Cheyenne VA Agent Orange Registry - Cheyenne VA Medical Center
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Cheyenne VA Medical Center


Cheyenne VA Agent Orange Registry

Agent Orange Registry Health Exam for Veterans

Thank-you for choosing the Cheyenne VA Medical Center!   The Agent Orange Registry health exam will provide valuable information and allow VA to better understand and respond to related health problems more effectively.

Important points about registry health exams:
  • Free to eligible Veterans, and without a co-payment
  • Not a disability compensation exam or required for other VA benefits
  • Enrollment in VA’s health care system is not necessary
  • Based on Veterans’ recollection of service, not on their military records
  • Will not confirm exposure to Agent Orange
  • Veterans can receive additional registry exams, if new problems develop
  • Veterans’ family members are not eligible for an Agent Orange Registry health exam

Important Note:

The Agent Orange Registry health exam is neither a disability compensation exam nor is it required for other VA Benefits.  Having a Registry Exam does NOT lead to any benefits.  A claim for benefits must be filed separately with Veterans Benefits Administration. 

For information on how to file for Agent Orange Disability Compensation, please Click Here


If you were exposed to Agent Orange during military service, you may be eligible for the Agent Orange Registry health exam. To better serve you and to make the best use of your time while at your exam, we will need to gather some basic information from you. 

Click Here to download the Agent Orange Registry Form.
The Agent Orange Registry Form will assist us in your exam.  You may print it and fill it out in pen or pencil, or you can fill it out on your computer. 

You only need to fill out the highlighted areas on the form.  Here are a few tips:

Page 1

  • Under Demographics, please fill out all the information.
  • Under Race and Ethnicity, provide the appropriate code, and under Collection Method, please place a 3 in that box for Self-Identification.
  • Under Periods of Service, please enter the code for the branch of service you served in, and the start and end date.

Page 2

  • Under Military, please place a 2 in the box for Outpatient, unless you are an Inpatient (1) or Incarcerated (3).
  • Please mark which Corps you served in.  Refer to the map below if you are unsure.
  • And finally, under Military, please list the military units in which you served in.

Page 3

  • Please fill out as much information as you know in regard to Exposure Periods, the type of Exposure, your Self Assessment of your health, and offspring Birth Data.

Return the form along with a copy of your DD214 to the Compensation and Pension Office at the Cheyenne VA Medical Center:

In Person: 

Buffalo Building Room B1-40 

Via U.S. Mail:

Cheyenne VA Medical Center
Compensation and Pension Office
2360 East Pershing Blvd.
Cheyenne, WY 82001

 Via Fax:


 Via Email:


Vietnam War Map Corps to Corps
Photo above depicts the Military Regions of South Vietnam
Photo below depicts the Provinces of South Vietnam.
Provences of Vietnam


Joseph Beneke
Environmental Health Coordinator
Compensation and Pension Office