Prostate Cancer & the Vietnam Veteran
The veteran diagnosed with prostate cancer will have tough decisions to make.
Will he choose to treat the cancer or will he decide to live with it? The need for treatment is hotly debated and has been for years. One thing is for sure...treatment leaves most men impotent and with urinary incontinence for life.
For the Vietnam veteran the decision becomes more complex. A diagnosis of prostate cancer in the RVN vet is a "presumptive" condition and the VA cedes that due to the veterans exposure to agent orange, the cancer is service connected and rated at 100% disabling.
Once treated the cancer is gone and the 100% rating for cancer is no longer applicable. VA then turns to the "residuals" of treatment to rate the veteran. Residuals are secondary effects related to the surgery or radiation that occurred to "cure" the prostate cancer. The usual residuals are incontinence (leaking, requiring the use of pads or "adult diapers") and impotence (erectile dysfunction).
The usual rating for the residuals will fall between 20% and 60% and often require appeal to reach a proper decision.
Interestingly, the veteran who chooses "watchful waiting" and does not get treated will retain the 100% rating until he dies...usually death comes from another cause, not the cancer.
How does that happen? Simple...a diagnosis of cancer calls for 100%. Once treated the cancer is gone. The veteran can't be rated for 100% if the cancer isn't there. With watchful waiting the cancer remains intact and the 100% rating is required.
The decision must be made in close consultation with a physician you trust. Keep in mind that there is no rush to have anything done after a diagnosis of prostate cancer. Take plenty of time to read and study and to talk to your family. Whatever you decide will be the right decision for you.
When the Vietnam veteran is diagnosed, he will be rated at 100% throughout treatment. The treatment may take 6 months or so. At the end of the treatment it's usually determined (by PSA) that the veteran is cancer free.
If the veteran no longer has prostate cancer, the rating must change. The veteran is then reexamined and rated on "residuals" or after-effects of treatments.
The after effects are usually some combination of leakage and erectile dysfunction. The veteran is normally rated at 40% or 60% depending on how severe the leakage is, usually measured by the number of absorbent pads necessary per day.
ED is rated under the Special Monthly Compensation category of SMC-k, "Loss of a creative organ". Veterans must remember to ask for this benefit.
Your Benefits: Prostate Cancer may cause secondary conditions such as Erectile Dysfunction. Read about Secondary Conditions here.
A New Prostate Cancer Treatment
New prostate cancer treatment may reduce side-effects
Many face a difficult dilemma: the disease kills about 10,000 men every year, but for some it may not get worse if left untreated. Standard treatment with surgery or radiotherapy involves treating the whole prostate gland, and can harm surrounding tissue, with a serious risk of side-effects, including urinary incontinence and impotence.
Your Benefits: Ratings - The Genitourinary System
Ratings
7528 Malignant neoplasms of the genitourinary system...100%
Note--Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100% shall continue with a mandatory VA examination at the expiration of six months. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of Sec. 3.105(e) of this chapter.
If there has been no local reoccurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.
Voiding dysfunction: Rate particular condition as urine leakage, frequency, or obstructed voiding Continual Urine Leakage, Post Surgical Urinary Diversion, Urinary Incontinence, or Stress Incontinence:
Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day 60%
Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day 40%
Requiring the wearing of absorbent materials which must be changed less than 2 times per day 20%
Urinary frequency: Daytime voiding interval less than one hour, or; awakening to void five or more times per night 40%
Daytime voiding interval between one and two hours, or; awakening to void three to four times per night 20%
Daytime voiding interval between two and three hours, or; awakening to void two times per night 10%
PROSTATE CANCER AND THE VIETNAM VETERAN
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" 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.
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.
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.
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