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welcome to Veterans legal Lowdown my name is Nicholas Briggs and today I'm joined by Kevin
Medeiros and Michelle datura and we're going to be talking about secondary conditions related
to conditions that are presumptively related to Agent Orange so first before we get started it
would be helpful to provide a brief description of what agent orange is and how it's relevant
to today's discussion so agent orange is one of several so-called rainbow herbicides used during
the Vietnam War era the United States military used agent orange and other herbicides like it to
Deforest large areas of land in Vietnam in order to disrupt enemy supply lines and prevent ambushes
Asian orange itself is a 50 50 mixture of two different kinds of herbicides 2 4-D and 245t
Asian orange also it contained the contaminant tcdd as a byproduct of its production tcdd which
is short for two three seven eight tetrachlorodi benzo paradoxin is the most toxic of all dioxins
and as a result of the that toxicity many veterans who served during the Vietnam War era
were in direct contact with the chemical and have developed a range of health conditions as a result
and not only have they developed these primary conditions they've developed secondary conditions
as well which we'll talk a bit more about later so Michelle first can you tell us a bit about
how a veteran is known to have been exposed to agent orange yeah so VA knowledge is presumptive
exposure for veterans with active military Naval Air or space service during the Folly following
periods of time and locations so you have January 1962 to May 1975 in the Republic of Vietnam you
have January 1962 to June 1976 in Thailand you have December 1965 to September 1969 in Laos
you have April 1969 to April 1969 in Cambodia you have January 1962 to July 1980 in Guam or American
Sonoma you have January 1972 to September 1977 at Johnson atoll you have September 1967 to August
1971 in the Korean DMZ and you generally have 1969 to 1986 when it comes to the c123 aircraft
now keep in mind I gave General months and years there are actual days specific as well so that's
just something to be mindful of when you are looking at time frames for presumptive exposure
and another important thing to know is they don't all automatically line up with the Vietnam War era
that's generally what we're talking about but for Thailand for example that was recently added as
a presumption in The Pact Act um on which we felt set filmed several several videos and the Thailand
presumptive window actually extends almost a full year longer than the Vietnam War era and that's
just meant to reflect that veterans served in Thailand longer than they were in Vietnam itself
so now that we know a bit more about where veterans might have been exposed to agent orange
Kevin can you fill us in on some of the primary conditions that it can develop as a result of this
exposure yeah sure and VA considers the follow this following list of conditions if a veteran
has been exposed to Asian orange and develops you know these conditions as presumptive they are Al
Amalie amyloidosis which is a rare disease that causes the bone marrow cells to mutate and usually
affects the heart and the kidneys bladder cancer chronic B cell leukemias chloracney which is a
skin disorder diabetes type 2. Hodgkin's Disease hypertension hypothyroidism ischemic heart disease
new one is monoclonal gammopathy of undetermined significance which is abnormal proteins in the
blood multiple myeloma Non-Hodgkin's lymphoma Parkinson's disease Parkinson's like symptoms
peripheral neuropathy porphyria cutania tarda which is another skin condition
prostate cancer respiratory cancer and soft tissue sarcomas like I mentioned that monoclomal
gammopathy of undetermined significance has been newly added to the presumptiveness as part
of The Pact act and so has hypertension so for more information on the The Pact act including
new toxic exposure presumptions we have a video about that on our website great thanks for that
Kevin so with that in mind we have a good sense of many of the conditions that are primarily
related to ancient orange exposure but that's not often where things leave off unfortunately
after veterans have suffered from these primary conditions for many years it's common for them
to start developing secondary disabilities as they attempt to treat that primary condition
so when it comes to secondary service connection it it is describing a condition that develops or
is the result of a condition that's already service connected and improving claims for
secondary service connection veterans often still need to provide medical Nexus in a way that they
didn't need to for the presumptive conditions because the important part of those presumptions
is that the medical Nexus the relationship between agent orange and the condition itself is assumed
whereas with these secondary conditions you still need to prove medical Nexus though that is
often easier because the medical community widely recognizes certain conditions as being obviously
secondary to diabetes and other disabilities like it so first we'll start off with a primary example
which is diabetes mellitus type 2. it was added to the list of presumptive conditions back in
May of 2001 and one of the most common residuals and secondary disabilities related to diabetes
is peripheral neuropathy peripheral neuropathy affects the veterans peripheral nerves and can
cause numbness weakness pain and tingling in both the upper and lower extremities though
oftentimes this numbness and weakness is largely confined to the fee in the hands um and Veterans
can be service connected for peripheral neuropathy either secondary to their diabetes however if they
had early onset neuropathy shortly after their exposure the regulations do technically allow for
neuropathy to be service connected based off of the Ancient Orange exposure itself so in
addition to peripheral neuropathy as a common secondary disability to diabetes we see other
conditions as well including diabetic retinopathy erectile dysfunction and chronic kidney disease
Michelle are there any other examples that we can highlight for us secondary disabilities
yeah unfortunately one we see very commonly which Nick briefly mentioned was that we see
erectile dysfunction secondary to prostate um while our child's dysfunction it's typically
gets a non-compensable rating veterans who are service connected for this condition are
likely eligible to receive special monthly compensation at the K level which is usually
about an extra 100 120 dollars it depends on the cost of living but adjustment for
each year but currently that's the range right now it's in addition to their monthly benefit
um also which was very common with prostate cancer is when originally service connected and
the cancer is active it's 100 after that it's usually rated based on urinary frequency and
urinary incontinence so you'll see that you'll be compensated for that as an unfortunate side effect
of prostate cancer great thanks Michelle and it's important to highlight cancers generally because
those are many of the conditions that have been presumptively linked to herbicide exposure over
the years um and more and more cancers are being added to that list all the time bladder cancer for
example was recently added back in 2020 so with that in mind are there any other common conditions
Kevin that might be associated with cancer that a veteran could potentially potentially
get granted as secondary to that condition yeah a big one we see is depression so it's common
for veterans with cancer to start suffering from depression as a result of the negative effects of
the disease on their life the treatments and everything they have to go
to go through associated with having the cancer so for for veterans they can file
for secondary service connection for depression and it's helpful in those cases for veterans to
provide lay statements from family and friends who can attest to the onset and progression of
their depression in relation to the cancer what's which like I said is is pretty common thanks Kevin
another thing to keep in mind when talking about presumptive service connected conditions and agent
orange exposure is that many of the conditions on the list are relatively systemic in terms of how
they affect the veteran so certain diseases like Parkinson's disease itself as well as other types
of parkinsonism can have widespread effects on the person's body that can result in many
different types of impairment all of which can be considered as secondary residuals of
that primary Parkinson's disease oftentimes we see veterans with Parkinson's developing forms
of upper and lower extremity neuropathy and Tremor disorders they often have difficulty
swallowing difficult difficulty speaking they develop urinary frequency and urinary bladder
control issues and many other residual conditions can be associated with that one primary condition
so it's critical for veterans to recognize all the problems that they're having and report
them to both their medical doctors and their CMP examiners that way anything that could
potentially be related to Parkinson's or systemic disease like it can be rated because they might
not necessarily know that this condition or that condition is related to their Parkinson's itself
um but another thing to keep in mind is that not only do conditions primary disabilities
cause secondary conditions but unfortunately sometimes medications to treat the primary
condition can cause disability as well are there any examples that come to mind Michelle that you
think might be helpful I think there is I think this is also an interesting one because I think
it's often overlooked as a potential so a lot of times medication side effects can cause anything
from headaches you have gastroesophageal problems like gerd you have IBS it could cause that I think
that another thing that is very common is not understanding that it didn't necessarily need to
cause it but it can also aggravate it so you could have had gerd beforehand but now the medication
is making it worse you could have had IBS but a side effect of that medication is diarrhea and
now you're having flare-ups more frequently of your IBS I think that those are things to
really be thinking about when you are you know seeking service connection is also looking at
the medication side effects and not only this General side effects but if the medication
is now worsen a condition that you might have had prior and another good example of this is
um additional disability and aggravated disability that might arise as a result of chemotherapy like
we've talked about before many cancers are on the list of presumptive diseases related
to agent orange and chemotherapy is used to treat many of those Cancers and it can have widespread
negative effects including neuropathy and many other disabilities like it so even the treatment
for your condition itself can potentially cause disability and again if those problems do arise
just make sure that you're reporting them to your doctor and to your VA examiners that way VA has
the information they need to or your disability appropriately um so with that in mind with uh the
idea of rating disabilities appropriately another thing that often comes up in our line of work
and representing disabled veterans is the idea of unemployability benefits and oftentimes while the
cancer itself may not stop a veteran from working it's certainly possible that the conditions they
develop as secondary to their primaries can cause them to stop working in one way or another so
Kevin can you tell us a bit more about secondary conditions and their overlap on uh via the
potential entitlement for tdiu sure yes secondary conditions can really go a long way to increase a
veteran's overall combined rating and the higher a veterans overall combined rating the more likely
the VA is to Grant tdiu tdiu stands for total disability based on individual unemployability
so it recognizes that a veteran veterans unable to to obtain and maintain substantially gainful
employment because of their service-connected conditions and a grant of tdiu will compensate
a veteran at the 100 level even if you know their overall combined rating isn't 100 percent
um and um under the VA regulations there's a scheduler tdiu which is when one service
connected condition is rated at 60 percent minimum or two conditions that can be combined
two conditions or more that can be combined to reach 70 if one condition alone is is rated
up the scheduler tdiu criteria are outlined in 38 CFR 4.16a and like I said if a veteran meets
that criteria VA is more likely to Grant tdiu but it's not necessary um veterans are also
may be eligible for extra scheduler tdiu if they don't meet those percentage thresholds
um you know if they can show that their service connected conditions nevertheless preclude them
from working thanks Kevin and thank you all for joining us today if you're interested
in obtaining more information on agent orange VA presumptions and service connection both primary
and secondary service connection all of that information can be found on our website please
also be sure to check out our other videos and subscribe to our Channel thank you for tuning in
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