Question:

In 2007 I was diagnosed by the VA as having prostate cancer. I served in Vietnam and actually had pictures of agent orange barrels that I handled. The VA quickly held that my prostate cancer was compensable and placed me on 100% temporary disability. My PSA was very high (over 30), and I underwent a complete prostatectomy. Because my PSA was so high and because of other characteristics of my condition, the VA enrolled me in a special treatment study, and I was given chemotherapy. I was also placed under the care of a very qualified oncologist who was participating in the study.   After the chemotherapy was completed, to the surprise of all the doctors, my PSA fell to a non-detectable level, and in due course I was evaluated for permanent disability.  Eventually I was awarded 40% plus an additional amount for ED.

In spite of apparently being cured, because I was in the study, I was, and continue to be carefully followed, by the oncologist and my other doctors. A few years ago my PSA began to rise, and even though it is still at a relatively low level, it caused some alarm with my regular doctor, my urologist, and my oncologist. My regular doctor suggested I go on anti-hormonal treatment. The urologist says the PSA shows cancer is present, and the oncologist says that it is returning. This morning I had an appointment with my oncologist who said the PSA is continuing to increase and is approaching the level which is considered "biological recurrence". He thinks that probably six months from now I will need to go on anti-hormonal treatment and that I will probably need a number of scans, etc.

My question is will the rise in PSA be considered a recurrence of the prostate cancer and will I be entitled to a return to temporary total disability. There are already notes in my medical record suggesting that the cancer is returning, but I have not started treatment yet. I should add that the oncologist wants to delay treatment until the PSA rises a little higher since he says the treatment will have undesirable side effects.

Jim's Reply:

Yes, if any one of your doctors believes that you are in the early process of a return of the cancer, then you're eligible for the 100% temporary rating for cancer. You don't need to try and explain that to VA, you just need to refile and seek the 100% benefit and tell them the cancer is back...don't go into detailed explanations. VA doesn't do a very good job with how they define prostate cancer and recurrences and metastases to other organs so you may be denied. Not a problem, a quick appeal will resolve that. I'd suggest that you file ASAP to set the effective date.