, the PACT Act matters for ALS in another important way: it lowered the general evidentiary standard for toxic exposure claims, and it extended the statute of limitations for certain appeals. Veterans whose earlier ALS claims were denied — particularly Vietnam-era veterans — may have new grounds for reopening their claims under the PACT Act's expanded framework.
Related resources on claim.vet: PACT Act Presumptive Conditions (Hub) · Agent Orange Presumptive Conditions · Burn Pit Exposure VA Claims.
ALS Claim: Start Here
ALS claims need to move fast. Our free claim review helps you understand your 100% presumptive rating, SMC-L eligibility, and DIC planning — and connects you with attorneys who specialize in terminal illness VA claims.
Check My ALS Benefits — Free →Editorial Standards: Written by Marcus J. Webb, veterans benefits researcher. Verified against 38 CFR § 3.318 and current VA rating schedules. Last reviewed: July 2026. Not legal advice — for representation, connect with a VA-accredited attorney.
ALS is 100% presumptive. Don't wait — your effective date is the date you file. Free claim review, no phone calls required.
Start My Free Claim Review — No Phone Required →