What is Bladder Cancer?
Bladder cancer is one of the most common cancers, affecting approximately 68,000 adults in the United States each year, including many veterans. The most common signs and symptoms include the following:
- Blood in urine (hematuria)
- Painful and frequent urination
- Pelvic pain
- Back pain
After the onset of the above-mentioned symptoms, bladder cancer is usually diagnosed through a variety of tests and procedures (e.g. CT scan, X-ray, biopsy, etc.). From there, doctors are able to discuss courses of treatment, including but not limited to, surgery, chemotherapy, radiation, and immunotherapy. If you are a veteran suffering from bladder cancer and believe it was caused by your military service, you may be eligible for VA disability benefits.
For veterans suffering from an active form of service-connected bladder cancer, or those in a period of post-treatment convalescence, VA will assign a temporary and total disability rating. This 100 percent rating will remain for up to six months following the end of treatment. If a veteran’s bladder cancer remains active, VA will extend the temporary and total disability rating until the cancer goes into remission. Once the veteran stops receiving treatment due to remission, VA will schedule a follow-up Compensation & Pension examination in order to reevaluate the condition. At that time, veterans may still receive disability compensation for residual symptoms. VA will rate the most predominant residual, typically either renal (kidney) dysfunction or voiding dysfunction.
Impact of Agent Orange Exposure on Bladder Cancer
VA is currently in the process of considering whether to add bladder cancer to its list of presumptive conditions associated with Agent Orange exposure, which currently includes 14 disabilities. This consideration comes following the “Veterans and Agent Orange: Update 2014” report that was released in March of 2016. In this report, the National Academy of Medicine released new research that, for the first time, recognized that evidence exists regarding a link between bladder cancer and Agent Orange exposure. Specifically, the report stated there was “limited or suggestive” evidence of an association, which is an upgrade from its previous “inadequate or insufficient” association. This determination was based on evidence that higher levels of exposure to herbicide agents are associated with an approximately 2-fold increase in death from bladder cancer. The updated report also studied the connections between hypothyroidism, hypertension, and Parkinson’s-like symptoms and exposure to Agent Orange.
In November 2017, VA sent a recommendation to the White House’s Office of Management and Budget that bladder cancer, along with the three other conditions, be added to the list of presumptive conditions. However, VA has yet to take any other action in regards to this matter. Instead, in August 2018, VA leadership informed the House Committee on Veterans’ Affairs that it was waiting on the results of two studies concerning mortality and morbidity, the second of which might not be complete until 2020. VA maintains that such research is necessary as it could provide more evidence of a connection between these conditions and Agent Orange exposure.
2019 Update: VA to Decide on Presumptive Status of Bladder Cancer
On March 26, 2019, VA Secretary Robert Wilkie testified before the Senate Veterans’ Affairs Committee about President Trump’s fiscal year 2020 budget request for the Department of Veterans Affairs. During this hearing, Senate members asked Secretary Wilkie to comment on the status of the above-mentioned conditions, including bladder cancer. Veterans groups have been calling on VA to add these conditions to the list of presumptive diseases related to Agent Orange exposure. In response to this, Executive in Charge of the Veterans Health Administration, Dr. Richard Stone, noted that VA hopes to make a decision regarding the presumptive status of these conditions within the next 90 days. If added to the list of presumptive conditions, veterans with eligible service who are suffering from bladder cancer will no longer have to prove a connection between their condition and service, thereby establishing an easier path to disability compensation.
Why Does VA Have to Add New Conditions to the Presumptive List?
In 1991, the Agent Orange Act was designed to respond to the many health-related concerns expressed by Vietnam-era veterans in relation to herbicide exposure. The Act set forth many requirements that VA must adhere to. Specifically, the Act required VA’s Secretary to contract with the Institute of Medicine (IOM). The IOM must submit a report every two years, at a minimum, that reviews and summarizes the link between exposure to herbicides during service and certain conditions. In developing the report, the IOM must consider useful clinical data gathered from VA medical exams and treatment provided after 1981 to Vietnam-era veterans who sought VA healthcare based on Agent Orange exposure. Ultimately, the IOM must determine if there is a statistical association between exposure to herbicides and a specific disease, and if there is evidence of a causal relationship. Whenever the Secretary determines that a positive association exists between Agent Orange exposure and certain conditions, presumptive service connection is warranted.