Vietnam veterans, bladder cancer and hypothyroidism: a claim map

The claim map

A claim map follows one veteran's route: where they served, the conditions the law presumes for that service, and the conditions that follow from them. Each box shows how the Board ruled at that step. Few Vietnam veterans had a secondary claim decided with the bladder cancer or hypothyroidism, so the second step counts all veterans who claimed a condition secondary to either one.

Where they served

Vietnam

Service in the Republic of Vietnam or its offshore waters, January 1962 to May 1975

58,055 Board decisions that name Vietnam

presumed by law38 U.S.C. 1116

Step 1 · presumed by law

Bladder cancer or hypothyroidism

54.5% granted

593 of 1,089 veterans · all bladder cancer or hypothyroidism claims 33.4%

secondary38 CFR 3.310(a)

Step 2 · claimed secondary to bladder cancer or hypothyroidism (all veterans)

• Sleep apnea DC 6847

  32.1% · 26 of 81

• Erectile dysfunction DC 7522

  37.7% · 20 of 53

  → may open special monthly compensation

• Hypertension DC 7101

  11.4% · 5 of 44

• Diabetes DC 7913

  14.8% · 4 of 27

• Nerve damage, legs DC 8520

  47.6% · 10 of 21

• Anxiety DC 9400

  11.8% · 2 of 17

• Prostate condition DC 7527

  31.3% · 5 of 16

Step 1 bars: share granted in Board decisions that name Vietnam; the red mark is all veterans. Step 2 bars: all veterans who claimed the condition secondary to bladder cancer or hypothyroidism. One count per veteran; a remand counts as not granted. Conditions with at least 15 veterans.

Are bladder cancer and hypothyroidism presumptive for Agent Orange?

Yes, since January 2021. The National Defense Authorization Act for Fiscal Year 2021 added bladder cancer, hypothyroidism and parkinsonism to the herbicide list in 38 U.S.C. 1116 (M21-1 VIII.i.1.C.1.f). For a veteran with presumed herbicide exposure, such as service in Vietnam, VA presumes the link to service, and neither condition has to reach a set level of disability (M21-1 VIII.i.1.C). In decisions that name Vietnam, the Board granted 54.5% of these claims (593 of 1,089), against 33.4% for all veterans: 56.8% for bladder cancer and 52.1% for hypothyroidism.

58,055 Board decisions from 2020 to 2025 name Vietnam or a place there; this page counts the claims rated as bladder cancer (DC 7528, only claims that name the bladder, since the code also holds prostate and kidney cancer) or hypothyroidism (DC 7903).

Decisions that name VietnamAll veterans

Bladder cancer

56.8%

41.6%

Hypothyroidism

52.1%

28.3%

Share of decided claims granted; a remand counts as not granted. One count per veteran. Service-connection claims only.

What changed in 2021

What changed in 2021?

Grants jumped. In 2020 decisions, before the law took effect, the Board granted 22.1% of these Vietnam claims, against 15.8% for all veterans. In 2021 it granted 79.6%. The share has fallen each year since, to 45.8% in 2025, still above 27.3% for all veterans. Fewer of these claims reached the Board too: 275 in 2021, 107 in 2025. The data does not show why the share fell.

Decisions that name VietnamAll veterans

2020

22.1%

15.8%

2021

79.6%

49.8%

2022

65.5%

39.1%

2023

54.2%

35.0%

2024

53.8%

33.3%

2025

45.8%

27.3%

Share of decided claims granted; a remand counts as not granted. One count per veteran. Service-connection claims only: bladder cancer (DC 7528, claims that name the bladder) and hypothyroidism (DC 7903). Both were added to the herbicide list from January 2021.

Vietnam is not the only route to the presumption: Blue Water Navy service, Thai air base service and Korean DMZ service also lead to it.

Why claims are denied

Why are these claims denied?

On the medical link, the diagnosis and the service, often more than one at once. For 155 denials, the Board's note named a medical link in 65.8% of them, the diagnosis in 59.4%, and the exposure or the service in 54.2%, for example when the records did not place the veteran in Vietnam. The presumption can also be rebutted: in one denial below, affirmative evidence showed that an unrelated disease caused the hypothyroidism.

How VA rates them

How does VA rate bladder cancer and hypothyroidism?

Bladder cancer is rated under DC 7528 in 38 CFR 4.115b at the full rating while treatment lasts and for six months after it ends, when a VA exam is required. After that, if the cancer has not come back or spread, VA rates what remains, as voiding problems or kidney problems, whichever is worse. Hypothyroidism is rated under DC 7903 in 38 CFR 4.119: the higher rating with myxedema (cold intolerance, muscle weakness, heart involvement and slowed thinking or depression), a lower one without it. Each lasts six months from diagnosis or from stabilization; then VA rates the lasting effects under the body system they affect, such as the eyes, digestion or mental health.

The second step: conditions that follow

What conditions are claimed secondary to them?

Across all veterans, sleep apnea was granted for 26 of 81 (32.1%) and erectile dysfunction for 20 of 53 (37.7%); nerve damage in the legs came out at 47.6%. Hypertension (11.4%), diabetes (14.8%) and anxiety (11.8%) did worse. Erectile dysfunction can also open special monthly compensation for loss of use of a creative organ (38 CFR 3.350(a)).

Claimed secondary to bladder cancer or hypothyroidism (all veterans)	Granted	Veterans	Share
Sleep apnea	26	81	32.1%
Erectile dysfunction	20	53	37.7%
Hypertension	5	44	11.4%
Diabetes	4	27	14.8%
Nerve damage, legs	10	21	47.6%
Anxiety	2	17	11.8%
Prostate condition	5	16	31.3%

The numbers are small.

Does the first claim have to be granted?

In practice, yes. Among Vietnam decisions that ruled on both, the Board granted 28 of 38 secondary claims when it granted the bladder cancer or hypothyroidism, and 0 of 16 when it did not.

Where the bladder cancer or hypothyroidism was not on appeal, usually because it was already service connected, 33.3% of the secondary claims were granted. Those claims stood on a medical opinion about the link, not on the presumption.

Earlier denials: the Nehmer rule

Can an earlier denial be paid back?

Possibly, under the Nehmer court orders. A Vietnam veteran with a covered herbicide disease, or the surviving spouse, child or parent of one who died from it, can get an earlier effective date when VA denied or received an earlier claim for the same disease (38 CFR 3.816). Bladder cancer and hypothyroidism are covered; hypertension and MGUS are not (M21-1 VIII.i.2.B). The rule applies only to service in Vietnam itself, not to herbicide exposure elsewhere, such as Thailand or the Korean DMZ (M21-1 VIII.i.1.B).

Read the decisions

Recent decisions, with the Board's reasoning as summarized by AI and checked against the decision text:

• A25110781, December 2025: hypothyroidism granted for an Army veteran with confirmed service in Vietnam; the Board noted that hypothyroidism was added to the herbicide list by the National Defense Authorization Act for Fiscal Year 2021, effective January 2021.
• A25050665, June 2025: bladder cancer granted for a Marine Corps veteran; the regional office had already found herbicide exposure in Vietnam, and those favorable findings carried the presumption.
• A25089354, October 2025: bladder cancer (urothelial cell carcinoma) granted for a surviving spouse. VA had denied the veteran's claim in 2014; after bladder cancer joined the list, VA reviewed the claim under Nehmer in 2021, and the Board found the cancer was a bladder cancer.
• A25080220, September 2025: hypothyroidism denied for a Vietnam veteran; herbicide exposure was presumed, but the Board found no current diagnosis of hypothyroidism.
• A25064222, July 2025: hypothyroidism denied for a veteran who served in Vietnam; affirmative evidence showed that an unrelated disease caused it, which rebutted the presumption.
• A25053309, June 2025: bladder cancer denied; the veteran reported temporary duty at Da Nang Air Base, but the service records placed the veteran at Kirtland Air Force Base in New Mexico.

What the data cannot tell you

The Vietnam group comes from the places each decision names. Decisions that name Vietnam only in a quote of the law, or in a finding that the veteran was not there, are left out; that check is automatic and misses some. A mention is not proof of qualifying service. Bladder cancer is counted only where the claim's caption names the bladder. Service-connection claims only; rating appeals are left out. The second step counts all veterans, not only Vietnam veterans, and only claims the Board marked as secondary. Denial notes are AI-extracted. These are historical outcomes, not predictions.

For representatives

• Settle the service first: land service or qualifying offshore waters, with personnel records, unit records and the veteran's statements.
• Get the diagnosis on paper: a pathology report for bladder cancer, thyroid tests and treatment records for hypothyroidism.
• Check for another cause in the record, such as thyroid treatment for an unrelated disease; affirmative evidence of another cause can rebut the presumption.
• For a Vietnam veteran or survivor with an earlier denial, check the Nehmer effective-date rules before accepting the date of the new claim.
• After the grant, screen for sleep apnea, erectile dysfunction and nerve damage, and consider special monthly compensation.