VA Disability Ratings for Hodgkin’s Lymphoma
Hodgkin’s lymphoma affects many veterans, particularly those who may have been exposed to toxins, or other chemicals, during their service. Veterans who developed Hodgkin’s lymphoma as a result of their service are eligible for monthly VA disability benefits.
What is Hodgkin’s 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. Most commonly, Hodgkin’s lymphoma starts in B cells. These cells are located in the lymphoid tissue, which is found in many parts of the body.
Types of Hodgkin’s Lymphoma
There are multiple forms of Hodgkin’s Lymphoma, such as:
- Classic Hodgkin Lymphoma—9 out of 10 people who have Hodgkin lymphoma have this form. 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. Additionally, there are four subtypes of classic Hodgkin lymphoma:
- Nodular sclerosis Hodgkin lymphoma—This form is most common in teens and young adults. It usually begins in the lymph nodes in the neck or chest.
- Mixed cellularity Hodgkin lymphoma—This sub-type is most common in people with HIV infection. It can also be found in children or elderly adults. It most commonly affects the upper body.
- Lymphocyte-rich Hodgkin lymphoma—This sub-type is not as common and usually occurs in the upper half of the body. It usually is only found in a few lymph nodes.
- Lymphocyte-depleted Hodgkin lymphoma—This sub-type is a rare form, occurring mainly in older people and those infected with HIV. It is a more aggressive form and is more likely to be advanced when first detected. It is usually in the lymph nodes of the abdomen, spleen, liver, and bone marrow.
- Nodular lymphocyte-predominant Hodgkin Lymphoma—This form of Hodgkin lymphoma is different than classic Hodgkin lymphoma. The cancer cells in this form are much larger variants of Reed-Sternberg cells. The cancer cells typically start in the lymph nodes in the neck and under the arms. This form can affect people of any age and is most common in men. Usually this form grows slower than the other types of Hodgkin’s lymphoma and is treated differently than the above forms.
Diagnosing and Treating Hodgkin’s Lymphoma
Often, a hematopathologist, or a doctor who specializes in the blood and cells of the body, to help diagnose Hodgkin’s lymphoma. Usually, this will involve a physical examination, especially of areas where there may be swelling.
Additionally, a biopsy of a lymph node may be necessary to diagnose Hodgkin’s lymphoma. The samples taken from the biopsy can be analyzed by a hematopathologist to determine if cancer cells are present.
There are multiple forms of treatment for Hodgkin’s lymphoma. These include chemotherapy, radiation therapy, and stem cell transplantation. Ultimately, the form of Hodgkin’s lymphoma a person has, and how severe it is, may determine the method of treatment that is best for them.
VA Service Connection for Hodgkin’s Lymphoma
When filing a claim for service connection for Hodgkin’s lymphoma, the veteran will need to demonstrate a connection between their military service and their Hodgkin’s lymphoma. The veteran will also need to submit a diagnosis. In general, the veteran will need to submit the following to VA:
- A diagnosis of Hodgkin’s lymphoma;
- An in-service event, illness, or injury; and
- A nexus linking the veteran’s in-service occurrence with their pancreatic cancer.
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 Hodgkin’s Lymphoma
Once a veteran files a claim for Hodgkin’s lymphoma, VA may request a Compensation and Pension exam, or C&P exam. To do this, VA may call the veteran or send a letter. It is very important to make sure VA has the most up-to-date contact information to ensure that the veteran does not miss any C&P exam requests. It is also very important to attend the exam, as failure to attend can result in VA denying the veteran’s claim.
The exam will usually be performed by a VA physician or a VA contracted physician. Before the exam, the examiner will review the veteran’s c-file. This will contain any documentation that has been previously submitted to VA, as well as the veteran’s medical and 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 that allows the veteran to address important aspects of their condition, such as symptoms, severity, and possible causes, as well as the relationship between their condition and other disabilities. The veteran may also have their private doctor fill out a DBQ for them. In claims for Hodgkin’s Lymphoma, DBQs can be helpful because a private doctor, such as the veteran’s hematopathologist, can provide more insight into the veteran’s condition.
VA Ratings for Hodgkin’s Lymphoma
Hodgkin’s lymphoma is rated under Diagnostic Code 7709. Under this code, Hodgkin’s lymphoma will receive a 100 percent rating when it is 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 VA will then re-evaluate the cancer based on its residuals.
Exposure and Hodgkin’s Lymphoma
Hodgkin’s lymphoma has been linked to several different forms of exposure which have affected veterans who served across multiple locations and time periods.
Agent Orange Exposure
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. Many veterans came into contact with Agent Orange, including those who served in areas other than Vietnam.
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
Hodgkin’s lymphoma is one of the conditions eligible for presumptive service connection. 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.
Burn Pit Exposure
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.
Unlike Agent Orange exposure, there is currently no presumptive service connection for veterans exposed to burn pits. Since there is no presumption, VA adjudicates burn pit claims on a case-by-case basis.
As of 2021, there are several major bills currently pending in the Senate, and one in the House of Representatives, that deal with the toxic exposure caused by burn pits. These bills include:
- Conceding Our Veterans’ Exposure Now and Necessitating Training Act (COVENANT)
- Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2021
- Veterans Burn Pit Exposure Recognition Act
- Toxic Exposure in the American Military Act (TEAM)
Any of these bills, if passed, would offer much needed relief to veterans suffering the toxic effects of burn pit exposure. Specifically, the COVENANT Act would make any form of lymphoma cancer a presumptive condition for veterans who were exposed to burn pits. If this were to pass, veterans would only need to provide evidence that they were exposed to burn pits, thus placing less of the burden of proof on the veteran.
TDIU and Hodgkin’s Lymphoma
Veterans who are prevented from working as a result of their Hodgkin’s lymphoma may be able to receive a monthly VA disability called total disability based on individual unemployability, or TDIU. This benefit compensates veterans at the 100 percent rating level, even if their disability rating may be less than that.
There are generally two pathways to become eligible for TDIU:
- 38 CFR § 4.16a (“Schedular”) – For this form of TDIU, the veteran must have:
- One condition rated at minimum 60 percent OR
- two conditions that can be combined to reach 70 percent, where one condition is at minimum 40 percent
- 38 CFR § 4.16b (“Extraschedular”) – This form of TDIU is for veterans who may not be able to achieve the ratings necessary for schedular TDIU but are still unable to obtain substantially gainful employment on account of their conditions.
- In this instance, the veteran must prove that their condition uniquely hinders their ability to obtain substantially gainful employment and therefore should not be rated on the standard disability rating criteria.
If a veteran is having difficulty getting a higher disability rating for their Hodgkin’s lymphoma, they may be able to seek compensation at the 100 percent level by applying for TDIU. The veteran may be able to achieve this through schedular TDIU if they have one service-connected disability at 60 percent or greater OR two service-connected disabilities which can combine to reach 70 percent, with one being rated at 40 percent at a minimum. If a veteran does not meet these criteria, they may be awarded TDIU on an extraschedular basis.
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