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PROSTATE CANCER AND THE VIETNAM VETERAN
--
Veterans' Advocate Jim Strickland on prostate
cancer screening and treatment.
Jim Strickland -- Veterans' Advocate
Veterans' Advocate Jim Strickland provides
regular columns for VA Watchdog dot Org.
If you would like to contact Jim about his
columns, you can email him here...
The archive of Jim's articles
is here...
To find an answer to a specific VA benefits
question, use the VA Watchdog search engine...
click here...
And, be sure to use Jim's: A Military
Veterans Guide To Disability Compensation and Pension Benefits -- A
Compendium of Resources and Knowledge For The Disabled Veteran --
click here...
Your comments accepted at bottom of
page.
Share story/email link.
-------------------------
by Jim Strickland
It is widely known and accepted
that men and women who served in Vietnam were exposed to a chemical that
has caused significant health concerns. Whether you refer to it as Agent
Orange, a defoliant, an herbicide or dioxin, anyone that served with their
boots on the ground of the Republic of Vietnam received some dose of the
chemical.
Over the years the Department of Veterans Affairs (the DVA or just "VA")
has ceded that there are known health risks that stem from this exposure.
During the decades following the end of that war, there has been a list of
conditions that are presumed to have been caused, contributed to or
aggravated by the exposure to Agent Orange.
The "Presumptive List"
http://tinyurl.com/cpmals isn't without its detractors and
controversy. If a 63 year old Vietnam veteran is diagnosed with lung
cancer this year, was it the long term effects of his pack a day cigarette
habit that caused the disease or was it the effect of exposure to dioxin
in 1967? While it's impossible to determine an answer to each individual
case, the law is clear; The VA must default to a presumption that the
tumor is connected to the RVN service and the award of benefits is mostly
on autopilot with no proof of cause and effect required.
The same is true of prostate cancer. The veteran who has a history of
Vietnam service and who is today diagnosed with prostate cancer will be
awarded service connected disability benefits for the condition. Prostate
cancer is presumed to be connected to the vet's RVN service and exposure
to Agent Orange.
Whether a man is a Vietnam veteran or not, to think about prostate cancer
is to accept that many of us are going to get the disease sooner or later.
It's almost another rite of passage for men as they age.
Any discussion about the diagnosis and treatment of prostate cancer
becomes contentious almost immediately. To screen via the Prostate
Specific Antigen (PSA) test or not to screen? Does the Digital Rectal
Examination (DRE) of the prostate make for a better diagnosis or is it
simply a test designed to make a man cringe? The PSA test tries to
identify a trend of a rise in the level of the PSA marker that would
indicate that there may be a problem while the DRE allows the examiner to
feel hardened lumps that may be tumor.
If either of those tests are positive, the man is usually referred to a
urologist who will then take a biopsy of the prostate gland itself. The
biopsy process is also an imperfect diagnostic tool. Consider that the
surgeon is trying to locate a tumor (or tumors) that may be the size of a
BB in an organ that is the size of a walnut. He stabs at it with a needle,
more or less blindly, in hopes of retrieving some few cells that can be
diagnosed to show cancer or not. If he misses the tumor you may get a
clean bill of health but still carry the cancer. If a good specimen is
obtained, the tumor hit may be a low grade of cancer while the tumor
missed may be a higher grade and much more aggressive.
click for more information -- a disabled veteran
owned business
If you're the Vietnam veteran (or any man) with a suspected or even a
confirmed prostate cancer, you have a lot of decisions to make. Those
decisions are hard enough but for the RVN vet they get even more
convoluted...more on that in a moment.
The New York Times recently published a great article about the most
recent international studies about men and their prostates.
http://tinyurl.com/d2kc8f
The bottom line, according to columnist Tara Parker-Pope is that, "...two
major studies from the United States and Europe found that P.S.A. testing
— the annual blood test used to screen men for prostate cancer — saves
few, if any, lives while exposing patients to aggressive and unnecessary
treatments that can leave them impotent and incontinent."
The very words, "impotent and incontinent" are enough to strike terror
into the hearts of the most decorated combat veteran. If the shouts of
"incoming" didn't frighten you back then, those words surely will.
Is that what awaits us...erectile dysfunction and a change of diapers 6
times each day?
Maybe, maybe not.
Ms. Parker-Pope's article describes some of the more modern thinking about
whether or not a man should even bother with screening. It's easy to
accept that a man of age 70 or so who is diagnosed with prostate cancer
may easily choose to leave it be. Most prostate cancers are very slow
growing and take as long or longer than 10 years to cause a death. In that
case, the treatments available...radical surgery and/or intensive
radiation therapy may cause his death long before the 10 years has passed.
If you're younger than 70 but you have other health care issues that are
likely to cause your demise, again...you may wish to ignore the prostate
cancer and avoid the side effects of treatments.
 Choosing
your treatment, should you decide to be treated, is ultimately one of the
most important decisions you'll ever make. My mailbag is peppered weekly
with veterans who have made successful recoveries after surgery and they
are returning to work and those who are just miserable with a constant
leakage they didn't anticipate.
The topics of screening and then treatment are ones you should begin to
discuss with your doctor now. Learn about the options that you may have
and if you don't care for the sound of that, seek out what other options
may be available to you. Ask about fee basis if your local VA Medical
Center (VAMC) isn't doing a lot of prostate treatment. Inquire as to what
treatments are popular in your VAMC and ask around to speak with others
who have received treatment there. If another veteran is happy and doing
well, you're more likely to have that result.
One of the topics that I don't believe Ms. Parker-Pope covered very well
is the treatment of no treatment at all. The term "Watchful Waiting"
http://tinyurl.com/e43ro describes
an accepted method of tracking the progress of a known prostate cancer
after diagnosis.
I promised a focus on the Vietnam veteran diagnosed with prostate cancer.
Whether or not one accepts that the Vietnam vet's prostate cancer has any
connection to exposure to Agent Orange, the rules are well established and
that veteran is eligible for disability compensation benefits upon
diagnosis and the beginning of treatments. The application for benefits
isn't automatic and the veteran should proceed immediately to begin the
process of filing for the benefit. Although the award is a foregone
conclusion, the Veterans Benefits Administration (VBA) will all too often
make hash-work of the application and deny the benefit for various
reasons. In that way the application is no different than any other so
you're wise to begin ASAP.
(You may find information about how to apply in my Benefits Guide at
http://tinyurl.com/5wxapm )
The Vietnam veteran is awarded 100% disability as of the date that the
application for his benefit is received by his Regional Office. The VA assumes that the
treatment will be totally disabling but won't be a permanent condition. If
the PSA level and biopsy are used as the markers of having an active
cancer, with treatment both of those will return to a normal state.
At that point the treated veteran no longer has prostate cancer. If he
doesn't have prostate cancer he can't be awarded a benefit for it. Thus,
usually at about the 6 month mark, the veteran is called in for a
Compensation and Pension (C&P) examination with a goal to set the rate of
compensation to equal the disabling effects of treatments...the
"residuals".
Incontinence or "leaking" is the usual residual measured by VA to
determine the rate of compensation. The degree of incontinence is measured
by how many pads or diapers a man must use each day and the rate is
correspondingly higher with the number of pads used.
The veteran may also claim Erectile Dysfunction and receive a Special
Monthly Compensation (SMC) benefit known as SMC-K. The SMC-K benefit is on
the books as "loss of a creative organ" and although the veteran impaired
by erectile dysfunction hasn't lost the organ, he's lost use of it for
procreative purposes and is entitled to the SMC-K benefit in addition to
the regular rated compensation.
The usual amount of the after-treatment benefits I see range from 30% to
60% plus the SMC-K add-on.
For the Vietnam veteran who chooses watchful waiting as his treatment,
this becomes more interesting. Let's do a quick fact check.
Keep in mind that watchful waiting is a treatment. Upon diagnosis and
beginning of treatment, the veteran is awarded 100% disability
compensation. The 100% is reduced to compensation of residuals of
treatment once the condition no longer exists.
For the veteran choosing watchful waiting, there is no end point to the
watchful waiting treatment. Until he elects surgical or radiation
treatment or dies of either the prostate cancer or another condition, he
will remain rated as 100% disabled.
One of the things that our VA does best is screening us for all kinds of
problems. VA learned long ago that testing and screening is a cost
effective approach to our care. We're often screened for our blood
pressure, lipid profiles, colon cancer, hepatitis, diabetes and much more.
Our flu shots, pneumonia shots and diabetes medications come to us earlier
than almost any other group of patients anywhere.
Now we must decide...to screen for prostate disease or not? If we decide
that we want to, do we accept treatment or not? If we accept treatment,
what will the treatment be and who do we want to deliver it?
Finally...for the Vietnam veteran who was leaning toward watchful
waiting...now you've learned of a financial incentive. I've communicated
with a couple of Vietnam veterans who chose watchful waiting years ago.
They wrote to me to ask when the 100% payments would end? They were
surprised (I was too) that after 5 and 6 years of watchful waiting, nobody
at VA had contacted them about their generous benefit. They were doing
well and held the same jobs they had when they were diagnosed.
Talk with your primary care provider and review that New York Times piece
with him or her. The time to ponder your options is now, while you're
feeling well and your prostate is enjoying its own good health. It's the
smart thing to do. Waiting until the doc walks into that exam room and
tells you, "You have a cancer!" is only going to make all this even more
difficult and confusing.
I have my appointment in mid-April. You?
-------------------------
posted by Larry Scott
Founder and Editor
VA Watchdog dot Org
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