Melanoma, a type of skin cancer, is a significant concern for many veterans. Its connection to military service and subsequent eligibility for VA disability benefits is a topic of importance for both veterans and healthcare providers. In this blog, Leah Bucholz delves into the nature of melanoma, explores its causes and symptoms, and highlights the specific risks military veterans face. We’ll also examine how the recent PACT Act has made it easier for veterans to secure disability benefits for melanoma and other related conditions.
Understanding Melanoma
What is Melanoma?
Melanoma is a type of skin cancer that originates in melanocytes, the cells responsible for producing melanin, the pigment that gives skin its color. According to the Mayo Clinic, melanoma commonly develops in areas of the skin frequently exposed to the sun, such as the arms, back, face, and legs. It can also occur in less common sites like the eyes and internal body parts such as the nose or throat. The exact cause of melanoma remains unknown, but exposure to ultraviolet (UV) light from the sun or tanning beds is a significant risk factor.
Melanoma can appear anywhere on the body but often affects the face or trunk in men and the lower legs in women. Symptoms of melanoma include:
- A large brown spot with darker speckles
- A mole that changes or bleeds
- Small irregular lesions
- Painful or itchy areas
- Dark spots on palms, soles, or mucous membranes
According to the American Cancer Society, Melanoma is highly treatable when caught early, with a 99% five-year survival rate, but this decreases as it spreads nearby, to the lymph nodes (65%), or other body parts (25%).
Risk Factors
The primary risk factor for melanoma is exposure to UV light. equatorial regions, more susceptible to melanoma. Limiting UV exposure is crucial in reducing the risk of developing this cancer. Individuals with higher sun exposure, such as those deployed in sunny or tropical environments, are at greater risk of skin cancer. This makes military personnel, particularly those serving in equatorial regions, more susceptible to melanoma. Veterans often have fair skin and are older, which are both risk factors for melanoma. The disease is also more prevalent among men, who make up a large portion of the veteran population.
Melanoma and Veterans Disability
The PACT Act and Presumptive Conditions
The passage of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act has significant implications for veterans. The PACT Act has added 20 new presumptive conditions related to burn pits and other toxic exposures, including melanoma. Under this legislation, veterans who served in certain locations, such as Southwest Asia during the Gulf War, are presumed to have been exposed to environmental toxins, thereby simplifying the process of claiming disability benefits for conditions like melanoma.
The PACT Act extends benefits to Vietnam-era veterans exposed to herbicide agents like Agent Orange. Those who served in Vietnam and later developed conditions such as chloracne, skin cancer like melanoma, or autoimmune diseases within one year of exposure are granted presumptive service connection. Gulf War veterans with chronic skin conditions, such as dermatitis, or other undiagnosed skin disorders may also qualify for presumptive service connection if their condition is rated at 10 percent or higher.
Medical Literature on Melanoma in Veterans
Research consistently shows an increased risk of skin cancer among military personnel. A systematic review published in the Journal of the American Academy of Dermatology in June 2018 examined skin cancer risk among US military personnel. The review of nine studies found an increased incidence of skin cancer, including melanoma, among military personnel. The studies highlighted that increased sun exposure during military service contributed to higher rates of skin cancer compared to non-military populations.
Another research by the Journal of the American Academy of Dermatology revealed that veterans had an 18% higher chance of being diagnosed with stage 3 melanoma and were 13% more likely to receive a stage 4 diagnosis, where the cancer has spread.
Other Relevant Research
The United States Environmental Protection Agency (EPA) has also addressed UV radiation’s impact, emphasizing that UV rays are strongest at the equator, where military personnel are often deployed. Another study published in StatPearls discussed the malignant transformation of melanocytes due to UV radiation exposure. The research highlighted that military personnel are an often-overlooked group with unique UV exposure risks, placing them at higher risk for melanoma.
A 2021 Air Force study also showed that fighter pilots and officers around jets were 24% more prone to melanoma than non-flying officers.
VA Disability Ratings for Skin Conditions
The VA rates skin conditions under Diagnostic Codes 7800-7833, based on the extent of the affected area and the type of treatment required. The General Rating Formula for the Skin gives a rating from 0% to 60% for conditions like dermatitis, skin lupus, psoriasis, and melanoma with higher percentages reflecting more severe or widespread conditions.
- A 60% rating which provides a monthly payment of $1,316.88 is given when lesions cover over 40% of the body or exposed areas, or when continuous systemic therapy such as corticosteroids, phototherapy, or immunosuppressive drugs is needed throughout the past year.
- A 30% rating is assigned if 20-40% of the body or exposed areas are affected, or if systemic therapy is required intermittently for at least six weeks within a year. Veterans with a 30% VA rating receive $524.31 per month as compensation.
- A 10% rating applies to conditions affecting 5-20% of the skin or exposed areas, or when systemic therapy is needed for less than six weeks. Veterans qualifying for a 10% VA rating receive monthly compensation of $171.23.
- A 0% rating is provided when lesions affect less than 5% of the body or when only topical treatments are required. This rating typically does not qualify for any monetary compensation. Special disability ratings may apply for disfigurement involving scars on the head, face, or neck.
Veterans may receive a 100% VA disability rating based on Temporary and Total Disability Individual Unemployability (TDIU) for skin conditions like malignant melanoma that require extensive treatments, such as radiation therapy. TDIU eligibility requires a single service-connected disability rated at 60% or multiple disabilities totaling at least 70%.
VA Disability Rating for Scars
The VA rates scars using Diagnostic Codes (DC) 7800-7805, considering factors such as location, size, disfigurement, and symptoms. Melanoma, classified under DC 7833, is rated similarly—either as scars (DC 7801-7805), disfigurement of the head, face, or neck (DC 7800), or by impairment of function based on the affected body system.
- Scars on Head, Face, and Neck (DC 7800) – 10% to 80% based on tissue loss and facial distortion.
- Deep, Nonlinear Scars (DC 7801) – 10%, 20%, 30%, or 40% based on affected area size (not on head, face, or neck).
- Superficial, Nonlinear Scars (DC 7802) – 10% if scar exceeds 144 square inches.
- Painful or Unstable Scars (DC 7804) – 10%, 20%, or 30% based on the number of scars; an additional 10% for multiple unstable scars.
- Other Scars (DC 7805) – Rated on disabling effects, such as joint motion limitations.
- Skin Cancer including Melanoma (DC 7833) – Up to 100% during active treatment phases like surgery, chemotherapy, or radiation. Post-treatment ratings are based on residual effects, such as disfigurement, tissue loss, or limitations depending on the severity of the condition and the likelihood of recurrence.
Establishing a Direct Service Connection for Skin Conditions
To obtain VA disability benefits for skin conditions like melanoma directly related to military service, veterans need to provide three essential pieces of evidence.
- First, a current skin condition diagnosis such as dermatitis, psoriasis, or skin cancers like melanoma is necessary.
- Second, there must be documented medical evidence of an in-service event or incident that likely caused or contributed to the skin condition.
- Lastly, a medical nexus, often provided through a doctor’s opinion or nexus letter, is required to link the current skin condition to the in-service event. A positive nexus statement will also be provided at the VA C&P exam if the examiner agrees that the condition is related to service.
This connection is vital for proving that the skin condition is directly related to military service, thereby supporting the veteran’s claim for VA disability compensation.
VA Resources and Benefits
VA.gov and Melanoma
The VA provides extensive resources for veterans, including information about melanoma and its connection to military service. The VA considers various types of melanomas as presumptive conditions, including melanomas of the skin, eyes, and mucosal melanomas, which originate in the tissues lining internal areas of the body. This classification simplifies the process for veterans to claim disability benefits for these conditions.
Service Connection and Sun Exposure
Veterans’ claims for melanoma-related disability benefits consider their lifetime sun exposure. For instance, a veteran who served many years in sun-exposed areas, such as on a ship’s deck in the Navy, may have a higher risk of developing melanoma. The VA evaluates each case based on individual exposure history, ensuring fair consideration of all contributing factors.
Additional Considerations
Other Skin Cancers
While melanoma is a primary concern, veterans may also develop squamous cell carcinoma, basal cell carcinoma, benign tumors, and other types of skin cancer. These cancers, along with the scars they leave, can be service-connected, providing additional avenues for veterans to receive disability benefits.
Pyramiding Skin Conditions
Skin conditions in VA disability claims can be complex due to the prohibition on pyramiding, which prevents double-counting the same disability. Multiple disability ratings are allowed if each condition is distinct and affects different areas. For a single condition affecting multiple areas, the VA assigns one rating for all areas. If multiple conditions affect the same area, the VA rates only the one with the highest rating.
C&P Exams for Skin Cancer
If veterans don’t have a presumptive service connection with melanoma, they may need to prove their skin cancer began or worsened during military service. Veterans undergoing Compensation and Pension (C&P) exams for skin cancer should be prepared for thorough evaluations. These exams assess the extent and impact of the cancer, including any scarring, to determine the appropriate level of disability benefits.
A medical professional will review your military service records, ask detailed questions about your condition, and conduct a thorough physical examination of the affected areas. Ensure all symptoms and changes in your skin are documented and discussed during the exam for a fair assessment.
Disability Benefits Questionnaire (DBQ)
A Disability Benefits Questionnaire (DBQ) is a form used during exams for skin conditions to help medical professionals accurately record your symptoms, diagnosis, medications, and the condition’s impact on your life. Completed by a doctor, the DBQ not only supports your VA disability claim but may also determine your VA disability rating and VA compensation amount. Note, that the VA may still require a C&P exam for final evaluation even if DBQ has been completed.
Conclusion
Melanoma poses a significant risk for veterans, particularly those with extensive sun exposure during their service. The recent PACT Act and other VA resources have made it easier for veterans to access disability benefits for melanoma and other related conditions. By understanding the risk factors, available research, VA rating criteria for melanoma, and VA resources, veterans can better navigate the process of obtaining the benefits they deserve.
Also read: New 2024 GERD VA Disability Ratings Updates
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