Question:
Jim, thanks again for your devotion to this and, of course, your service. I’m 100% temp disabled, Agent Orange - Prostrate Cancer. When and if the VA lowers my rating and I present evidence that there is cancer, do the payments reflect the time from lowering the rating until reinstatement of 100%. I just had my 6 month exam and am delaying biopsy until October. PSA dropped very slightly. How and why does the VA get away with this?
Jim's Reply:
The Vietnam veteran who has an active prostate cancer is rated at 100% disabled with a temporary rating. There is no particular logic to this since prostate cancer in and of itself isn't disabling. The fact is that if it weren't for a vague and unreliable blood test (The PSA) most men wouldn't know they had prostate cancer until they died of something else.
That's one of the reasons so many of us choose to skip treatments and die with the cancer...not of the cancer. Watchful waiting seems to be the way to go for many.
So if you treat the disease that isn't causing you to feel ill and gets you a 100% rating, after treatment you're going to feel worse with residual effects of therapy and then your rating will drop. The rating will fall to 60%, 40% or 20% depending on how many pads you use each day to collect leaked urine. Six pads will be 60%, etc.
If you show that cancer is still active after treatment, your rating will remain at 100%. But you will have to provide a definitive statement from a physician that "it is more likely than not" that your cancer is still active. If your PSA drops at all after treatment, that's a cure in VA terms.
Here's my own view...I'm 72. My PSA has steadily, slowly climbed over the last 10 years. There is nothing alarming and it has yet to rise to 10. I have an MRI of my spine that includes a glance at the prostate that shows a tiny nodule. Nobody is able to feel the nodule. I'm not a Vietnam vet so a 100% rating doesn't influence any of my thinking.
I have declined any number of offers to do a prostate biopsy. A slow climb in PSA is anticipated in a 72 year old. Nobody can detect my (questionable) nodule. My last PSA sowed that it dropped by almost 2 points...all without benefit of a biopsy. If I have cancer, I'll die with it, not of it.
"How does VA get away with this?", you ask. Because it's the VA is the only answer I can provide.
Any time you engage VA you can anticipate outmoded technology and early 20th century thought processes. The ratings schedule was built in the 1940s and hasn't been adequately revised since. Good luck!