Testicular Cancer as a Presumptive Condition Under the Pact Act

Many veterans exposed to toxic contaminants during their military years have struggled for decades to receive the well-deserved medical care and benefits. Now, the PACT Act provides access to care for millions of veterans and their survivors from the Vietnam and Gulf War eras and post-9/11 eras and aims to change the old paradigm.

By adding more than 20 new presumptive conditions linked to toxic exposures, the Act expands VA healthcare and benefits for multiple service-connected cancers, including testicular conditions. Veterans become eligible to file claims under the PACT Act if exposed to harmful substances such as:

• asbestos
• sand and dust
• particulates
• oil well or sulfur fires
• chemicals
• radiation
• warfare agents
• depleted uranium
• herbicides

It's vital information that testicular cancer is listed presumptive only in the burn pits section, and it doesn't appear under Agent Orange (AO) exposure because there is no established link or official presumptive connection between AO exposure and testicular cancer for benefits purposes. While some studies have examined the relationship with mixed results, the current scientific consensus and the VA do not recognize a direct association, making it harder for veterans to receive benefits for this condition solely based on herbicide exposure. Even so, veterans diagnosed with testicular cancer and who have a history of AO or any?other toxic exposure can still file a claim. In such cases, they would need to provide medical evidence linking their condition to the exposure, because the presumption does not apply.

However, the PACT Act addresses veterans who may have sustained an injury to the testis or been exposed to harmful chemicals during their service, which increases the risk of testicular cancer. Such injuries and illnesses can result in testicular dysfunction or the removal of one or both of the testicles. Although rare, testicular cancer is a severe condition that has been linked to in-service exposure to toxic substances listed above. A growing body of research suggests that veterans -especially those who have served overseas or worked with or around hazardous chemicals - face a higher-than-average risk of this disease. Besides exposure to chemicals and other toxic agents, they were at risk due to other factors as well, such as:

• environmental factors like extreme heat, ionizing radiation from medical procedures, or nuclear weapons
• physical factors (vulnerability to physical trauma), though a direct link requires more research.

Signs and Symptoms

Unfortunately, testicular cancer may happen at any age; statistics show that it most often occurs between the ages of 15 and 45. Estimates from the American Cancer Society indicate that approximately 10,000 new cases will be diagnosed in 2025, along with about 600 deaths. Furthermore, the incidence of testicular cancer is about one per 250 young men, with a peak between the ages of 30 and 34 years old.

Even if testicular cancer is a severe disease, it can usually be treated successfully. Hence, the risk of dying from this type of malignancy is very low: it's about 1 in 5000, even when it spreads in the body. Common treatments include surgery and chemotherapy, depending on the type of this malignancy and how far it has spread. Testicular cancer is categorized into two main types:

1. Germ cell tumors start in the sperm-producing cells, and are the most common type, making up over 90% of testicular cancers. They're categorized as:

• seminomas, which grow and spread more slowly than other germ cell tumors, and
• non-seminomas are more aggressive and can spread more rapidly. They're further categorized into embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and teratoma.

2. Stromal tumors make up less than 5% of testicular cancers and develop from the supportive tissues of the testicles. They're categorized as:

• Leydig cell tumors develop in the testosterone-producing cells
• Sertoli cell tumors start in cells that help sperm development.

The first symptom of testicular cancer is often a bump or lump on a testicle. Given that the cancer cells can proliferate, they usually spread outside the testicle. Other symptoms include:

• enlargement or lump in a testicle
• ache in the abdomen or groin
• pain, swelling, or discomfort in a testicle
• a heavy sensation in the scrotum
• breast growth and tenderness

Reproductive Cancers and the Pact Act

When Congress passed the PACT Act in 2022, it included "reproductive cancers of any kind" on the list of presumed conditions for qualifying Gulf War and post-9/11 veterans exposed to toxic substances from burn pits. By recognizing testicular cancer as a presumptive condition, the Act ensures that veterans can access the benefits and healthcare without having to prove a direct connection to their service.

If a veteran served in one of the locations and time periods listed under the VA's Burn Pit Presumption of Exposure, the VA automatically assumes they were exposed to burn pits or other toxic substances. It means veterans do not have to prove individual exposure; the VA presumes it based on service location and time. Furthermore, the PACT Act considers these male reproductive cancers presumptive:

• testicular cancer
• prostate cancer
• penile cancer
• urethral cancer
• breast cancer

Consequently, any veteran diagnosed with testicular cancer who has not yet filed a VA claim for this presumptive condition should file a new claim:

• online
• by mail
• in person

Former service members can also file claims with the help of a trained professional, such as a VSO or a nonprofit organization.

Testicular Conditions as Secondary Diseases

Veterans may also have testicular issues that are secondary conditions, meaning they are caused by another condition that is service-connected and may still receive disability benefits for these secondary testicular conditions. They can file a secondary claim to get more disability benefits for a new disability that's linked to a service-connected disability they already have.

Testicular Cancer and Testicular Mesothelioma

It's not uncommon that people confuse testicular cancer and testicular mesothelioma. However, they're not the same thing. Even if these cancers develop in the same part of the body, they affect different tissues.

Testicular mesothelioma is a rare type of testicular cancer that can grow in some unusual cases, especially in patients with a toxic exposure history. It is a malignant mutation of mesothelial cells. Although there's only limited research regarding this malignancy, asbestos exposure was associated with it based on the fact that 35% of all testicular mesothelioma patients have been exposed to asbestos at some point.

Sadly, veterans with testicular mesothelioma usually have a short life expectancy; even so, it has a slightly better prognosis than those of the chest or abdomen, accounting for about 5% of all mesothelioma cases.

Considering that there are no specific signs of testicular mesothelioma, many vets with this cancer initially receive a wrong diagnosis. Often, most doctors mistake it for common conditions such as a hernia and recognize it only during or after surgery.

Helping Veterans Affected by Toxic Exposure

If you are a veteran diagnosed with a testicular condition, you should be informed of your legal rights and options. By consulting an attorney specializing in toxic exposures, you can ensure a correct assessment of whether your condition is connected to your military years directly or as a secondary condition.

Furthermore, a toxic exposure lawyer can assist you with getting the higher VA rating you deserve. The newly added presumptive conditions and changes in VA policy may even mean you have a valid case today, even if you were denied years ago. We can help by connecting you with attorneys ready to take on your case.