To: President Biden and all who wrote and passed the PACT Act of 2022 to help veterans.
From: David Bittleman, MD, Primary Care Internal Medicine Doctor at VA San Diego, CA.
Date: August 7, 2023
J.W. a soft-spoken, Vietnam War Navy veteran has been my patient at the VA San Diego for about 10 years. I’ve helped him with diabetes, high blood pressure and other medical problems. A nagging question that I had was: Could his diabetes and other medical problems be service-related? Before the PACT Act, I looked up criteria, and it didn’t look like it fit his service record. I asked repeatedly, and he replied that he didn’t think so. He had spent his Navy career “scraping paint off of decks.” I looked at his tired eyes and wanted to do more for him. He had risked his life for our country. He is a kind man. We share stories about our families and pets. I really feel a connection to him.
In 2016 he suffered a stroke and had residual balance problems. Even then, we didn’t believe that the problems were service-related. He is a proud man, and he said that he was just doing his duty during the war. He did not think he deserved any more money for his service. He again told me that he didn’t spend time on the ground or in the inland waterways of Vietnam. “I just scraped paint and swabbed the deck, Doc.” We both figured he didn’t qualify for any agent orange associated disease disability payments.
After his stroke, I told him he should think about retiring, but he said he wanted to keep working. Work gave him purpose. He also confessed that he needed the money. I offered to help him get social security disability, but he wasn’t interested.
Late in 2022 he came to see me for a new golf ball sized mass in his right breast. I knew this was serious. He was quickly diagnosed with Large B cell lymphoma, Stage IIE (a Non-Hodgkin’s Lymphoma) and started to receive chemotherapy. At this point, I wanted to clarify his military service. Breast tumors are rare in men. I continued to wonder: Could it be service-related? We returned to the VA website. Things had changed. The PACT Act expanded the criteria of who may have been impacted by agent orange: “Veterans will have presumptive agent orange exposure if between January 9, 1962, and May 7, 1975, the veteran served for any length of time in a vessel operating not more than 12 nautical miles seaward from the demarcation line of the waters of Vietnam and Cambodia.”(1)
J.W. looked at me. “Doc, I served on the Guided Missile Light Cruiser the USS Oklahoma from 1970-1971 and on the USS Dubuque from 1971-1972.” He remembered watching the shore bombardments of North Vietnam. They also made stops in Danang Harbor. At that moment I knew that he was within 12 nautical miles of the shores of Vietnam. (2) I wrote a nexus letter linking his military service with presumptive agent orange associated non-Hodgkin’s lymphoma and had him bring it to an AMVETs service representative who helped him file a claim. It took about about a month for him to have a compensation and pension evaluation and in July 2023 he received the letter from the Veterans Benefits Association telling him that he was awarded 100% service-connected disability for agent orange associated lymphoma.
I saw him follow-up August 7, 2023. He feels financially more secure. He was amazed at the thousands of dollars he had received and will continue to receive. He is thrilled to finally be able see a dentist for the first time in years.
I went into medicine to help people. There is no greater joy than reducing suffering and helping people with their problems. The PACT Act of 2022 has brought joy to my practice and improved the lives of my patients. Thank you, President Biden and those lawmakers who championed this important legislation that helps veterans.
Corresponding Author: David Bittleman, david.bittleman@va.gov
Authors: D Bittleman1
Author Affiliations:
1 VA San Diego Healthcare System
