What to Expect in a Prostate Cancer C&P Exam

Leah Bucholz, a US Army Veteran and physician assistant at Prestige Veteran Medical Consulting, provides insights into what to expect during a prostate cancer C&P exam. C&P exams can evoke anxiety among veterans, and understanding the process can alleviate some of those fears. This guide will provide veterans with essential information on the exam’s structure and help them prepare adequately for a successful VA disability claim exam.

Understanding Prostate Cancer in Veterans 

Each year, around 15,000 Veterans are diagnosed and treated for prostate cancer at VA facilities, while more than 200,000 Veterans are living as prostate cancer survivors. It makes up for 30% of new cancer diagnoses in the VA. Symptoms of prostate cancer can include painful or frequent urinating, blood in the urine and semen, erectile dysfunction, enlarged prostate or benign prostate hyperplasia (BPH), and pelvic discomfort. 

Diagnosis of prostate cancer typically involves a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. If these results suggest cancer, a biopsy or imaging tests may be performed to confirm the diagnosis.

Treatment options vary based on the cancer stage and may include surgery, radiation therapy, hormone therapy, or active surveillance in less aggressive cases. 

Common Causes of Service-Related Prostate Cancer

Veterans are at heightened risk for prostate cancer due to various service-related exposures. Two primary causes are Agent Orange exposure and burn pit exposure, for which prostate cancer is considered a presumptive condition. There’s also increasing evidence linking prostate cancer to contaminated water at Camp Lejeune.

Agent Orange, used extensively during the Vietnam War, contains toxic chemicals that have been linked to several cancers, including prostate cancer. Veterans who served in Vietnam, the Korean DMZ, or certain areas of Thailand are presumed to have been exposed, allowing them to automatically qualify for VA disability benefits without needing to prove a direct connection.

Burn pit exposure affected veterans deployed in Iraq and Afghanistan after 9/11. The VA has recognized prostate cancer as a presumptive condition for burn pit exposure following the passage of the PACT Act in 2022. Veterans must submit medical records proving their diagnosis and evidence of service in areas known for burn pits.

At Camp Lejeune, contaminated drinking water from 1953 to 1987 has been linked to various cancers, including prostate cancer, though it is not yet a presumptive condition. Veterans must provide a medical nexus linking their cancer to contaminated water to establish service connection for disability benefits.

Establishing a Service Connection to Prostate Cancer

Veterans seeking VA disability compensation for prostate cancer must show a link between the condition to their military service. Before anything else, veterans often apply for VA disability benefits on their own or with the help of an accredited legal professional by using VA Form 21-526EZ. To prove a direct service connection for prostate cancer, veterans often follow many of these steps:

1. Obtain a current diagnosis of prostate cancer.
2. Provide evidence of a service-related event or injury that may have contributed to the development of your cancer.
3. Submit a nexus letter drafted by your treating physician linking prostate cancer to your service. This letter can be included with your disability benefits application should you decide to submit one.

The VA often requires a C&P exam to assess your claims for benefits and verify medical evidence. For prostate cancer, it helps determine the severity of the condition, residual effects, and impact on your daily life and work. During the C&P exam for prostate cancer, your doctor evaluates symptoms, diagnosis, and treatments to establish eligibility for VA benefits.

Preparing for the VA C&P Exam for Prostate Cancer

Before the exam, veterans receive a packet containing details about the provider, location, and time of the evaluation. This packet also outlines the qualifications of the examiner, whether they are a urologist, internal medicine doctor, or another healthcare provider such as a nurse practitioner or physician assistant. Additionally, veterans may be asked to complete a Disability Benefits Questionnaire (DBQ), which aids in gathering information about their medical history and current condition.

Disability Benefit Questionnaire (DBQ)

The DBQ covers various aspects of male reproductive organ conditions, including prostate cancer. It begins with basic information such as the veteran’s name and social security number. The examiner then reviews evidence provided by the veteran, such as medical records, diagnostic test results, and personal statements.

Medical History

The DBQ delves into the veteran’s medical history, including the onset and course of their condition. It inquires about the cancer treatment, including medications like hormonal therapy or chemotherapy and surgeries like orchiectomy (testicular removal) or radical prostatectomy (prostate removal). Veterans are also asked about any renal dysfunction or voiding dysfunction related to their condition.

Physical Exam

During the physical exam, the examiner may assess the veteran’s genitalia, testicles, epididymis, and prostate. However, veterans have the right to decline any part of the examination. For instance, they can choose not to have their genitalia examined if they feel uncomfortable. The DBQ includes sections for recording the findings of the physical examination, including any abnormalities or pertinent observations.

Prostate Cancer-related Inquiries

For veterans with prostate cancer, the DBQ includes specific questions about the nature of the cancer or disorder, such as whether it is benign or malignant, and if it is in remission or actively progressing. Details about treatments, including surgery, radiation, and chemotherapy, are also documented. The examiner may inquire about the prostate cancer residuals or complications resulting from the cancer or its treatment, for example, urinary incontinence, erectile dysfunction, and chronic pain.

Functional Impact Assessment

Veterans are asked whether their condition affects their ability to perform occupational tasks, regardless of their current employment status. This assessment considers the impact on activities such as walking, lifting, and sitting for extended periods. Functional impact assessment helps evaluate how the condition interferes with veterans’ daily activities and work and eventually determines their VA disability rating. 

VA Rating for Prostate Cancer

The VA rates prostate cancer under Diagnostic Code 7528, which applies to malignant neoplasms of the genitourinary system. If the cancer is active or the veteran is undergoing treatment, a 100% disability rating is assigned. This rating continues for at least six months following the end of treatment, after which the VA schedules a follow-up examination to determine if the cancer is in remission or has residuals.

If the cancer is in remission, the VA rating is based on residual effects such as:

• Frequent urination: Ratings range from 10% to 40%, depending on the frequency. For example, a 40% rating requires needing to urinate five or more times per night or having a daytime voiding interval of less than one hour.
• Urinary incontinence: Ratings go from 20% to 60%, depending on how often absorbent materials (like diapers) need to be changed. To qualify for the highest 60% rating, changes of absorbent materials must occur four or more times per day.
• Erectile dysfunction: Typically rated at 0%, unless there’s a deformity, which could increase eligibility for Special Monthly Compensation (SMC-K) due to the loss of a creative organ.

The rating can fluctuate depending on whether the cancer reoccurs or worsens, requiring the veteran to undergo periodic C&P examinations. If the cancer returns or metastasizes, the veteran can return to the 100% VA rating.

TDIU Benefits and Prostate Cancer

Prostate cancer alone grants a maximum disability rating of 60%. However, if cancer’s residual effects or combined disabilities prevent substantial employment, you may qualify for a 100% rating under Temporary Disability for Individual Unemployability (TDIU). Eligibility requires either a single 60% rating or a combined 70%, with one disability rated at 40%.

Expert Tips for Prostate Cancer C&P Exam

A Compensation & Pension (C&P) exam for prostate cancer evaluates your condition for VA disability benefits. Here are key tips to prepare effectively:

1. Document All Symptoms: Keep detailed records of symptoms like urinary incontinence, fatigue, or pain, and how these affect your daily life. Mention related emotional stress or any mental health issues.
2. Explain Treatments and Side Effects: Share information about all past and current treatments, such as surgery or chemotherapy, and their impact on your quality of life, including side effects.
3. Mention Secondary Conditions: Address conditions related to prostate cancer, like erectile dysfunction or bowel issues, and explain how they impact you physically and mentally.
4. Prepare Documentation: Bring relevant medical records, including treatment histories, biopsy results, and lab reports, to support your claims.
5. Be Honest and Clear: Speak openly about all symptoms, even if they are sensitive topics like urinary incontinence or erectile dysfunction. Accurately describe how your condition impacts your daily routine.
6. Attend the Exam: Missing the exam can result in claim denial. If rescheduling is needed, contact the VA immediately to avoid delays or negative outcomes.

Conclusion – Prostate Cancer C&P Exam

Understanding what to expect during a prostate cancer C&P exam can help alleviate anxiety and prepare veterans for the process. By familiarizing themselves with the DBQ and knowing their rights during the physical examination, veterans can confidently approach the exam. Understanding the exam process, bringing relevant medical records, and being honest about the impact of prostate cancer on daily life enable veterans to better advocate for VA disability compensation. Prestige Veteran Medical Consulting and professionals like Leah Bucholz are dedicated to supporting veterans through every step of their healthcare journey.

Also read: Crohn’s Disease and PTSD in Veterans Disability

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