Agent Orange and Parkinson’s-Like Symptoms
VA Disability Ratings for Parkinson’s Disease
VA rates Parkinson’s disease under 38 CFR § 4.124a – Schedule of Ratings, Neurological Conditions and Convulsive Disorders, Diagnostic Code (DC) 8004. This diagnostic code assigns an automatic minimum 30 percent rating for the condition, but it does not take into account other symptoms associated with it. Therefore, VA should continue rating as follows, after beginning with the minimum 30 percent rating:
- Evaluate each of the veteran’s symptoms/residuals associated with Parkinson’s disease
- Calculate the combined disability rating for the symptoms
- Assign the higher evaluation (i.e. minimum 30 percent rating for the disease itself or the combined rating of the symptoms)
Examples of symptoms/residuals of Parkinson’s disease that VA can evaluate when assigning a disability rating include the following:
- Difficulty swallowing (dysphagia) – DC 7203
- Speech problems (dysarthria) – DC 8210
- Bladder incontinence (neurogenic bladder) – DC 7542
However, in order to receive a disability rating for Parkinson’s disease, VA requires that the condition be service connected. Importantly, Parkinson’s disease is one of the presumptive conditions associated with Agent Orange exposure. Therefore, VA will grant service connection for Parkinson’s disease on a presumptive basis for veterans with qualifying service. However, VA currently requires veterans to have a formal diagnosis of Parkinson’s disease in order to receive VA disability benefits.
“Veterans and Agent Orange: Update 2014” – Parkinson’s-like Symptoms
In 2016, the Institute of Medicine (IOM) published its 10th edition of “Veterans and Agent Orange: Update 2014” regarding the health effects related to Agent Orange exposure. This update included some clarification about Parkinson’s disease and how it is diagnosed that may be beneficial for veterans pursuing VA disability compensation. Specifically, the report noted that Parkinson’s disease is diagnosed “by exclusion” (i.e. a diagnosis of a medical condition reached by a process of elimination). Doctors will diagnose the condition by taking into account all of the veteran’s symptoms and then ruling out other possible conditions that could be causing them. When all other possible conditions are effectively eliminated, the doctors will then formally diagnose Parkinson’s disease.
In some cases, veterans have the symptoms of Parkinson’s disease but lack a formal diagnosis, which prevents them from receiving service-connected compensation. However, the IOM report clarified that a formal diagnosis should not be important in VA disability claims for service connection for Parkinson’s disease on a presumptive basis. Instead, Vietnam veterans who have Parkinson’s-like symptoms should be afforded the same presumption of service connection as those who have Parkinson’s disease itself. The IOM update could potentially provide affected veterans with the evidence necessary to obtain the VA disability benefits they deserve. Here, veterans can use the report to argue that there is no medical difference between an individual who is formally diagnosed with Parkinson’s disease and an individual who has the symptoms of Parkinson’s disease.
After releasing “Veterans and Agent Orange: Update 2014,” the IOM urged VA to act on its recommendations and extend the presumption of service connection to Parkinson’s-like symptoms, as well as bladder cancer, hypothyroidism, and hypertension. However, VA has continued to prolong this process.
Consideration of Presumptive Status for Parkinson’s-like Symptoms: VA’s Timeline
VA has reportedly been working with the presidential administration to conduct a legal and regulatory review of conditions for awarding disability compensation to eligible veterans. However, this process has been ongoing since 2016 when the IOM released its report. In March 2016, former VA Secretary Robert McDonald formed a working group of scientists and experts to evaluate the IOM report and make recommendations by August of that year. In November 2016, VA stated the working group was nearing completion of its evaluation and preparing a draft response and action plan, which would be given to a more-senior task force in early December 2016. Nonetheless, VA encountered yet another delay when the changeover in presidential administrations took place. VA then informed the public that the deadline for proposing new rules for potential new presumptions of service connection passed and will become work for the new administration to complete. The Senate Committee of Veterans Affairs inquired about the status of VA’s review in February 2017. VA indicated that the recommendations had been forwarded to the Secretary for a decision that has still yet to come.
At the recent Senate Veterans’ Affairs Committee hearing held on March 26, 2019, Secretary Wilkie was asked to comment on the presumptive status of Parkinson’s-like symptoms. Dr. Richard Stone (Executive in Charge of the Veterans Health Administration) responded to this inquiry, noting that VA hopes to make a decision within the next 90 days, determining whether this condition will be afforded the presumption of service connection associated with Agent Orange exposure.
