Prostate Cancer 

Prostate cancer in the Vietnam veteran is a presumptive condition. Read more about presumptive conditions here.

If you choose watchful waiting as your treatment, your 100% rating will continue uninterrupted. There is no end to the 100% rating until you have definitive treatment such as surgery or radiation.

Once you have definitive treatment (surgery, radiation) your future rating will be modified to reflect that your cancer is gone. Without cancer, you will no longer be rated at 100%. Your rating will reflect the residual effects of treatment. Most veterans will have a 40% or 60% rating. Whether you have 40% or 60% will largely depend on how many pads or adult diapers you soil each day, how many nighttime awakenings occur for you to urinate and the degree of frequency and urgency you experience when you need to urinate.

Erectile dysfunction is rated as  SMC-k (Special Monthly Compensation -k) condition. It is paid separate from your overall rating. You must ask for the SMC-k benefit.

Choosing ‘Watchful Waiting’ for Prostate Cancer

When Eddie Carrillo, a Los Angeles contractor, was found to have prostate cancer at the age of 52, his primary care doctor and his urologist both urged him to have his prostate removed.

That was 15 years ago, and Mr. Carrillo, still hale at 67, is glad he did not succumb to pressure to undergo surgery.


Study Finds Observation as Effective as Surgery in Early Prostate Cancer  

Men Treated Surgically Have No Greater Lifespan in 15-Year Follow-Up 

What the press release doesn't tell you is that if you are a Vietnam veteran with a presumptive prostate cancer and you choose "watchful waiting", your rating will stay at 100% (temporary) until you die or until your cancer is surgically treated.



Study Finds Observation as Effective as Surgery in Early Prostate Cancer   

A major federal study led by the Department of Veterans Affairs found no difference in survival between men with early-stage prostate cancer who had their prostate surgically removed and those who were simply watched by their doctors, with treatment only as needed to address symptoms if they occurred.


"is prostate cancer consider to be service connected through va"

Prostate cancer is one of the diseases on a presumptive list for veterans who have boots on the ground service within the country of Vietnam. This is one of the infamous agent orange diseases. The other service connections for prostate cancer must be established by direct connection or diagnosis while still on active duty.


"agent orange and incontinence"

When we talk about agent orange we must talk about a specific disease. Your VAWatchdog gets a ton of email that begins with "I have symptoms of agent orange...". Of course, there are no symptoms of agent orange. However, VA does recognize that agent orange may have caused certain disease (the presumptive list) and that those diseases have certain symptoms. To talk about incontinence (the inability to control the flow of urine from the bladder) and agent orange first makes the VAWatchdog think of prostate cancer after it's been treated. Many Vietnam vets who have had prostate cancer treated by surgery experience some degree of incontinence. Once the cancer is treated, the rating will be assigned based on the residuals of the treatment of the disease. If there are few problems, the vet is likely to be rated at 40%. If there is a lot of incontinence, the rating will probably be 60%. Incontinence is measured by VA as the number of pads (adult diapers) that a vet must use each day. The rating may also be judged by excessive nighttime awakenings for urination and the feeling of urgency and loss of control when the urge to urinate comes on. Don't forget to seek an SMC-k rating for erectile dysfunction. VA won't usually rate you for ED unless you ask for it.


"does va recognize watchful waiting as treatment for prostate cancer"

Yes. Watchful waiting (in the Vietnam veteran) will result in the veteran receiving a 100% rating as long as the diagnosis of prostate cancer remains. Once there is treatment and the cancer is gone, the rating can no longer be 100% and will be adjusted down based on residuals of the treatment. Many more men are choosing "active surveillance" to monitor their prostate cancer.


"va watchful waiting"

This is a very good question. "Watchful waiting" is the non-treatment of prostate cancer rather than going all out with surgery and radiation. It just so happens that the outcomes of doing nothing (watchful waiting) are about the same as when the veteran opts for all the treatment he can get. In the VA system, a veteran with a service connected prostate cancer is rated at 100%. That's a temporary rating. Once the treatment is finished, the vet is then rated on the problems left by the treatment...the "residuals". Residuals might be leakage of urine, ED and so on. The veteran who chooses watchful waiting keeps the cancer...and the 100% rating indefinitely. Read more about prostate cancer here.

Erectile Dysfunction  ED

This isn't a topic that we enjoy discussing at the dinner table. It can be embarrassing. However, our sexuality is an important part of a veterans overall physical and mental health. There are a lot of powerful medications in use today that can inhibit the ability to achieve and maintain an erection that is suitable for sexual intercourse.

When Bob Dole did an ad for Viagra, the topic became more mainstream. Today, although some of the stigma has been taken away from ED, it still may not be easy for you to talk about.

However...your ED may be service connected and if it is, you deserve the rating and benefit that comes with the condition. Many vets don't understand that ED can be a secondary service connected condition. For example, if you have a mental health condition like PTSD and you have a rating for that condition and you take potent drugs in treatment, and those drugs cause ED...you should file for the ED condition. If you've been treated for a service connected prostate cancer, you are probably eligible for the ED rating.

ED is rated as a Special Monthly Compensation (SMC) condition and is referred to as SMC-k. Information about SMC is here. The rating tables are here.

Learn more about secondary conditions and how to file  here.

Viagra for vets costs surge on war disorders    

The Department of Veterans Affairs has almost tripled spending on erectile-dysfunction drugs in the past six years as war-related psychological disorders contribute to sexual difficulties.

The VA spent $71.7 million on drugs including Pfizer’s Viagra and Bayer’s Levitra in the year ended Sept. 30, up from about $27.1 million in fiscal 2006, records show.

Prostate Cancer & the Vietnam Veteran

The Vietnam veteran (or any man) 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 many 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.


Article Continues Below...

(Continued)  Prostate Cancer & 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.


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(Continued)  Prostate Cancer & the Vietnam Veteran 


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.

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%

Questioning Surgery for Early Prostate Cancer  

A new study shows that prostate cancer surgery, which often leaves men impotent or incontinent, does not appear to save the lives of men with early-stage disease, who account for most cases, and many of these men would do just as well to choose no treatment at all.

Secondary Conditions  

Prostate Cancer may cause secondary conditions such as Erectile Dysfunction.  Read about Secondary Conditions here.

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.

VA cancer screening reminder falls short: study   

Ratings - The Genitourinary System

Prostate cancer  

Cancer - prostate; Biopsy - prostate; Prostate biopsy; Gleason score


Prostate Cancer Foundation  


Prostate Cancer Health Center  


Prostate Cancer Wiki  


Prostate Cancer Surgery Shows No Benefit For Many Men