| Type of Treatment | Potential Side Effects | Rating Considerations |
|---|---|---|
| watchful waiting |
◦ also called
◦ conservative management
◦ observation, or
◦ surveillance.
◦ No immediate specific therapy is being used, but cancer is active. | ◦ none, except for the continued presence and potential metastasis of cancer
◦ often used when life expectancy is short due to age or other illness since prostate cancer is slow- growing. | ◦ Review to confirm the continuation of active cancer previously confirmed by biopsy. ◦ Evaluate at 100 percent, despite the lack of treatment and possible lack of symptoms. | | radical prostatectomy surgery which is characterized by ◦ removal of prostate gland and seminal vesicles ◦ most common treatment for localized cancer ◦ can be curative, and ◦ nerve-sparing procedure can be performed to improve chances that the patient will retain normal erectile function. | ◦ impotence ◦ incontinence | ◦ In all cases of radical prostatectomy, award SMC (k) for LOU of a creative organ. ◦ Consider SC for ED on a facts-found basis. | | Cryotherapy, also known as cryosurgery or cryoablation, is a procedure by which the prostate and nearby tissues are frozen with liquid nitrogen via probes in the perineum. | ◦ impotence ◦ incontinence ◦ urethral scarring ◦ rectourethral fistula (rare) | Consider SMC (k) on a facts-found basis. | | Radiation ◦ can be curative if cancer is confined to the prostate and surrounding tissues and PSA is 15 nanograms (ng)/ml or less ◦ is also used as palliative therapy to relieve symptoms of advanced cancer, such as bone pain due to metastasis ◦ can be ◦ internal radiation therapy, or brachytherapy, in which radioactive seeds are implanted in the prostate. ◦ high dose radiation (HDR) seeds are implanted for less than a day and then removed. Radiation is present only while seeds are in place. ◦ low dose radiation (LDR) seeds are permanently implanted and give off radiation for weeks to months, depending on the radioisotope used. ◦ external radiation therapy, in which radiation is delivered by high-energy eternal radiation for six to eight weeks. | ◦ after external beam radiation ◦ impotence ◦ incontinence ◦ after brachytherapy ◦ bowel problems ◦ urethral complications | ▪ After internal HDR ▪ the radiation continues only for hours or days, so a six-month assignment of temporary 100-percent under 38 CFR 4.115b, DC 7528 is appropriate, and ▪ consider SMC (k) for impotence on a facts-found basis. ▪ After internal LDR ▪ the effective radiation should be gone by one year ▪ assign a 100-percent evaluation for one year, and ▪ schedule a review exam six months following the cessation of the one-year treatment period. Note: If radiation is used only as palliative therapy in advanced cancer, the 100-percent evaluation will continue because the cancer will remain active. Therefore ◦ review for metastatic disease, and ◦ consider permanency. | | Hormone therapy is primarily for palliation of prostate cancer which is not confined to the prostate for the purpose of testosterone deprivation. Types of hormone therapy include ◦ orchiectomy, the removal of testes to prevent testosterone production ◦ luteinizing hormone releasing hormone agonists (LHRH analogs), which can lower the testosterone as effectively as orchiectomy such as ◦ Lupron (leuprolide) ◦ Zoladex (goserelin), and ◦ busrelin ◦ estrogens or estrogen-like drugs, which lower the level of testosterone ◦ second-line hormonal drugs, which are used when first-line hormone therapy fails ◦ anti-androgens, which block the ability of the body to use androgens, such as ◦ Eulexin (flutamide) ◦ Casodex (bicalutamide), and ◦ Nilandron (nilutamide), and ◦ combined hormone therapy, which is an anti-androgen combined with orchiectomy or an LHRH agonist (analog). | ◦ after any hormone therapy ◦ hot flashes ◦ osteoporosis ◦ loss of muscle mass ◦ after orchiectomy ◦ impotence ◦ sterility ◦ loss of sex drive ◦ after anti-androgen therapy ◦ gastrointestinal upset ◦ breast tenderness ◦ gynecomastia ◦ decreased libido ◦ impotence ◦ after LHRH analogs | ◦ Orchiectomy results in anatomical loss of a creative organ; therefore ◦ evaluate under 38 CFR 4.115b, DC 7524, and ◦ award SMC. ◦ Hormone therapy may continue for many years; therefore ◦ review treatment records for expected duration of treatment, and ◦ consider permanence. | | chemotherapy | Depending on the type of chemotherapy used, there are multiple possible side effects. | Chemotherapy is used for palliation as current agents will not eradicate prostate cancer; therefore ◦ evaluate as 100 percent ◦ consider permanence ◦ review for metastatic disease, and ◦ if metastatic disease affects body systems other than the genitourinary system, award a separate evaluation for confirmed metastatic disease under the appropriate code for that body system. |
DC 7630 - Breast Cancer
Note: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation, antineoplastic chemotherapy or other therapeutic procedure.
Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of Sec. 3.105(e) of this chapter.
Rate chronic residuals according to impairment of function due to scars, lymphedema, or disfigurement (e.g., limitation of arm, shoulder, and wrist motion, or loss of grip strength, or loss of sensation, or residuals from harvesting of muscles for reconstructive purposes), and/or under diagnostic code 7626
DC 7343 - Digestive System
Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure.
Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.
If there has been no local recurrence or metastasis, rate on residuals.
DC 6208 - Ear
Note: A rating of 100 percent shall continue beyond the cessation of any surgical, radiation treatment, antineoplastic chemotherapy or other therapeutic procedure.
Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination.
Any change in evaluation based on that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter.