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If you choose watchful waiting (many men today make that choice) your rating will continue at 100% temporary. You will have regular C & P exams to determine whether you still have cancer.

Your VA isn't really prepared for the recent trend to choose watchful waiting when diagnosed with prostate cancer.

The reasoning behind watchful waiting is simple. Most prostate cancers are very slow growing, men often die with prostate cancer but not of prostate cancer. The treatment for prostate cancer is brutal, surgery will often leave you leaking urine and impotent. Statistically you're more likely to die of another cause than you are your prostate cancer.

In the ratings schedule VA assumes that every veteran diagnosed with a cancer will choose to be treated. VA also assumes that every cancer treatment will be succesful and the cancer will be cured. Ratings for service connected cancer are always 100% and they are almost always temporary ratings.

Once you've declined treatment you have to be alert because VA will assume you've been treated even when you tell them you haven't.

After a C & P exam you may get a letter telling you that since your cancer has been treated and your symptoms aren't really present, VA is proposing to lower your rating from 100% to 0%. The examiner paid no attention at all to you when you told him you still have cancer.

Don't panic, this is pretty easy to resolve and you can DIY this one. You appeal promptly and that usually fixes the issue right away. In your appeal you briefly explain that you have cancer and that you have had no treatment. Bingo, that usually gets the job done.

No, you do not have to have any further prostate biopsies done to prove you have the cancer. VA can monitor your PSA and the lack of any records of treatment is enough to show you continue to have an active cancer.

Prostate Cancer

Prostate cancer & the Future Exam


Hey Jim,
Thanks for the solid advice in the past. I received a 100% Compensation Rating in 2012 for Agent Orange Viet Nam Prostate Cancer. I had my first Reevaluation test in 2015 with a Contractor Doctor. He sent in some false reports saying I wasn't seeing a doctor and was in remission. I had all my info with me, which he didn't look at, I answered all his questions politely, and was denied. I appealed and won, receiving all back pay and started receiving checks again in march of 2017. It took 2 years for them to read my appeal, which was basically My doctors letter simply stating that he saw me regularly, that my cancer was not in remission, and was active prostate cancer. My question is, I have a Re evaluation C & P test coming up in 2018. Any advice for this C & P test, and how to avoid another failure?


My reply,

Your story is very typical, this happens daily. VA rates all cancers as temporary. VA assumes every patient will be treated promptly and that every treatment will be successful and that every cancer will disappear.  Once the cancer is gone they rate you on the residuals of treatment and most ratings for prostate cancer are 20% to a max of 60%. The post-treatment rating is usually based on how many absorbent pads the veteran must use each day to control leakage of urine.
I don't understand the disconnect. Active surveillance or "watchful waiting" is an accepted process in our modern era since the treatment for prostate cancer is often worse than the disease. I have to think that the C & P examiners must know about watchful waiting but if so, they don't explain that to the rater back at the regional office.
All too often the active surveillance veteran patient will have been on a prostate medicine for benign prostatic hypertrophy (BPH - or enlargement of the prostate) and the rater will see that and assume that is treatment for prostate cancer. But the patient has no symptoms, uses no disposable pads so the rating comes back as 0% service connected even though the veteran still has an active cancer.
This has been the status quo at VA for years. I've talked with dozens and dozens of veterans over the years who have had to do just what you did...appeal. VA has had zero interest in any fix to the problem...fixing this won't add to their bonus so why would they?
In the future, you can try to talk with the C & P examiner like he's a 6 year old. Carefully explain what you're doing and that your cancer is active.
Keep your fingers crossed.

/s/ Jim

VA Form 21-0960J-3

Prostate Cancer Disability Benefits Questionnaire (Fillable)
File Type: PDF  Issue Date:   06/01/2017
Revision Date:   02/2015  Total Pages:   3

Prostate Cancer  Watchful Waiting

Watchful Waiting or Active Surveillance for Prostate Cancer

If you are a Vietnam veteran (or any other veteran who believes your prostate cancer may be service connected for any reason) and you are diagnosed with prostate cancer, your first move should be to file a claim. Filing the claim sets the effective date and no matter how long it takes VA to sort out the claim, the effective date will ensure that is when your disabled veterans benefits will begin.

Your rating will be 100% but it will be a temporary rating subject to a future exam, usually 6 months or so after treatment.

Now you have choices to make. You can choose treatment (surgery, radiation, chemoterapy or a combo of all the above) or you can choose active surveillance...often called watchful waiting. More on watchful waiting in just a minute.

If you choose treatment, the rules you see above will apply. Your rating will fall from 100% to 60% or less determined by your symptoms of leaking urine requiring absorbent pads, the frequency of your daytime urination and the frequency of awakening at night to urinate.

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38 U.S. Code § 5107

Claimant responsibility; benefit of the doubt

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%

7528    Malignant neoplasms of the genitourinary system ...100%  

(This is service connected prostate cancer.)
Note: Following the cessation of surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure, the rating of 100 percent 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 §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals as voiding dysfunction or renal dysfunction, whichever is predominant.

Prostate Cancer

Prostate cancer is the most common cancer among men (after skin cancer), but it can often be treated successfully. If you have prostate cancer or are close to someone who does, knowing what to expect can help you cope. Here you can find out all about prostate cancer, including risk factors, symptoms, how it is found, and how it is treated.

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The Bash Bulletin: Prostate cancer reduction-ratings

​Prostate cancer reduction-ratings (medical diagnostic codes) are confusing because often the patient has a 100%

disease cancer code for 6 months then the code is reduced and the reasoning is often unclear to the patient. 

§4.115a  Ratings of the genitourinary system—dysfunctions.
Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Since the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis.

The Vietnam veteran who served with "boots on the ground" in the Republic of Vietnam is generally eligible for Service Connected Prostate Cancer & Disabled Veterans Benefits once the medical diagnosis of prostate cancer is made.

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