Non-Hodgkin’s lymphoma is a type of 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. Symptoms associated with non-Hodgkin’s lymphoma include the following:
- Swollen, painless lymph nodes in the neck, armpit, or groin areas in early stages
- Night sweats
- Weight loss
- Abdominal pain or swelling
- Chest pain or trouble breathing
- Itchy skin
In order to diagnose this type of cancer, doctors will typically perform a physical exam and check areas of the body with lymph nodes to feel if they are swollen. Additionally, either a lymph node biopsy, a blood test with a complete blood count, or imaging tests will be performed. If the test results are positive for the presence of non-Hodgkin’s lymphoma, more tests will be conducted to determine how far it has spread to guide future treatment and follow-up. Treatment depends on the specific type of non-Hodgkin’s lymphoma, the stage at which it was first diagnosed, the individual’s age and overall health, and the accompanying symptoms.
Research Findings on Non-Hodgkin’s Lymphoma and Herbicide Exposure
The Institute of Medicine (IOM) must 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. In developing the report, the IOM must consider useful clinical data gathered from VA medical exams and treatment provided after 1981 to Vietnam 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. In its 1994 report on “Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam” and in future updates, the IOM concluded that there is “sufficient evidence of a positive association between exposure to herbicides (2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram) and non-Hodgkin’s lymphoma.
Presumptive Service Connection for Non-Hodgkin’s Lymphoma
As a result of the IOM’s findings, VA presumes non-Hodgkin’s lymphoma is related to a Veteran’s exposure to Agent Orange or other herbicides during qualifying military service, or service in Vietnam or in the offshore waters of Vietnam during the Vietnam Era. These Veterans do not have to prove a connection between their disease and service to be eligible for service connection. Importantly, non-Hodgkin’s lymphoma differs from the other presumptive conditions associated with herbicide exposure insofar as there are multiple legal presumptions of service connection available, including:
- 38 CFR § 3.309(e) – provides for the presumption of service connection for any diagnosis of non-Hodgkin’s lymphoma, anytime that the disease manifests itself after service, as a result of exposure to herbicides and Agent Orange
- 38 CFR § 3.313 – provides for the presumption of service connection for any diagnosis of non-Hodgkin’s lymphoma, anytime that the disease manifests itself after service without reference to Agent Orange or herbicides
38 CFR § 3.313 is particularly significant because the presumption of service connection is based solely on service in Vietnam, which is defined in the regulation as including “service in the waters offshore, or service in other locations if the conditions of service involved duty or visitation in Vietnam.”
Importance for Blue Water Navy Veterans
The presumption of service connection for Vietnam veterans with non-Hodgkin’s lymphoma is unique because VA holds that veterans do not have to show that they were “boots on the ground” in Vietnam. Instead, veterans are only required to show that they had service in Vietnam as defined above to be eligible for presumptive service connection for this disease. This is important for Blue Water Navy veterans, because it allows those who served on the offshore waters of Vietnam to be eligible for benefits on a presumptive basis anytime they are diagnosed with non-Hodgkin’s lymphoma following military service.
How Does VA Rate Non-Hodgkin’s Lymphoma?
VA rates non-Hodgkin’s lymphoma under 38 CFR § 4.117, Schedule of ratings – Hemic and Lymphatic Systems using Diagnostic Code 7115. A 100 percent disability rating is assigned when the disease is active or during a treatment phase. This rating continues beyond the completion of any treatment and then six months after treatment has ended, 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.