Cholangiocarcinoma (Bile Duct Cancer) and Veterans of the Vietnam War

What is Cholangiocarcinoma (Bile Duct Cancer)?

Cholangiocarcinoma (i.e. bile duct cancer) is a cancer of the biliary duct system, which includes the gallbladder, bile ducts, and certain cells inside the liver.  This disease often goes undetected for long periods of time, as symptoms do not appear for nearly 30-40 years in most cases.  However, when symptoms do present themselves, they typically include the following:

• Jaundice (i.e. yellowing of the skin and the whites of the eyes
• Pain in the abdomen
• Dark urine
• Light or “clay” colored stool
• Fever
• Itchy skin
• Nausea and vomiting
• Unexplained weight loss

To test for cholangiocarcinoma, doctors rely on an individual’s medical history, physical examinations, and may employ a variety of blood tests and medical imaging (e.g. X-rays, CT scans, MRI scans, and/or ultrasound).  To diagnose cholangiocarcinoma, doctors will often need to consult with specialists as well.  Cholangiocarcinoma is very rare, but becomes more common as people get older.  However, there are several other risk factors aside from age that are particularly important to Vietnam War veterans.

How Does Cholangiocarcinoma Affect Vietnam Veterans?

Another risk factor for cholangiocarcinoma is past infection with tiny parasitic worms called river flukes, which are found in the freshwaters of Southeast Asia.  The presence of liver flukes is ten times higher in Southeast Asia than anywhere else in the world.  People can become infected by eating raw or undercooked fish that have these parasites.  Then, once eaten, the liver flukes grow to adulthood inside the human biliary duct system causing infection that can lead to bile duct cancer.  Opisthorchis verrini is the most common type of this parasite found in Vietnam.

This is significant because there is a possibility that veterans who ate raw or undercooked freshwater fish during their service in Southeast Asia, such as Vietnam War veterans, might have been infected and later developed cholangiocarcinoma as a result.  According to its website, VA is not currently aware of any studies that show bile duct cancer occurs more often in Vietnam veterans than in other groups of people.  However, it is important to be aware of the risk of exposure due to service in Southeast Asia.

VA Disability Benefits for Cholangiocarcinoma

Vietnam veterans are afforded a presumption of exposure to herbicide agents, including Agent Orange.  As a result, VA will also presume service connection for certain conditions that are associated with Agent Orange exposure.  Cholangiocarcinoma is not one of the presumptive conditions associated with herbicide exposure.  Therefore, service connection must be established on a direct basis.  This requires a nexus opinion linking your military service to your bile duct cancer.

VA’s History of Adjudicating Claims for Cholangiocarcinoma

VA has a history of both granting and denying veterans’ claims for service connection for cholangiocarcinoma.  However, in cases where service connection is granted, VA recognizes the connection between service in Vietnam and the later onset of the disease.  Nevertheless, it may be helpful to seek a private medical opinion to establish a positive nexus.