Potential Eligibility Changes For Vietnam Veterans
The Department of Veterans Affairs may be close to including bladder cancer among the presumed affects of Agent Orange.
Currently, if a veteran can prove that they were exposed to Agent Orange during military service, they may be eligible for disability compensation. However, the VA has a defined list of health problems which are “presumed” to be the result of that exposure. The list of presumptive diseases includes conditions like prostate cancer, peripheral neuropathy, and non-hodgkin’s lymphoma.
Periodically, the VA re-evaluates its stance regarding which medical conditions are presumed to be a result of Agent Orange exposure. The most recent change to the VA’s position regarding Agent Orange presumptive illnesses was in 2010, when the VA added ischemic heart disease, Parkinson’s disease, and chronic B-cell leukemia to the list. The addition of these three conditions to the presumptive list, resulted in newfound compensation eligibility for thousands of Agent Orange exposed Veterans and their survivors.
Fortunately, it appears that the VA may be on its way to adding even more conditions to the Agent Orange presumptive list. A new report issued in March 2016 by the Institute of Medicine, an IOM committee charged with reviewing the health effects of Agent Orange on Vietnam Veterans, states that there is “limited or suggestive evidence” to link bladder cancer to this type of herbicide exposure.
This could mark a major shift in their position. Previously, the IOM denied that there was a connection between bladder cancer and Agent Orange. Due to the IOM’s position, most claims for bladder cancer were denied.
Rating Bladder Cancer For VA Disability
While this change in policy marks a significant step forward for Vietnam veterans, the fight for adequate compensation still continues. Assuming that bladder cancer will be added to the Agent Orange presumptive list, the VA will now need to rate the disease. If a veteran is experiencing bladder cancer at a certain rating, they may be eligible for disability benefits.
When the VA evaluates bladder cancer, the rating would be based on Diagnostic Code (DC) 7528, “malignant neoplasms of the genitourinary system.” Pursuant to DC 7528, a 100% rating will be assigned for bladder cancer, for a six month period following the end of any “surgical, x-ray, antineoplastic chemotherapy, or other therapeutic procedures.” Then, at the end of this six-month period, the VA will schedule a follow-up Compensation and Pension (C&P) examination in order to determine the ongoing severity of this condition.
In other words, as long as the bladder cancer is still active, or, if the veteran is still undergoing treatment for this condition, then the 100% rating will continue. However, the VA will reduce the rating below 100% six months after treatments have ended and the cancer is no longer active. At that point, the VA will rate the bladder cancer based on the remaining residuals, if any.
When the VA evaluates residuals, they will consider whether there is any “voiding dysfunction” or “renal dysfunction.” For voiding dysfunction, the symptoms that count are urinary leakage, urinary frequency, and obstructed voiding. For renal dysfunction, the VA health care providers will run lab work and evaluate whether there is a decrease in kidney function.
In my experience, the most common residual from bladder cancer tends to be voiding dysfunction. Voiding dysfunction means that there is urinary leakage or incontinence, which may require the use of an appliance or absorbent materials, such as adult diapers or pads. There may also be obstruction in urination, where too much urine is retained, which may result in frequent urinary tract infections, the need for more surgery, or the use of a catheter. There may also be abnormal urinary frequency, which causes the veteran to have to urinate several times during the day and/or several times per night.
In addition to voiding dysfunction, some veterans may also develop erectile dysfunction. If erectile dysfunction develops secondary to the bladder cancer, then the veteran would also be entitled to special monthly compensation for loss of use of the genital organ.
In order to demonstrate a need for a compensable rating for bladder cancer residuals, the veteran should submit thorough and supportive medical evidence. This evidence can prove that, even though the cancer may not technically still be “active,” there are still residuals that do deserve compensation. For example, letters from the veteran’s treating doctor and lay statements from the veteran and family members, would help to establish the severity of the symptoms. Basically, any form of supportive evidence of continued residuals would greatly support the veteran’s claim that ongoing compensation for the bladder cancer residuals is warranted.
Addressing The Full Impact of Agent Orange
The signs are positive that bladder cancer will likely to be added to the VA’s Agent Orange presumptive list. If that happens, thousands of Vietnam war veterans and other related claimants will finally become eligible for compensation for this condition. At this point, it is a matter of “wait and see” to find out if the VA will do the right thing, and respond favorably to the new IOM report. My hope is that this blog will help veterans and their families navigate this new, but exciting, terrain.