What is Multiple Myeloma?
Multiple myeloma is a cancer caused by an overproduction of certain proteins from white blood cells. Specifically, the type of white blood cell called plasma becomes cancerous and grows out of control. Normally, plasma cells are beneficial to our immune system as they make up the antibodies that fight infections. However, in multiple myeloma, they release too much of the protein immunoglobulin into our bones and blood. This protein then builds up throughout the body and causes organ damage. There are often no symptoms of multiple myeloma until the disease progresses. At that point, symptoms include but are not limited to the following:
- Bone pain
- Unexplained bone fractures
- Repeated infections
- Weakness or numbness in the legs
- Abnormal proteins in the blood or urine
- High level of calcium in the blood
Multiple myeloma is a relatively uncommon cancer as the lifetime risk of getting the disease is 1 in 132. However, it is most prevalent in men over 65 years of age and found to be related to both lymphoma and leukemia. Lab tests such as blood and/or urine tests, X-rays of the bones, or a bone marrow biopsy are usually performed to diagnose people with multiple myeloma. Once diagnosed, treatment includes various types of medicine, most often given to prevent complications such as bone fractures and kidney damage. Radiation therapy may also be used to relieve bone pain and in certain cases, bone marrow transplant may be recommended.
Presumptive Service Connection and Agent Orange Exposure
If a veteran has qualifying service, meaning they served in a specific area during a defined time frame, VA will presume that they were exposed to certain harmful chemicals or environmental hazards. In regards to Agent Orange exposure, VA has established a presumption of exposure for the following locations and time periods:
- Vietnam between January 9, 1962 and May 7, 1975 – this only includes veterans who were boots-on-the-ground in Vietnam, or veterans with service aboard a ship that operated in the inland waterways of Vietnam or made visits ashore.
- In or near the Korean demilitarized zone (DMZ) between April 1, 1968 and August 31, 1971.
Importantly, a presumption of exposure replaces the element of service connection that requires veterans to have an in-service event or symptoms that caused their disability. In these instances, VA counts the in-service exposure as the event. In addition to a presumption of exposure, VA also offers a presumption of service connection in which it presumes a veteran’s condition was caused by their military service. Here, VA presumes that certain diseases are caused by a veteran’s exposure to Agent Orange, with multiple myeloma being one of them.
Research on Multiple Myeloma and Agent Orange Exposure
VA is contracted with the Institute of Medicine (IOM) of the National Academy of Sciences, Engineering, and Medicine. The IOM is required to submit a report every two years, at a minimum, that reviews and summarizes the link between exposure to herbicides during service in Vietnam and certain diseases. The IOM concluded in its 1994 report on “Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam” and in its 1996, 1998, 2002, and 2004 updates, that there is “limited/suggestive evidence of an association between exposure to the herbicides used in Vietnam and the development of multiple myeloma”. As a result, veterans who were exposed to Agent Orange and developed multiple myeloma, are entitled to the presumption of service connection described above. Specifically, such veterans do not have to prove a connection between their multiple myeloma and military service to be eligible to receive VA health care and disability compensation.
VA Disability Benefits for Multiple Myeloma
Prior to establishing service connection and receiving VA disability benefits, exposed veterans are eligible for a free Agent Orange registry health exam. Once presumptive service connection is awarded, veterans’ multiple myeloma is rated under 38 CFR § 4.117, Schedule of ratings – Hemic and Lymphatic Systems. However, multiple myeloma does not have its own diagnostic code (DC). Instead, it is given an analogous rating – ratings given to conditions that are not explicitly included in the VA Schedule for Rating Disabilities. The analogous rating is based on what condition most closely matches the overall symptoms or treatment of the disability that VA is trying to rate. Therefore, as multiple myeloma is found to be related to both lymphoma and leukemia, it is rated analogous to either Hodgkin’s disease (DC 7709) or Leukemia (DC 7703). If rated analogous to Hodgkin’s disease, the 100 percent disability rating is assigned if the cancer is active or undergoing treatment. The 100 percent rating continues for six months after the last treatment, and the condition is then re-evaluated based on the ongoing symptoms. If rated analogous to Leukemia, the 100 percent rating is also assigned if the cancer is active and continues for six months following the last treatment. Then, the condition is rated as either anemia or aplastic anemia, whichever gives the veteran the higher rating.