Restrictive Lung Diseases (COPD) and Agent Orange . . . Scientific Research to Assist Your Claim

In November 2012, we published a short article entitled Agent Orange Presumptive Conditions – A Nation’s Belated Acknowledgement to Vietnam-Era Veterans.  As the above article documents, while respiratory cancers are considered presumptively service connected to herbicide exposure, restrictive lung diseases (such as Chronic Obstructive Pulmonary Disease (COPD)) are not.  But cf. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994) (the Veterans’ Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, does not preclude establishing entitlement to service connection with proof of actual direct causation).

Establishing direct service connection for restrictive lung diseases, such as COPD, will be difficult absent a solid medical nexus statement from the veteran’s physician.  That said, there is significant medical and scientific research analyzing the correlation between dioxin exposure and conditions such as COPD.  For those veterans seeking compensation for such conditions, I have provided citations and links to some of the operative studies on the issue:

1. Chiba, Takahito, et al., Role of the Arylhydrocarbon Receptor (AhR) in the Pathology of Asthma and COPD, Journal of Allergy, Vol. 2012 (2012)), at

2. Cypel Y., and Kang H., Mortality patterns of Army Chemical Corps veterans who were occupationally exposed to herbicides in Vietnam, Ann. Epidemiol.; Vol. 20:339-346 (2010), at

3. Bertazzi, Peter A., et al., The Seveso Studies on Earl and Long-Term Effects of Dioxin Exposure: A Review, Environmental Health Perspectives, Vol 106, Supp. 2 (April 1998), at

If you are confused about how to advocate of your VA disability compensation or pension claim, please do not hesitate to contact me for a free consultation at or (732) 382-6070.

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Seth Director

About Seth Director

Over nine years of trial and appellate litigation experience at the Department of Justice and the Army Judge Advocate General Corps where I frequently handled high profile, complex litigation before various federal courts. I am now an associate in the Veterans’ Law section at the law firm of Fink Rosner Ershow-Levenberg, LLC, and a Department of Veterans Affairs accredited attorney. The Veterans’ Law section at Fink Rosner Ershow-Levenberg offers nationwide representation at all levels of the VA administrative process, as well as in the Federal court system, at the U.S. Court of Appeals for Veterans Claims, and the U.S. Court of Appeals for the Federal Circuit. I focus solely on Veterans’ law and Veteran-related issues, claims and benefits and can offer a unique perspective as a veteran of Operation Iraqi Freedom.

82 thoughts on “Restrictive Lung Diseases (COPD) and Agent Orange . . . Scientific Research to Assist Your Claim

  1. I’m a vietnam vet stationed in the iron triangle, war zone d. I believe I was exposed to radiation from agent orange. Most recent I was diagnosed with COPD, by my primary care physican. My first agent orange exam came in 1982, that doctor told me what to look for in my 20th year anniversary. He said my Kidneys. Liver, or Pancreas would go bad. I have now had pancreatitus for 26 years. In Jan. I got a call from the dept.of vetran servs.saying the Va now reconizes pancreatitus,caused by agent orange, and you have back-pay coming. I have never recieved anything, and no one admits to making the call. Any help would be helpful.

  2. Norman,

    Pancreatitis is not one of the diseases to which the presumption of service connection applies for veterans of the Vietnam War under 38 C.F.R. § 3.309(e). That said, the presumptive diseases set forth in Section 3.309 are not the only means of establishing service connection. Feel free to give me a call at (732) 382-6070 or via email at to discuss further. I should be able to triage some of the issues and provide specfic guidance on how to proceed.



  3. Back in 2006 I had a heart attack. The Baylor doctors said it was congestive heart failure.
    The V A finally agreed, and I got back pay compensation at a 100% disability up to April of 2012, then they cut my disability back to 30% then a month later to 40%.
    They also said I have COPD, but it is because I smoke. Maybe if they had not furnished cigarettes in our C rations I wouldn’t have started smoking, like a lot of others did while they were in Vietnam.
    It must have been a very lucrative contract with the tabacco companies.

  4. Michael, please be aware that if you had a prior claim denied for a form of Ischemic Heart Condition there may be an issue regarding the effective date of award as a Nehmer-class member. Feel free to contact me at or (732) 382-6070.

  5. I was recently denied a claim I had for COPD and they said it was not service connected. but I was in Vietnam and I was getting 100% for prostate cancer until this year. I started getting it in 2000 now they have reduced my percentage to 40% because of some more claims I have. hypertension, low back strain and the cancer which they have reduced because of the remission..

  6. George:

    Feel free to call me at (732) 382-6070 to discuss. COPD is not presumptively service connected for Agent Orange (dioxin) exposure. That said, veterans can still establish service connection on a direct basis if their COPD is causally related to a condition/event that occurred in service. Good Luck. Seth

  7. I am a U S Army vietnam veteran 90% disability 100% ui I have a Calcfied aotic valve, High Bp, .copd, Graves diease , allergic to uv rays are these symptoms service connected

  8. Jimmy, don’t see a specific question, but feel free to call me at (732) 382-5060 or email at There are forms of monetary compensation that a veteran may be eligible to receive in excess of a 100% disability rating (specifically various forms of Special Monthly Compensation). If your service-connected disabilities are increase due to individual unemployability sometimes we still need to appeal decisions regarding specific ratings for individual disabilities. This sometimes needs to be done so that a veteran can obtain employment without the concern of losing entitlements or to smooth the transition for survivor benefits in the event of a veterans death later in life.

  9. I recently filed a claim with the VA for eschemic heart disease. I served in Vietnam 1960-1963.
    The supporting documentation I submitted included 10 a ten year period from 2004-2014. In addition to my by-pass surgery noted in the documentation, the fact that I had COPD was noted.
    Will the VA consider both eschemic heart disease and COPD in determining compensation?

  10. John:

    I suspect if you simply filed the claim for IHD, the RO will only open up a claim for IHD. If you filed for both conditions the VA will consider both. Will email you, because tactically it may be beneficial for you to have the IHD claim considered and adjudicated before considering filing for COPD. Seth

  11. I have an extremely rare blood disorder, Polycythemia Rubra Vera. Normally this disease is only found in Old country Jewish. There are no Jewish blood relatives in my family. I did serve 2 years in Helicopters in Viet Nam. Oct. 68 thru Oct. 70. At one time or another I was in every part of Viet Nam. My hematologist questions whether there is some connection to the disease. This is considered a Non Lethal Blood Cancer, if treated. I am currently on Chemo Pills that I take twice a day and will take them forever. Maybe you can answer the question is it, or should it be covered under the causes of Agent Orange? Thank you.

  12. Tom, First the caveat . . . not a doctor but I do try and keep myself informed about medical conditions. I don’t believe that Polycythemia Rubra Vera (PRV) is considered a form of B-Cell leukemia. My lay understanding is PRV is a bone cancer that effects the red-blood cells. The distinction being, B-Cell leukemia is a presumptive condition, while other forms would not be subject to the presumptive regulations governing Agent Orange exposure. I did locate one BVA opinion that service connected PRV on a direct basis. This was done after the veterans physician proffered a medical opinion. BVA opinions cannot be substantively considered related to another veterans claim, however, provide a terrific roadmap for veterans. Link at

  13. Seth: Thanks for the reply. Polycythemia Rubra Vera is the rarest form of Blood Cancer and is formed in the Bone Marrow. It not only increases the red cells, but also the white cells and platelets. My VA Dr. monitored my situation for 5 years and never addressed it. He misdiagnosed it and called it Secondary Polycythemia. When it was finally addressed was when I had a Heart Attack last August and my blood work was “Critical”. This was at a private hospital who did a stint and have since been treating me for the blood. I might add that at no time in 5 years did my VA Dr. refer me to a VA Hematologist. He was prepared I think to let me die. Bottom line and after reading the prior case, which was awarded, should I seek a disability claim and if so is this something that you can handle or can you refer me to someone that can. Thanks again.

  14. Tom, foremost, ischemic heart disease is a condition presumptively related to Dioxin exposure (Agent Orange). If you are not currently service connected for that condition, please considering filing for this condition first. Tactically, for Vietnam vets I try to file the easy issue (heart) through the fully developed claim program (FDC); get a decision back; then file for the more complex etiological issues if needed. In terms of PRV have your doctor draft a medical opinion if possible. The VA may consider this a presumptive condition (though I don’t believe it is classified as a B-Cell leukemia or myeloma) or under direct service connection. Feel free to email me, and may be able to direct you to a good VSO or pro bono organization in your area. Seth

  15. I opened a claim for service connection to Agent Orange which was denied and closed after appeal in 2005.They stated there’s was never any Agent Orange where I was stationed at Supic Bay Philippines,Cubic Point separate guard co.But there was,while I did century duty along the Camayin Pier and Baston Pier,Agent Orange was brought in and I guarded the Naval Ammunition Depot.I was seen at Clark Air force Base Phillipines,for severe itching,blisters and rash.I was placed in a lite box for treatment and it worsened,told I was a light reactor.Now years later I cannot tolerate sun exposure at all.I do receive after much battle 60percent for eczema and psoriasis.Should I reopen a claim for exposure?I also have COPD and other health issues .Thank you.

  16. James, Agent Orange exposure is not compensable under Title 38 . . . it is the underlying disability that is compensable. Thankfully, they did service connect your skin condition on a direct basis. A 60% disability rating is the maximum compensable disability rating for the diagnostic code for eczema/dermatitis. If you were not stationed in a location that is presumptive for exposure (i.e. Vietnam), you’ll have to demonstrate direct exposure to a tactical herbicide (to include Agent Orange). COPD is not a condition presumptive for dioxin exposure, so I advice that your treating physician review your service medical records/personnel records and, if willing, proffer an opinion as to the causal connection between any disability (such as COPD) and what occurred in service. Good luck. Seth

  17. Seth,
    This is not an exposure question but deals with the approved claims for presumptive or direct service connected conditions. I have read many comments where the veteran was award “back pay” for conditions that was many years prior to the claim. My claim retroactive pay was limited to “from the date of the claim” or 1 year but never longer. Do you know which is correct? VA also made an administrative error on the amount of my initial claim in 1988 which they corrected in 2013 but only authorized retroactive payment to the date of the claim 8/2013. I only discovered the error when a VA phone rep asked me why I was only being paid at a no dependents rate for my 30% rating back then. I have never been unmarried since 4/4/1969 and all of my military records to include DEERS and other databases have always been up-to-date, especially at the time of the claim award. I never received any communications from anyone questioning my dependency status and never indicated otherwise on any paperwork. At first they stated that the dependency statement was part of the claim processing until I showed an original copy of my claim award with no dependency question on it at all. Since no effort by VA was made to determine my dependency status and awarded me the w/no dependents rate; aren’t they responsible for the error back to the date of the claim and error? Thanks

  18. Jack, The general rule is that the effective date of award for a claim will be the date of filing; however, there are a number of exception to the general rule. I usually leave the proverbial ball in the veteran’s court. If the veteran/claimant wants to forward me copy of the Rating Decision
    I’m happy to review and give my opinion if there is an effective date of award issue that I spot. Easiest vehicle is via email at or via fax at (732) 382-7986.

    The “one year prior” you are hearing about can apply in situations where, off the top of my head: (1) there is a liberalizing law that formed the basis for the grant of service connection; (2) this was a veteran’s initial claim filed via the FDC program; or (3) the veteran filed for an increase of a service connected disability and evidence establishes that the disability had increased in severity up to one year prior to the date of filing. Those are the three separate regulatory provisions that the “one year prior” could have application. There are separate provisions for earlier effective dates (lets say to the date of filing prior now-final Rating Decision. Dependency status is a separate animal and happy to clarify if you want to give me a call at (732) 382-6070.

    In short, maybe but is fact and issue-dependent. Seth

  19. Im just finding out about AO Exposure for those who did not go to Vietnam. I took part in Bold Eagle Excessive at Egland AFB Florida in 1983. It seems with the research ive been doing, that Base was the main US base for testing AO and other toxins and i’m finding that clean up didnt take place until the late 80’s, early and late 90’s. 4 years after being there, I started having collapsed lungs, 1987 they cracked my left side open and removed blebs, some of my upper and lower left lobes. I had 2 more events on the right side, the second in 95’ish, the operated. I have had an open claim, appeals and BVA on my lungs since 95 and was finally awarded SC for it in 2010 and with my combined SC’s put me at 70%, 60 of which was my lung condition. In Feb of this year, my VA RO reduced my rating for my lungs to 0% while they were sapose to be addressing a Remand from BVA for the RO to address 4 issues, only 2 were addressed (dependents and trailing Board Hearing Date scheduled), they initiated a File Review and said there was a CUE to which i appealed and from the “proposed Rating Reduction” letter to the actual reduction, they did not follow CFR which makes it an “Unlawful Reduction” per CFR. While on active duty, i have been exposed to countless chemicals, probably like every other Vet who served, and provided proof that sides on me (Benefit of Doubt) CFR)) yet they keep messing with me. Still in appeal and with the RO. I came across a group member of a group on FB asking about exposure to AO and other from Egland AFB so i started research and found this site. I was diagnosed with COPD sometime around 95 i think. Ive only found one BVA case so far (Citation Nr: 1226982
    Decision Date: 08/06/12 Archive Date: 08/10/12) that has awarded SC for exposure at Egland AFB but its not for COPD, or Blebs/collapsed lungs (Blisters and for lack of words, Pockets, that could bursts. Do you know of any cases like this i can referance. Thanks in advance! -Dave

  20. Dave, I’m going to simplify the procedural waters. VA has proposed reduction in rating percentage for respiratory disease (uncertain which diagnostic code it is currently rated under). The VA did not propose severance of service connection, so this is not an issue driving forward. I’ll also make a reasoned guess as to why you were initially granted S/C – the accepted exposure for tactical herbicides at Egland AFB was prior to 1983 and I suspect you were granted service connection because your service medical records demonstrated a respiratory condition while in service . . . not because of latent manifestations of dioxin exposure while in service. Will email you copy of DBQ for respiratory conditions, completion of this will remedy the question of current rating percentage. Seth

  21. I have nerve problems in my back ,legs,arms and hands and I also have copd . I was in the I corp in Vietnam around Danang where agent orange was heavily sprayed. I was also stationed at Camp Lejeune between 1957-1987.

  22. Larry, uncertain whether the nerve issues you are having are related to neurological effects or musculoskeletal issues. Neurological problems are not commonly associated with dioxin exposure, however, there is a substantial body of medical literature associating neurological problems to exposure to VOCs (the Camp Lejeune contamination problems stem from exposure to Volatile Organic Compounds). Talk to your doctor concerning etiology of COPD. If there is a significant history of inhalation smoke exposure (cigarettes) then your physician may believe that the COPD is most likely related to than. However, there are a number of studies linking COPD to dioxin exposure. The critical component if you chose to file or have filed a claim is the causal relationship between any exposure and current disability. Personally, I would try to get a medical statement from your physician if he/she believes there is a relationship between the two. Good Luck. Seth

  23. My husband was in Vietnam in 1964-65. He was exposed to Agent Orange. About 2 years ago he filed for disability under the assumptive diagnosis of Isemich Heart Disease. He received 100% disability and an additiona 10% for Diabetes.
    This past January he passed away and the cause of death was noted as end stage COPD. I filed a widow’s claim and of course they denied it because it wasn’t the IHD.
    My question is, could I, as his widow, retroactively make a new claim for the COPD? Is there any other way to try to get my widow’s benefit.(I don’t know why it wasn’t added to the conditions he had when we initially filed.)

  24. Ginny, feel free to give me a call at (732) 382-6070. There may be an easier path to successful resolution. Specifically, I’m talking about the application of 38 CFR 3.312(c)(3) (diseases effecting the vital organs in relation to DIC claims). That section actually has two distinct concepts: 1) careful consideration of active processes affecting vital organs as contributory causes of death without regard to the rating percentage and (2) assumption that death is related to disease affecting the vital organs if vet is rated at 100%. Uncertain if your husband was rated at 100% for IHD prior to death, however, happy to clarify with you. Seth

  25. I was rated 30% for ISD in April of 2012, in May of 2014 I went into the hospital and had 5 by-passes and an Abdominal Aorta Aneurysm operation. The VA paid for the heart surgery but denied the aneurysm saying it is not connected to the ISD. My Drs. are dumbfounded that they can make that distinction. I am thinking this is just a word game, ISD instead of Cardiovascular Disease. The wording on VA Health Benefits form clearly states “Yes, for service connected disabilities or any disability associated with or aggravating a service connected disability”. Pretty plain I thought. Is there a wording that I should use or another way to file that is better? Also they have not paid me 100% after I spent 35 days in the hospital and they tell me I do not need to file that it is automatic??
    I spent 18 months in Vietnam, May 1, 65 to Dec. 66 so never a question on AO.
    Any information is appreciated.

  26. Earl, To crystalize the issues: (1) it appears that you were denied in part for reimbursement for non-VA treatment for a S/C disability (heart); and (2) no claim for temporary increase was filed. Actions I would take are: (1) file a request for increase in disability rating with your Regional Office, to include a request for temporary increase to 100% for period of hospitalization. I would want to provide copy of recent ECG and cardiac stress test; and (2) talk to the patient advocate at the VAMC that you received the fee basis decision from. There is a formal appellate process related to the denial of fee basis reimbursement, however, it is lengthy and most issues can be resolved through the patient advocate. Will email you and happy to guidepost you along. Seth

  27. I;m receiving 20% disability AO. diabetes type 2, can I get a higher %? I also have COPD, Hypertension (high blood) pressure, and Chronic Heart Failure. What can you tell me. yes I smoke, started in Vietnam 1969. Also on back side of my right shoulder, I have a scab. it’s about the size of a pea. told va doctor I’ve had this for about 3 months. she said, don’t worry about it, it’ll go away. this was over a year ago, still there, not going away? doesn’t get any bigger. any ideals or suggestions. any help or advice would be a really big HELP. Thank You, So Much.

  28. Charles, Slightly concerned about the heart failure (both as to your health and some VA issues) and will email you to hopefully provide some guidance. So you are aware (given the fact that you indicate service in Vietnam), forms of heart diseases that effect the amount of oxygen to the heart (Ischemic Heart Disease) are considered presumptive conditions related to Agent Orange exposure since 2010. As to other questions: (1) the rating percentages for diabetes can increase from your current 20% disability rating. Much will depend on if you are insulin-dependent, have restricted diet/activities; (2) COPD is not a presumptive condition related the Agent Orange exposure. It can be service-connected on a direct basis, however, given the lengthy history of smoking may be difficult for you to obtain sufficient medical evidence to establish a causal relationship; and (3) hypertension is a common secondary condition related to diabetes. If your physician believes there are secondary conditions related to the diabetes you may want to consider filing (hopefully along with a statement from your doctor indicating as such).

  29. In June I had my r-hip replaced due to avascular necrosis. Doc/s can’t tell me why it occurred as there was no trauma, no abuse of steroids or alcohol. Is it worth it to file a claim for AVN w/ the VA?

  30. Tom,

    Feel free to email me at There would need to be a causal relationship between the necrosis and military service and/or a relationship between the necrosis and a condition that is service connected (called secondary service connection). With the amount of information provided difficult to assess relationship. Sincerely, Seth

  31. Seth, In 1969 I was wounded in the chest,stomach, and back. I lost a rib, and some use of my left lung. I received 80% disability. In 2009 I had shortness of breath and went to the hospital, after a few months and many tests they said I have Sarcoidis. I filed a claim with the V.A. which was dined. I began going to the V.A. hospital because my condition did not improve as far as being able to walk on inclines or stairs with out shortness of breath. The V.A. doctors believe I have Asthma now along with the Sarcoidis. They are treating me for Asthma. Can I get a higher disability with Asthma

  32. Paul, rating criteria for Asthma are under Diagnostic Code 6602. Depending on lung capacity/use of oral corticosteroids the rating percentage can go to 100% disability rating. I’m slightly concerned that asthma is correct diagnostic code based upon history you presented. I’ll email you the same, but happy to triage the issues with you. Seth

  33. Hello, I am a 62 year old Vietnam Veteran who was exposed to Dioxin (Agent Orange). I have been working with the Veterans Administation(VA) with my disability claim, however, the VA only reconizes certain condition from the exposure, and will not accept my claim without medical or scientific evidence. I have the following medical conditions:

    nausea and vomiting

    erectile dysfunction

    fainting and dizziness

    liver disorder

    sleep apnea

    paralysis of left diaphragm

    sensitivity to heat and cold

    skin lumps and growths

    joint pain and stiffness

    Does your organization have any evidence supporting these condition associated with dioxin exposure? If so, could you email me that information?

  34. Sam, many of the issues listed are symptoms rather than diagnoses. That is problematic under Title 38 (one of the elements is current diagnosis). Is there an overarching diagnosis that is causing such issues as nausea/joint pain/liver dysfunction? Seth

  35. hi can you please send me information on code 6602 I have been reading and reading and found I think the help I needed>From you. My husband was in Vietnam he is a Marine.They say he has severe Copd but they say that is not recognizes on agent orange list but if I am reading correctly asthma is ?
    Thank you for your Service.

  36. Connie,

    I suspect what you are referencing is language in 38 C.F.R. 3.309 related to certain presumptive conditions that manifest to a compensable disability rating within one year of discharge. This is separate from the regulatory provisions covering presumptive conditions related to TCDD (Agent Orange) exposure. I’ll email you with my contact information and would be happy to discuss the issue if you so choose. Seth

  37. Seth, I have been diagnosed with Diaphragmatic paralysis and elevated hemidiaphragm. This was the result of being knocked off a rope in the Marines. I had two pulmonary doctors (both board certified) write a “nexus letter, in which they explained that the blunt force trauma of being knocked off the rope resulted in the lung problem. They explained thoroughly and stated “more like y then not” the fall from the rope was the result of my problem. They stated the problem was chronic, and no treatment could reverse the decision. I also submitted the pulmonary tests (FVC-1 three tests all under 40). The VA gave me an exam and agreed it was Diaphragmatic paralysis, but stated it could be caused by a number of issues such as stretching or cooling during cardiac surgery, polio, shingles, neck surgery (note; I have had none of those problems) or just undetermined. Should I have the new Pulmonary doctor dispute that, or write a complete new letter, reinforcing the two previous doctors opinions? Also I have been diagnosed l with COPD. Should that be addressed in the letter, or do I file a separate claim on the COPD? Thanks for your help. James

  38. James, it this type of scenario continuity of condition would be a critical element that a physician would be able to opine to. Suspect VA-examiner opined it was idiopathic (no known contributory cause) and your doctors have opined that trauma-induced. Docs would really need to evaluate the service medical records documenting the injury, post-incident medical documents, and post-discharge medical documents. Possible that the actual diagnosis did not occur in service, however, symptoms consistent with the diagnosis are noted. I would also be helpful for the opining doctor to review and comment on the VA examiner assessment. From a lay perspective (suspect would never have gotten into medical school if applied), issue of COPD is going to be difficult to relate to trauma but docs would better able to opine to relationship. Will email you same. Seth

  39. I was the chemical officer of an infantry brigade and ran gas chamber exercises. During these exercises, I would be inside the chamber for some hours at a time. Hence, the CS gas would permeate my clothes to the point that my wife couldn’t wash them due to her vomiting when in contact, and at meetings, within minutes everyone in the room would be crying due to the CS gas exposure. I was breathing this gas coming off my clothes nearly 24 hours a day for weeks at a time. I filed a claim with the VA that the CS gas aggravated my COPD condition. It has been denied, and I’m on appeal currently. Any thoughts?

  40. William, located medical study examining the short- and long-term health effects of CS gas at
    Difficult issue, would be extremely helpful for your doctor to review service records, evaluate both service and post-service factors for COPD (occupational exposure/smoking/etc…) and offer opinion as to whether constant exposure to CV caused or materially contributed to current diagnosis of COPD. I don’t mind triaging issue with you if you would like to give my office a call at 732-382-6070. Seth

  41. I have a VA disability of 60%. 20 % for my diabetes and 50% PTSD When I got my percentage rating they only gave me 60% because my VA rep said that that’s the way the VA does it. So now i’m at 60% disability. I’ve been diagnosed with High Blood Pressure with the VA claiming that its not caused by Agent Orange .I’ve recently been diagnosed with COPD which I know I will be denied. I had read that High Blood Pressure was considered to be caused by Agent Orange. What would I have to do to get my high blood pressure approved . Or is it not worth me trying to file a claim

  42. Tony, I’ll try and answer in order: (1) high blood pressure itself is not a presumptive condition related to Agent Orange (TCDD) exposure, however, if the diabetes caused or aggravated the HBP (beyond normal course of condition) then the HBP pressure can be secondarily service connected. HBP can manifest independent of DMII so really only a physician with knowledge of your medical history could clarify. Similarly, there are a number of conditions that can be caused or aggravated by DMII (for example PN, PAD, diabetic retinopathy). If those conditions are caused or aggravated by the DMII, then those conditions would be secondarily service connected; (2) COPD is not a presumptive condition related to Agent Orange (TCDD) exposure. There is scientific research indicating the biological plausibility of TCDD causing or contributing to a COPD diagnosis and epidemiological evidence of a correlation between Vietnam veterans and COPD. That said, cigarette smoke is acknowledged to be the primary cause of COPD, so the VA will review on a case-by-case basis. Hope this assists. Seth

  43. Hello Seth,
    Would it be okay if I emailed you regarding my husbands condition and to receive your input regarding the direction he should turn? He has suffered COPD since 2010 but his VA Doc also claims it came from smoking. He has an Aortic heart valve aneurism, very enlarged prostate for which two meds he’s been taking has done very little and must cath four times a day. This man served 7 weeks in Vietnam as a Navy/Marine Corp man. It took nearly three years to get him on oxygen and during this time he has lost over 70 lbs due to fighting for oxygen so long, it’s like running a marathon 24/7. My husband had filed a claim for COPD a couple months ago but his VSO included hearing and sight loss. They required he travel four hours from our home to get his hearing checked and he just doesn’t have the strength to add more long distant driving to the mix so he withdrew his claim. Remember, COPD is not on covered list so he felt it wouldn’t go anywhere. We travel the four hours to the VA hospital in MN to receive care for his condition and he didn’t want to add more of these trips. Any way, I would love to correspond with you via email in hopes you may supply the direction to take. Thank you!

  44. Sherry, I’d be happy to review any decision you received from the VA. Sometimes review of this alone will provide an assessment of what actions the veteran claimant should take to hopefully resolve the issue. My email address is
    That said, I think it will be difficult to service connect the COPD related to TCDD exposure if there is a significant risk factor of cigarette use. Given your husband’s history of some form of heart valve problem it may be worthwhile to speak to cardiologist to assess whether your husband has a form of ischemic heart disease. Provided the VA has evidence of service in Vietnam, any form of ischemic heart disease would be considered a presumptive condition related to TCDD exposure. Seth

  45. Hi Seth: My husband Jim served aboard USS OKINAWA LPH-3 : The ship was anchored in Danang harbor he did go ashore (boots on ground) . He has COPD Emphysema Acute Chronic Bronchitis and was denied the claim. When the ship was anchored the water was being filtered thru intake for drinking and bathing the AC was filtering in all the contaminated air. I have doctor reports since he was discharged he has had respitoray problems. I am going to appeal this just wondering how many have you heard from that have similar health related issues? The VA has to start recognizing these are REAL issues that resulted from agent orange. Your feedback will be interesting. Thank You

  46. Kathleen, foremost, to some degree issues pertaining to latent manifestations of environmental/chemical exposure are not as relevant with the condition is chronic since military service. For example, gulf war veteran began having respiratory problems in Iraq, still has those respiratory problems after discharge, and there is a continuity of symptoms and evidence establishing the link between event/occurrence/injury in service. Regardless of the reason why the condition manifested in service (exposure to burn pits/dust) the veteran should be able to establish service connection. I would have your physician review copy of service medical records and medical records immediately after discharge and see if he/she feels like husband’s current diagnosis is related to those symptoms. I will express one concern, the diagnosis of COPD/emphysema is going to cause pause for the VA because those diagnosis are commonly associated with smoking. While on occasion we’ve been able to secondarily service connect COPD to smoking when there is medical evidence that a service connected mental health disorder contributed to the substance abuse problem, normally cigarette smoke is going to be extremely problematic. Seth

  47. Dear Mr. Seth Director, I am a Vietnam Veteran. In the 1990s I developed High Blood Pressure and COPD (back then they first said it was Bronchial asthma because of my age). As I got older they called it COPD (emphysema). I just figured it was smoking. In 2008 I developed diabetes 2 . I started receiving Agent Orange compensation of 10% for my diabetes 2. I never thought about my COPD or my hypertension. Later I needed pills for my diabetes 2 and received 20% compensation. In 2010 if I carried something to the car, I would get a bad pain in my throat and be out of breath more than usual. Ever since I was diagnosed with COPD I physically couldn’t do much because of getting out of breath (long walking, lifting, walking up incline or very many stairs). We moved back to Ohio Dec 2011 ( I couldn’t physically help). When I told my new doctor about the throat pain, which I thought was COPD, he gave me Nitro and stated next time I get it, take a Nitro and if it stops, I should see VA doctor. Well it did stop my pain. Long story short, I had stress test and was told I had Agent Orange ischemic heart disease. Since the meds they gave me only helped a little I had a heart Cath which they said I needed a triple bypass because all 3 of my major arteries where over 80+% blocked. At that time I received 10% before open heart surgery, then for 3 months after surgery 100%, then after that only 10% compensation for my heart. So I was total 30% with heart and diabetes2. After halfway thru my cardio rehab I started having mild jaw pain when using both arms and legs. The doctor at Cardio Rehab told me I had to go back to VA and tell them what was happening. So from then on they have been increasing meds. I currently take metoprolol 100mg per day, Lisinopril 60mg per day, Isosorbide monontrate 30mg per day, aspirin 80mg per day and once in a while I still have to take nitroglycerin. When my heart started causing me problems during the Cardio Rehab and they started increasing meds for it I filed a NOD in July 2013 for the 10% they said my heart was after surgery. I am still waiting for that Answer. During this wait I was evaluated for PTSD and they diagnosed me with PTSD for my Vietnam Service. I didn’t know I had it but after looking back, I realize I have had PTSD since coming home from Nam. The Psy told me the dept would look at it and rate me. Well they rated me a 50% for PTSD. Which increased my total to 70% (with my heart at 10%). Oh, I also had a secondary problem with my heart surgery. I have a brachial plexus injury which has done damage to my right arm and hand. After 2 years, it got some better but I have to take pain and nerve pain meds and have lost about 20-25% of my strength in my arm/hand. They finally gave me 10% for it but stated it wasn’t adding any money to my total compensation. I also have had erectile dysfunction since 2009, which they have given me, finally in 2015, a monthly compensation since 2009.
    Now back to COPD and Agent Orange. Since I never saw COPD on the Agent Orange List I never applied. However, I want to tell everyone, that I have been going to VA hospitals and clinics for at least 6 years and almost every Vietnam Vet I see has COPD and most on oxygen. I currently take 3 types of inhalers but no oxygen. I would like to know more about compensation for COPD and Agent Orange because I am sure it caused COPD in many people. Oh, also my first child was born 2 years after I got home from Nam and she was born with Down Syndrome and she died in 1983 due to heart problems.
    Thanks for all your help with vets I know we all appreciate it.

  48. David, foremost, sorry to hear about your daughter. Second, I would speak to your VSO concerning your rating percentage for IDH, something tells me there is an easier path towards resolution of the IHD than waiting for resolution subject to NOD. Thirdly, use of inhalation tobacco (cigarettes) is a major reason why the VA will deny compensation for COPD. That said, if a veteran’s PTSD contributed to the use of cigarettes, than the VA can and does grant service connection on a secondary basis (ie. COPD caused by cigarettes and cigarettes caused in part by a veterans PTSD). Seth

  49. Robert, it appears that the IOM will have completed review of their 2016 study in early summer/late spring. Suspect it will take a long longer to publish. I follow scientific publications pretty closely and, frankly, I doubt that the IOM will change its status re: non-cancerous lung conditions, however, the IOM reports are good at briefing the issue and provide insight for the medical community as a whole. I’ll post as I receive information in the future. Seth

  50. Hi Seth, I served in Vietnam 68-69 infantry (boots on ground) A.O. exposure ! I recently filed claim for copd. which was diagnosed 2 years ago ! I never smoked in my life ! My Doctor wrote a letter with my claim stating his believe that it was as likely as not service connected. How would the V.A. in researching my claim know that I was never a smoker ! ( I sent my claim in six month,s ago, still waiting on decision ). Thank,s Tim !

  51. Tim, Appreciate question and would love to know outcome once a decision is reached. As an aside the March 2014 Agent Orange Report commented on a long-pending study due on non-cancerous respiratory conditions and exposure to Agent Orange. Hopefully, that VA study will be published soon (I’m a glass-full type of person).
    Simple response is provide a statement in support of claim attesting the fact that you are a non-smoker. I personally don’t use the VA FORM 21-4138 much but form itself contains language for the purposes of a declaration under penalty of perjury. Slightly more complex answer is this, whenever a physician is commenting on the etiological basis for a condition/disease when a number of variables could cause the condition/disease it is helpful if the physician could comment on other causative factors that are not present (for example, smoke inhalation, post-discharge occupational hazards, etc…). Seth

  52. Hi Seth, I am a 66 year old Vietnam veteran (1970-1971) diagnosed with IHD in 1995 when I had a heart attack (40% damage) and had 2 stents installed. In 2010 had heart valve replaced along with Aorta replaced. In 2016 had 2 stents installed.
    Last week I learned that the VA is paying benefits for IHD due to Agent Orange exposure. I filed a claim today and was dumbfounded to discover that my benefits will only be effective from the date of claim (today) and not based on the date of the diagnosis my disease. Please advise as to whether there are any remedies to this situation. This seems to be a very convenient way for the government to limit their liability.

  53. George, no worries. I’ll walk you through issue pertaining to effective date for now-presumptive conditions related to AO. Really two separate regulatory provisions that can apply. Your date of diagnosis clearly pre-dated when IHD was included as a presumptive condition by the DVA (approx March 2010). This will likely entitle you to an effective date of award one year prior to recent claim, however, does not necessarily mean your claim will be governed by the Nehmer provisions. For simplicity purposes, much will depend of claim status (if any) between 1995 and Present, and whether medical evidence previously submitted documented a form of IHD prior to March 2010. Seth

  54. Mr. Director,
    Danang, Vietnam, 68-69, worked in an area that was the storage and loading for Operation Ranch hand ( AO spraying) before they moved all their ops to Bien Hoa Airbase. In 2008 (40 years later) the area was tested for AO and the result was 310,00 ppm. I applied and was granted 60% IHD and 50% “other specified depressive disorder” (total 80%). I almost immediately filed a claim for increased compensation on IHD since they stated that I was a lot more able-bodied than I was/am (>3-5METs). The VA has issued me an electric scooter because I can’t walk any distance at all. Last November they finally made a decision… No change in my rating. They stated that I should be able to walk two blocks at 2 miles/hr. Not possible. Said that 90% of my lack of stamina is due to COPD. My cardiologist stated “from a cardiac stand point, my cardiac functional capabilities are to be considered only 1-3 METS and would probably remain so until my death”. The denial letter says” The medical opinion that we received from the VA Medical center was more persuasive than your private physician’s opinion because it is based on a thorough review of your relevant military and/or personal history and contained a more convincing rationale. There can’t be much information in either. The only thing I get from the VA is glasses, hearing aids, and psychological counseling. Nothing there that would give any kind of rationale for turning down a claim.

    I’m concerned that if the VA is not challenged they will use the VA doctor’s incorrect diagnosis of COPD and cut the IHD benefit and blame everything on COPD which they won’t pay anything for. Is there a way to avoid this? I have filed a NOD on the IHD. Should I file for benefits on the COPD and the extremely high exposure that I got?


  55. Jim, foremost, feel free to contact me at (732) 382-6070. There may be a simple solution and, if so, happy to discuss. As you are aware rating percentages for IHD are — for the most part — predicated on a veterans LVEF and METs. Sometimes, at non-service connected disability (peripheral neuropathy, COPD, etc…) can impact the ability for the veteran to conduct a full cardiac stress test to assess METs and the DVA will try and separate the level of METS attributable to IHD versus the non-service connected disability. See Mittleider v. West, 11 Vet. App. 181 (1998). This appears to be the issue you are having with the DVA. In terms of COPD, may be helpful to discuss risk factors for the development of this condition (in service chemical exposure, post-discharge occupational hazards, cigarette use). I’d hate for you to go down the rabbit-hole without an understanding of what actions you need to take to develop the claim or whether the claim is not worth pursuing. Seth

  56. I served in the AF 1979-1983 plus other times in reserve for 23 years and recieved retired pay starting at age 60. A year or so before my discharge a fire started in my building. I was in a sound proof SKIF and did not hear the fire alarms and was rescued 15-20 minutes or so later by firemen in hazmat suits. They advised I was exposed to phosgene gas in the smoke as a product of freon burning in air conditioning units and developed breathing problems. I filed a claim as I left active duty for breathing problems and it was denied in 1984. Now I learned that phosgene gas is the same as mustard gas and have filed claims. I have extensive evidence of asthma, COPD, emphysema, since the date of the fire 35 years ago.. Two questions….will I come under the mustard gas presumptions, and can I go back to the denial of the first claim. They treated me extensivley on active duty for allergies and breathing issues, ie, they misdiagnosed it. So, can I go back before the filing to reopen the claim or am I stuck with the date of filing. Thanks. You have a great blog.

  57. Phil, there are a number of regulatory provisions that can entitle a veteran to an effective date prior to date of filing claim (in this case claim to reopen). Mu suggestion is to first resolve the issue of service connection, prior to concern with effective date. Genuinely, the only way to ascertain whether there were issues regarding clear and unmistakable error or recent located service records, is to obtain copy of entirety of C-File, and separate what evidence was available at the time of original adjudication versus current. Seth

  58. Seth,I was in viet nam in 1969 and 70. In 2008 I was treated for ihd in private hospital.Had stent placed. In 2014 had two stents placed at the Denver va hospital. I filed and was awarded a 60% ao ihd disability claim in May of this year, 2016, only going back to Feb. when I first filed. I read in my c&p exam the examiner used those two dates,08 and 14,for part of her conclusions. My question sir is, should I be getting any retro or backpay and if so, how would I ask for it? Thank you

  59. John, really two different issues that hopefully I can clarify: (1) if you can establish a diagnosis of IHD prior to March 2010 [date IHD was added a presumptive condition] you’ll likely be entitled to an effective date of award one year prior to date of filing (appears to be May 2016); and (2) assuming a diagnosis of IHD in 2008 are you entitled to an effective date of award from an initial date of diagnosis under Nehmer? As to the second question, it wholly depends on whether there were active claims pending during that period of time and whether there was evidence in the VA administrative record confirming a diagnosis of IHD during that period of time. In short, no simple answer without understanding the claim file. Hopefully, you and your VSO can look through the VA administrative record and talk about effective dates. Sincerely, Seth

  60. Seth,thanks for responding to my question from 11/14/2016. I talked to my vso as you suggested. I couldn’t make him understand that I wasn’t trying to file a Nehmer claim, I just wanted to see if I qualified for a one year retro pay using 38 cfr 3.114. He said they would just throw the claim in the trash. I know I’m not a Nehmer claim. My first and only claim was filed Feb. 2016 and was awarded 60% disability for ao ihd in May of 2016. As I said in my first letter I was first diagnosed and treated for ihd in 2008 at a private hospital and started receiving care
    from va in 2009. Got any options about how to file this claim without my vso?

  61. Seth,thanks for your reply on 11/15/2016.I talked to my vso about filing for one year retroactive pay for being diagnosed and treated [one stent placed] for ihd in 2008 at private hospital, then two stents placed in 2014 at Denver va and have been treated for it since then through va. Vso says if it isn’t Nehmer I don’t have a claim. He said if we filed va would just throw it in the trash. I know it’s not a Nehmer claim. I’m just trying to find out if I qualify because of 38cfr3.114. My first and only claim was filed the end of Jan.2016 and in May,2016 I was awarded 60% disability for ao ihd going back to Feb.2016. Knowing you’re previous reply and now what the vso says I’m confused. Any suggestions would be appreciated. Again,thank you.

  62. John, as it relates to Section 3.114 (liberalizing law) the DVA can and does grant one year prior to date of claim if the evidence demonstrates that your diagnosis of IHD predates the change in law granting IHD presumptive status (approx. March 2010). There would also be a separate issue about your actual rating percentage assigned for the one year prior so I would provide copy of that year’s ECG/EKG and cardiac stress test if possible. Personally, if you are going to address the issue I’d simply file a request for reconsideration and provide copy of the above (evidence of diagnosis of IHD one year prior and cardio reports for that one year prior). The DVA will normally address issues related to Section 3.114 sua sponte if there is sufficient evidence. Good luck, and hope I’m simplifying and not confusing. Seth

  63. I was a WAC stationed at Fort McClellan (1972), which was rife with Agent Orange, airborne PCB’s (Monsanto next door), cobalt 60, mustard gas, nerve agents, etc. Much of this was incinerated into the air. I have had a checkered medical history and not able to work for over 20 years. The VA acknowledges this issue. The base was closed in the 90’s and is a superfund site for cleanup. Currently, I am already at 70% perm and total for PTSD/MST and 100% for IU (Crohns Disease–which they service connected.) I haven’t been able to work for over 20 years and challenged every day over plenty of surgically removed internal body parts. Presently, they wondering if I have COPD, never having smoked a day in my life with chronic cough over several years, asthma, bronchial symptoms, etc.

    I only found out about the toxins I was exposed to through word of mouth from another veteran who was stationed there. I am surrounded by other other women vets who were there also and most of them have moderate to severe medical issues that has greatly handicapped their lives. Some of them were in Vietnam, as well, as nurses. Most of them are at a 100% rating already.

    My question is since I already made sure my primary doc at the VA notated this on my records, is there any path of recourse or restitution I can follow? Or any advice you might give me and my fellow vets who are suffering? I don’t foresee that more compensation would be in line since we are already at 100%, but I would like it addressed as the VA denies there is any meaningful impact on anyone that was stationed at Fort McClellan and refuses to service connect it.

    Thank you!

  64. Susan,

    Over the years many veterans have complained about exposure issues at Fort McClellan and I believe the VHA is conducting a limited study into exposure issues. These are difficult issues for a veteran to obtain service connection for under Title 38 and, frankly, for you I do not think it will effect your benefits regardless of service connection (at a non-scheduler 100% due to unemployability). In terms of other remedies, you can file an SF 95 with the Army (Federal Tort Claims Act application), however, the DoD is immune from suit under the FTCA (or any other suit) for service members or former service members due to a Supreme Court case called Feres. Seth

  65. Thank you so much for your answer! I really appreciate you taking the time out to let me know and answer my question thoroughly.

    This will also help me when I’m talking to other veterans who were stationed at Fort McClellan.


    I’m from Nebraska USA, I was diagnosed with Emphysema in July of 2009. I may have had it for 6 months to 1 year prior to diagnosis. It started with a dry cough, shortness of breath, and fatigue. A chest x-ray confirmed it and I was placed on corticosteroids. As the disease progressed all medication stopped working, i was introduced to NewLife herbal clinic who have successful herbal treatment to Emphysema and other lungs related diseases. I spoke to few people who used the treatment here in USA and they all gave positive responses, so i immediately purchased the emphysema herbal remedy and commenced usage, i used the herbal supplement for only 7 weeks, all symptoms were reversed, herbs are truly gift from God. contact this herbal clinic via their email (newlifeherbalclinic @ gmail. com or visit www. newlifeherbalclinic. weebly. com)

  67. I am a Vietnam Veteran. I served during 1967 in the Central Highlands. I am presently receiving Agent Orange Compensation for my type II Diabetes. I have recently been diagnosed with Non Small Cell Cancer. As a result, my Right Middle Lobe was surgically removed by a surgeon at a local Cancer Hospital. My question is: Does “Non Small Cell Cancer” constitute a cancer related to the VA’s definition of Agent Orange related Lung Cancer?

  68. John, a primary form of non small cell cancer of the lungs is considered a disability that would trigger the presumption of service connection under Section 3.307 and 3.309. This is a presumptive disease related to Agent Orange exposure. Because you were treated at a non-VA hospital it will be important to obtain copy of those treatment records. The filing of claim should be pretty straightforward but I still recommend you enlist a local VSO (DAV, American Legion, VFW) to assist you in filing a claim. Good luck Seth.

  69. Seth,this is about a reconsideration claim using 38 cfr 3.114 for a one year retroactive payment on a cad disability claim awarded in May,2016.Per your advice back in Nov.,2016 I went to my vso end of Jan.,2017,told him what I wanted to do.He didn’t ask for any medical proof showing I had cad two years before va made it a presumptive in 2010 with va treating it.Stents in 2008,2014 and double bypass cabg this past month.Vso had me sign a paper for eed and sent it to Cheyenne,Wy. In e-benefits it showed in the work claim what I was asking for,eed,but at the bottom of the page it had the word increase. Decision letter only stated disability rating increase denied. No where in the letter is reconsideration for eed mentioned. Do you think I should file a nod,I have until May before my year is up or go with a cue? thanks

  70. John, reconsideration does require the submission of new and material evidence (in this scenario treatment records evidencing a diagnosis of IHD prior to March 2010). CUE (request for revision) would not resolve anything since the DVA properly adjudicated the effective date of award for your claim for IHD in May 2016. A NOD can be filed (along with providing copy of the treatment records evidencing IHD prior to March 2010). The DVA did further clarity the basis for reconsideration in the M21-1 a few weeks ago at!portal/554400000001018/article/554400000032429/M21-1, Part III, Subpart ii, Chapter 2, Section F – Requests for Reconsideration



    The great cover-up of the White House and our Military.

    What they do not want you the know.

    All Military Forces are lied to.

    I write this website not only for myself, but for all the other Blue Water Navy personnel that served off shore of Vietnam, even Boots on Land and Brown Water Navy, and for their spouses and children and grandchildren and so on and families that survived, that needs your support.

    Blue Water Navy is dying about 8 to 10 times faster the Boots on Land.

    As of 2009, Boots on Land are 70% alive and Blue Water Navy are 30% alive.

    The VA, Government, and the White House cannot figure this out?

    These websites above, are Spam Free, there are No Ads, Pop-ups and etc.

  72. Is Sleep Apnea And Kidney Stones Related To Agent Orange???

    God Bless
    William D Wheeler Sr
    SGM (R) USA

  73. William, I’m personally not aware of medical treatise indicating a direct causal relationship between sleep apnea and/or kidney stones. Your clinician, however, would be better able to comment based upon your personnel medical history. Seth

  74. My father died in 2010 of emphysema, which i understand was caused from watching the bombs tested at white sands, nm. Is there compnsation paid out to these soldiers for this?

  75. Hi I was in the Air force and was in and out of DaNang Vietnam making drops in 1972 and 1973 and I was in Hanoi helping bring home our POW. I had foot on the ground on all the TDYs. The TDYs show on my Military Personnel Record. 11 days Foreign Service TRY. area Pac Ocn GP. and I was one of the lucky ones that used the C-123bs after they came back to the States from being used to spray the Agent Orange in Vietnam. So I got hit a lot with it. Now I filed my Claim for IHD, Diabetes 2 and Lungs and was turned down the first time. It is now in for a NOD. I have the Order of the purple heart doing the claim. We have send in the copy of the TDY orders and Info on my trips bring home the POWS. That was not put in the first time. Do you think I have a claim or not. I’m 80 0/0 S/C now for other things. Leonard.

  76. Hello Leonard,

    Apologies for the delayed response to your comment – Seth is out of the office for the time being. I will forward your question to our staff for more information, and ask them to email you back.

    Thank you!

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