Soft tissue sarcoma is a disease in which cancer cells are found in soft tissue in the body. Soft tissue includes muscles, tendons, connective tissues, fat, blood vessels, nerves, and synovial (joint) tissues. The extremities are the most frequent sites (60%), and the lower extremities are involved three times more often than the upper extremities. In this case, the sarcoma arises in blood vessels.

Etiologic factors may include: injury as sarcomas arising in scar tissue of burns, fractures, or operations or implantation of a foreign body or both. Chemical carcinogens may be involved, (e.g., asbestos). Cancer patients who have been treated with radiation have sarcomas arising in the irradiated field after 5 years or longer. The new herpes virus (HHV8) may be the cause in Kaposi's sarcoma. Genetic factors and immunodeficiency are associated with the development of sarcoma.

Manifestations are related to any mass that arises, and are asymptomatic. If there is cardiac sarcoma, then heart failure, tamponade, arrhythmias, or heart block may appear. Sarcomas spread through the blood, not through the lymph system, and often spread to the lungs.

All growths require biopsy. Visualization of the tumor can be done by x-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scan.

A radical excision of the entire tumor is the usual treatment. Following the excision, the additional use of radiation therapy or chemotherapy or both may be used.

Most metastatic soft tissue sarcomas are not cured. If a patient is made free of clinical disease, then the chances of being a long-term survivor are up to 20%. Thus the goal is to obtain a complete remission with surgery and chemotherapy.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [38 CFR 38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309 (a) [chronic disease].

• This condition shall be service connected when meeting the criteria as set forth in 38 CFR 3.311 [Claims based on exposure to ionizing radiation], and 38CFR 3.311(b) [Initial review of claims] provided the provisions of 38 CFR 3.311(b)(5)(iv) have been met. A claim under 38 CFR 3.311 that involves radiation exposure requires an opinion by the C&P Service before any decision may be made by a Regional Office to grant or deny benefits.

• If the Veteran was exposed to an herbicide agent during active military, naval, or air service, soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma or mesothelioma) shall be service-connected if the requirements of 38 CFR 3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 CFR 3.307(d) are also satisfied. See Note 1 under 38 CFR 3.309(e) which refers to specific soft-tissue sarcomas to be considered under this provision.

Notes

• 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 38 CFR 3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

• The rating criteria for cardiovascular conditions underwent full-scale revision effective on November 14, 2021 and January 12, 1999.  A regulatory change was effective August 13, 1998, updated criteria for cold injury residuals under 38 CFR 4.104, DC 7122.  The changes are not considered liberalizing and should not be used as the basis for reduction unless the disability has actually improved.