Jim,

We are in the process of filing a notice of disagreement because my husband's cancer is in remission. VA has proposed tp reduce his 100% rating. We are trying to get diagnosis for residual effects of the chemo. My question is, do we need a nexus letter with Mantle Cell Lymphoma as it is a presumptive disease for agent orange exposure? My logic says we only need to connect the residuals to the cancer treatment and PJP pneumonia that developed during treatment, and the service connection is presumptive. Thanks for your advice.

Reply:

You don't necessarily need a nexus letter. The VA rates some active cancers in Vietnam veterans at 100%. These are the presumptive conditions that VA cedes may be caused by herbicide exposure. It is assumed that the treatment for the cancer will render the veteran temporarily 100% disabled. Once a veteran who had a cancer is in remission (or cancer free) it's very hard to keep that 100% rating. Residuals from chemo, for example, are generally not 100% disabling.

If VA proposes to lower his rating from 100% he will have a C & P exam first. Depending on what the examiner observes regarding residuals, he will probably receive a 60% or 40% rating. If you aren't happy with the rating then is the time to appeal.