Agent Orange and Liver Cirrhosis: VA Disability Benefits

CCK Law: Our Vital Role in Veterans Law

Veterans exposed to Agent Orange and later develop liver cirrhosis may qualify for VA disability benefits if they can prove a relationship between exposure and their disability.

Agent Orange Overview

Agent Orange is an herbicide agent that was used by the United States military during the Vietnam War.  Specifically, Agent Orange is a 50/50 mixture of two kinds of herbicide agents: 2,4-D and 2,4,5-T.  Agent Orange also contained the contaminant TCDD as a byproduct of its production, which is the most toxic of all dioxins.  Agent Orange is just one of the “rainbow herbicides” that the United States used during the Vietnam War, including Agent Blue and Agent White, among others.

Presumptive Conditions

VA lists several conditions that are associated with exposure to Agent Orange, all of which can be found listed on its website:

• AL Amyloidosis
• Chronic B-Cell Leukemias
• Chloracne (or similar acneform disease)
• Diabetes Mellitus Type 2
• Hodgkin’s Disease
• Ischemic Heart Disease, including Coronary Artery Disease, stable and unstable angina, myocardial infarction, and sudden cardiac death
• Multiple Myeloma
• Non-Hodgkin’s Lymphoma
• Parkinson’s Disease
• Peripheral Neuropathy, Early-Onset
• Porphyria Cutanea Tarda
• Prostate Cancer
• Respiratory Cancers, including Lung Cancer
• Soft Tissue Sarcomas (other than Osteosarcoma, Chondrosarcoma, Kaposi’s Sarcoma, and Mesothelioma)

Presumptive Service Connection

VA has a presumption for veterans who were exposed to Agent Orange in the following areas and developed one of the associated conditions listed above:

• Veterans who served in Vietnam between January 9, 1962 and May 7, 1975 – this includes veterans who were boots-on-the-ground in Vietnam, “Blue Water” veterans with service aboard a ship that operated in the inland waterways of Vietnam, or veterans who served within 12 nautical miles seaward of the demarcation line of Vietnam.
• Veterans who served in or near the Korean Demilitarized Zone (DMZ) between September 1, 1967 and August 31, 1971.

For presumptive service connection, veterans do not need to provide a medical nexus to prove their claims to VA.  Instead, veterans must only provide the following: (1) a diagnosis for a condition associated with Agent Orange exposure (see previous section); and (2) evidence that they served at a qualifying location during one of the specified time periods (listed above).

What is Liver Cirrhosis?

Generally speaking, cirrhosis is a late stage of fibrosis (i.e., scarring) of the liver caused by many forms of liver diseases and conditions (e.g., hepatitis, chronic alcoholism).  Each time an individual’s liver is injured or damaged, it tries to repair itself, during which process scar tissue forms.  As cirrhosis progresses, additional scar tissue forms, thereby making it difficult for the liver to function.  In severe cases, advanced cirrhosis is life-threatening.

Although the liver damage done by cirrhosis generally cannot be undone, if the condition is diagnosed early and the cause is treated, further damage can be limited.  Symptoms of liver cirrhosis include the following:

• Fatigue
• Easily bleeding or bruising
• Loss of appetite
• Nausea
• Swelling in the legs, feet, or ankles (i.e., edema)
• Weight loss
• Itchy skin
• Yellow discoloration in the skin and eyes (i.e., jaundice)
• Fluid accumulation in the abdomen
• Spiderlike blood vessels on the skin
• Redness in the palms of the hands
• For women, absent or loss of periods not related to menopause
• For men, loss of sex drive, breast enlargement (i.e., gynecomastia) or testicular atrophy
• Confusion, drowsiness, and slurred speech (i.e., hepatic encephalopathy)

Liver Cirrhosis and Exposure to Agent Orange and Other Herbicides

Importantly, VA does not include liver cirrhosis on its list of presumptive conditions.  As such, veterans who are seeking disability benefits for liver cirrhosis as due to herbicide exposure must establish service connection on a direct basis.  To do so, veterans should provide the following to VA: (1) a current diagnosis of liver cirrhosis; (2) evidence of in-service exposure to herbicides, such as Agent Orange; and (3) a medical nexus linking the current, diagnosed liver cirrhosis to the in-service herbicide exposure.

Although VA does not presume liver cirrhosis is caused by Agent Orange exposure, direct service connection (described above) may still be warranted.  In a direct service connection case, it is crucial for the veteran to obtain a strong medical nexus opinion and submit relevant evidence.  For example, there are several reports of changes in liver enzymes among workers occupationally exposed to the contaminant TCDD (Institute of Medicine, 1994, p. 686).  Such research may be helpful in establishing the medical nexus evidence to win the claim.

Secondary Service Connection for Liver Cirrhosis Due to Agent Orange Exposure

Veterans should also be aware that they may be able to obtain service connection for liver cirrhosis on a secondary basis, as related to Agent Orange exposure.  Specifically, secondary service connection is warranted when an already service-connected condition causes a secondary condition.  If a veteran is service-connected for a primary condition due to Agent Orange exposure, and this condition then causes them to develop liver cirrhosis, then their liver cirrhosis should warrant service connection as well.

VA Ratings for Liver Cirrhosis

Liver cirrhosis is rated under 38 CFR § 4.114, Schedule of Ratings – Digestive System, Diagnostic Code 7312.

Veterans can receive ratings at 0, 10, 30, 60, or 100 percent. The rating criteria for each percentage are outlined below:

• 100 percent – “Liver disease with Model for End-Stage Liver Disease score greater than or equal to 15; or with continuous daily debilitating symptoms, generalized weakness and at least one of the following:

• • ascites (fluid in the abdomen), or
  • a history of spontaneous bacterial peritonitis, or
  • hepatic encephalopathy, or
  • variceal hemorrhage, or
  • coagulopathy, or
  • portal gastropathy, or
  • hepatopulmonary or
  • hepatorenal syndrome”

• 60 percent – “Liver disease with Model for End-Stage Liver Disease score greater than 11 but less than 15; or with daily fatigue and at least one episode in the last year of either:

• • variceal hemorrhage, or
  • portal gastropathy, or
  • hepatic encephalopathy”

• 30 percent – “Liver disease with Model for End-Stage Liver Disease score of 10 or 11; or with signs of portal hypertension such as splenomegaly or ascites (fluid in the abdomen) and either weakness, anorexia, abdominal pain, or malaise”

• 10 percent – “Liver disease with Model for End-Stage Liver Disease score greater than 6 but less than 10; or with evidence of either anorexia, weakness, abdominal pain or malaise”

• 0 percent – “Asymptomatic, but with a history of liver disease”