VA Disability Rating for Lymphoma and Toxic Exposures
What is Lymphoma?
Lymphomas are cancers that start in the white blood cells, or lymphocytes. There are two types of lymphocytes: B-cells and T-cells. B cells create proteins called antibodies that help protect against bacteria and viruses. T-cells destroy germs or abnormal cells in the body, as well as aid the activity of other immune cells.
There are multiple forms of lymphoma that can be categorized by the cells each cancer affects.
Types of Lymphoma
- Chronic Lymphocytic Leukemia – This form of lymphoma is a blood cancer that begins in the bone marrow.
- Hodgkin Lymphoma – There are multiple subtypes of Hodgkin Lymphoma. The cancer cells in this form of lymphoma are called Reed-Sternberg cells. They are an abnormal form of B-cells. People who have classic Hodgkin lymphoma usually have enlarged lymph nodes with a small number of Reed-Sternberg cells and many surrounding normal immune cells. These immune cells are what cause most of the swelling in the lymph nodes.
- Non-Hodgkin Lymphoma – Non-Hodgkin’s lymphoma is a cancer of the lymph glands and other lymphatic tissue, which are part of the body’s immune system that help to fight infection and disease. Specifically, lymphatic tissue is found in the lymph nodes, spleen, and other organs of the immune system.
- Lymphoma of the skin – is a type of non-Hodgkin lymphoma where the cancer cells make a large amount of abnormal protein called macroglobulin.
Diagnosing and Treating Lymphoma
Diagnosing lymphoma, and determining which form a person has, may require the specialty of a hematopathologist, or a doctor who specializes in the blood and cells of the body. To make a formal diagnosis, the specialist may perform a physical examination, as well as review the person’s medical history.
A biopsy may also be performed to diagnose a specific form of lymphoma. For example, a biopsy of a lymph node may be necessary to diagnose Hodgkin’s lymphoma. The samples taken from a biopsy can then be analyzed and used to determine if cancer cells are present.
The treatment used for lymphoma will often depend on the form of lymphoma, the rate at which the cancer has progressed, and the person themselves. Forms of treatment can include chemotherapy, radiation therapy, stem cell transplantation, immunotherapy, and more.
Service Connection for Lymphoma
In order to file a claim for service connection for any form of lymphoma, the veteran will usually need to demonstrate the link between their military service and their lymphoma. Along with this link, or nexus, the veteran also needs to submit a formal diagnosis. In total, the veteran will typically need to submit the following to VA:
- A diagnosis of lymphoma;
- An in-service event, illness, or injury; and
- A nexus linking the veteran’s in-service occurrence with their lymphoma
In some instances, veterans who developed lymphoma as a result of exposure to specific toxins may be eligible for presumptive service connection. The burden of proof is significantly less for veterans who qualify for presumptive service connection, as the veteran does not need to prove the connection between the in-service occurrence and their lymphoma.
To support the veteran’s claim for service connection, the veteran may submit lay evidence. Lay evidence, or lay statements, can be written by the veteran or anyone who knows the veteran and can speak to their condition. Importantly, lay evidence may also be submitted by fellow service members.
Compensation and Pension (C&P) Exams for Lymphoma
Oftentimes, VA will request a Compensation and Pension exam, or C&P exam. This exam will usually be performed by a VA physician or VA contracted physician who may physically examine the veteran, as well as ask questions regarding the veteran’s military service and their symptoms.
To schedule a C&P exam, VA will usually call the veteran or send them a letter. As such, it is crucial to ensure that VA has the veteran’s most up-to-date contact information. If VA does not have the current contact information, the veteran might miss a C&P request. If a veteran fails to attend an exam, or fails to reschedule one they have missed, their claim could be denied.
Prior to the exam, the examiner should review the veteran’s c-file. The c-file will usually contain any documentation that has previously been submitted to VA, as well as the veteran’s medical and military service records.
The veteran may also use a DBQ, or Disability Benefits Questionnaire, to bolster their claim. A Disability Benefits Questionnaire is a form created by VA so that the veteran may address important aspects of their condition, such as symptoms, severity, possible causes, and relation to other disabilities. The veteran may also have their private doctor fill out a DBQ for them. In claims for any form of lymphoma, DBQs can be helpful because a private doctor, such as the veteran’s hematopathologist, can provide insight into the veteran’s condition.
VA Disability Ratings for Lymphoma
Lymphomas are rated under 38 CFR § 4.117, which is the schedule of ratings for hemic and lymphatic systems. Below the ratings for different forms of lymphomas are outlined:
Chronic Lymphocytic Leukemia VA Ratings
Chronic Lymphocytic Leukemia is rated under Diagnostic Code 7703. While CLL never goes away, it is treatable and can become asymptomatic with treatment. As such, VA rates CLL as follows:
- 100%—This rating, for leukemia, is given to veterans with an active leukemia disease or during a treatment phase.
- This rating will continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures for six month, at which time VA will reexamine the condition and assign a rating based on residual symptoms under the appropriate diagnostic code (i.e., Diagnostic Codes 7704, 7718, 7719).
- 0%—This rating is given to veterans with asymptomatic CLL, meaning the disease is inactive or not actively being treated.
Hodgkin’s Lymphoma VA Ratings
Hodgkin’s lymphoma is rated under Diagnostic Code 7709. Under this code, Hodgkin’s lymphoma will receive a 100 percent rating for being an active disease or within a treatment phase. The rating will continue for as long as the veteran’s cancer is active, or they are undergoing treatment. After six months, following the veteran’s treatment program, VA will schedule a C&P exam to re-evaluate their condition. If the veteran’s cancer is in remission, then VA will evaluate the cancer based on its residuals.
Non-Hodgkin’s Lymphoma VA Ratings
VA rates non-Hodgkin’s lymphoma using Diagnostic Code 7115. A 100 percent disability rating is assigned when the disease is active or during a treatment phase. This rating continues for six months beyond the completion of any treatment, at which point the appropriate disability rating is determined by a mandatory VA examination. If there is no recurrence of the disease itself, veterans will be rated based on its residuals.
Toxic Exposure and Lymphoma
Lymphomas have been linked to several different forms of exposure – such as herbicide exposure, burn pit exposure, and other military toxic exposures – in veterans who served in varying locations and time periods.
Agent Orange Exposure Explained
One of the forms of exposure that has been linked to lymphomas is exposure to Agent Orange. Agent Orange is one of several herbicides, or “rainbow herbicides,” that were used during the Vietnam War era. Specifically, Agent Orange was a mixture of two different kinds of highly toxic chemicals: 2, 4-D and 2, 4, 5-T. The highly toxic dioxin contaminant known as 2, 3, 7, 8-TCDD is a byproduct that is produced by Agent Orange. Exposure to Agent Orange was not limited to Vietnam, however, as veterans came into contact with Agent Orange in other areas such as Thailand.
Burn Pits and Military Toxic Exposure Explained
Military burn pits are large areas of land in which the military and its contractors incinerated all waste generated by military bases. The United States military used burn pits as part of its waste disposal protocol in places such as Iraq and Afghanistan in the post-9/11 era. The practice was effective in reducing large quantities of waste, but the pits emitted plumes of toxic smoke which were later found to cause damaging health effects. Materials such as human and medical waste, plastic, rubber, petroleum, and ammunition were disposed of in burn pits.
VA Presumptions for Agent Orange Exposure and PACT Act
The Agent Orange Act of 1991 created a presumption of service connection for veterans who served in specific times and locations and have developed certain conditions as a result of their exposure. Specifically, veterans who served in the following locations at the specified time periods are eligible for presumptive service connection:
- Boots-on-the-ground in Vietnam, veterans with service aboard a ship that operated in the inland waterways of Vietnam (i.e., Brown Water veterans), or veterans with service aboard a ship in Vietnam’s territorial seas (i.e., Blue Water Navy veterans) between January 9, 1962 and May 7, 1975
- On or near the Korean demilitarized zone (DMZ) between September 1, 1967 and August 31, 1971
- Active duty and reservist personnel who had regular contact with C-123 aircraft between 1969 and 1986
As of the Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2021, this presumption also extends to service members with active military, naval, air, or space service in the following locations and time periods:
- The Republic of Vietnam from January 9, 1962 to May 7, 1975 (expanded to include all Vietnam veterans);
- Thailand, at any US or Thai base, from January 9, 1962 to June 30 1976, without regard to the Veteran’s MOS or where on base they were located;
- Laos from December 1, 1965 to September 30, 1969;
- Cambodia, specifically at Mimot or Krek, Kampong Cham Province from April 16, 1969 to April 30, 1969;
- Guam or American Samoa or in the territorial waters thereof from January 9, 1962 to July 30, 1980;
- Johnson Atoll or a ship that called at Johnston Atoll from January 1, 1972 to September 30, 1977.
Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma, and Chronic B-cell leukemia are all conditions which are eligible for presumptive service connection for Agent Orange exposure. Essentially, this should make it easier for veterans to secure benefits, as they do not have to prove a medical nexus between their condition and their military service.
VA Presumptions for Toxic Exposure and PACT Act
The PACT Act of 2021 added 23 burn pit and toxic exposure-related conditions, including lymphoma cancers of any type, to VA’s presumptive list for “covered veterans.” A covered veteran is defined as the following:
- A veteran who, on or after August 2, 1990, performed active military, naval, air, or space service while assigned to a duty station in, including air space above:
- Bahrain
- Iraq
- Kuwait
- Oman
- Qatar
- Saudi Arabia
- Somalia
- United Arab Emirates
- A veteran who, on or after September 11, 2001, performed active military, naval, air, or space service, while assigned to a duty station, including the airspace above:
- Afghanistan
- Djibouti
- Egypt
- Jordan
- Lebanon
- Syria
When President Biden officially signed the PACT Act into law, he and VA Secretary McDonough announced that the rollout period for certain presumptive conditions for covered veterans would be waived. Initially, these presumptions were effective upon the date of enactment of the PACT Act only for certain conditions, while presumptions for other conditions would become effective on a rolling basis over the next few years. Now, with this new rollout plan, the presumption for all conditions are effective from the date the PACT Act was signed (August 10, 2022) and VA will begin adjudicating these claims as soon as January 2023. Veterans should know, however, that newly eligibly claimants will not get retroactive benefits back to the date of their original claim unless they are filing a claim for DIC benefits.
Was Your VA Disability Claim Denied?
The accredited VA disability attorneys and advocates at Chisholm Chisholm & Kilpatrick LTD have decades of experience successfully representing veterans before VA and the Court of Appeals for Veterans Claims (CAVC). We may be able to help you with an appeal. Contact our office today at 800-544-9144 for a complimentary consultation.
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