Dear Jim,
I am a Vietnam Veteran (67-68) who has applied for additional benefits related to Agent Orange. I have been diagnosed with Myelodysplastic Syndrome (MDS) which is better known as pre leukemia.
This is my second time being denied and being told that there is no connection to Agent Orange. If you have any info about MDS and can help me I would be very grateful. Thanks.
Reply:
I'm sorry to hear that you're diagnosed with MDS.
I personally believe that there are a host of diseases associated with agent orange and that we may not recognize the long term toxicity of the stuff for generations yet to come. The science to support precise relationships between all these diseases and agent orange isn't quite good enough to be specific enough to be positive though. VA continues to deny most cases of MDS as service connected.
There are a couple of ways to achieve service connection...service connection is the link required for a condition to be awarded a disability benefit. When talking about agent orange disease, we generally think of the presumptive factor. Presumption simply means that a veteran doesn't have to prove that there is a connection (nexus) between agent orange exposure and a given disease. This is all laid out in the presumptive list of conditions. There are many presumptive conditions beyond agent orange although we tend to think of AO most often. Exposure to atomic bomb radiation, POW status and a number of other conditions may be viewed as presumptive.
The other way to prove that a condition is service connected is by direct connection. This usually means that the veteran can provide evidence that directly links the current disease to agent orange exposure. All Vietnam veterans who served with boots on the ground in the RVN are presumed to have been exposed to agent orange.
The usual way to establish a direct connection is by submitting a nexus letter from a physician who has some expertise in the diagnosis and treatment of the disease claimed. A nexus letter is often obtained by an Independent Medical Examination (IME) or an Independent Medical Opinion (IMO). The IME would involve a direct physical examination of the veteran patient whereas the IMO can be a review of pertinent military records and medical records.
In a report of an IME or IMO, we seek that the expert physician will write that he or she concludes that the claimed condition is "more likely than not" the result of exposure to agent orange or any of the other chemicals that the veteran may believe caused the condition. The phrase, "equally as likely as not" is helpful but less so than "more likely than not". There are other phrases that VA likes to see listed here. Note that other than the 2 phrases I've listed, the other phrases are not helpful to your claim.
When writing a nexus letter as a part of an IME/IMO, the physician must clearly state that your military service records have been reviewed. This establishes that the examiner has knowledge of your military service and that you served in Vietnam. The nexus letter should be specific as to what records have been reviewed. For example, the DD 214, awards and medals, your honorable discharge and so on.
The examiner must clearly state a reason for the belief that your condition is caused by, contributed to or aggravated by the exposure to agent orange. The doctor can't just say, "I think so". The doctor must refer to any scientific medical literature and studies that are used to arrive at the conclusion that your condition is caused by agent orange.
It may be helpful to include copies of the scientific literature referenced although the veteran must be careful that he doesn't overdo it. Submitting 500 pages of obscure medical literature isn't necessary if the links to the literature as it is provided on the Internet can be listed. This doesn't imply that the veteran can simply find supportive scientific studies and submit them himself. The veteran isn't an expert and can't draw conclusions about scientific findings.
You and others that share your dilemma can begin to understand more about how the direct connection works by studying the cases that have been decided at the Board of Veterans Appeals (BVA). BVA cases are relatively easy to understand once you get used to the boilerplate legalese that is included as reference to laws that have an effect on the claim being discussed. You may search for cases that address your condition by clicking here http://www.index.va.gov/search/va/bva.html
You'll see the space provided to enter your search terms. In your claim you're interested in MDS and agent orange. Entering those words and choosing the year or years to search will display the cases that include your topic. You'll read the cases that are won and lost and you'll be able to learn just what the details were in those cases so that you may duplicate the successes and avoid the denials. Interestingly, the first case I found in my brief look was a successful award for service connection for MDS by a Vietnam veteran. See http://www.va.gov/vetapp11/Files4/1133409.txt
Interestingly, the decision may rest on how effective the opinion of the VA examiner is as compared to how effective your IME/IMO doctor is. The VA C & P examiner is almost always going to produce an opinion that favors the VA and denies your benefit. Your independent examiner will render an opinion without the bias of being employed by VA. So, which doctor is right? I sometimes refer to this as the battle of letters. The doctor who has the most letters behind his name wins. Of course, that's an oversimplified way of saying that if your examiner has significant training and skills that the VA doctor doesn't have, your examiner's opinion will be given more weight by the judge. Most VA C & P examiners aren't particularly highly qualified in a specialty so this can be a significant factor in your favor.
I'll recommend that you read my pages about IME/IMO here http://www.vawatchdog.org/imo-ime-medical-opinions-exams.html and I'll also urge that you read up on how to write a great nexus letter here http://www.vawatchdog.org/How_To_Write_A_Nexus.html