This condition refers to a group of neoplastic disorders (cancer) originating in the lymph glands and lymphoid tissue which may also be known as lymphomas.

The cause of the condition is unknown, but it is thought to result from various potential stem cell defects.Cancer cells may originate in lymph tissue, or they may metastasize from a primary tumor. Once they are in the lymph system, they may also spread to other areas of the body through the lymphatic system. These cancers may cause the formation of abnormal concentrations of white blood cells in the lymph system which can interfere with the functions of the vital organs. Cancers of the lymphatic system include

• Hodgkin's lymphoma (see Diagnostic Code: 7709),

• malignant lymphomas such as Non-Hodgkin's lymphoma (see Diagnostic Code: 7715), and

• acute leukemia (see Diagnostic Code:7703).

Lymph nodes are usually not palpable. When lymph nodes become palpable, an inflammatory response to infection is indicated. However, superficial or major swelling and morbid changes in lymph nodes or glands (lymphadenopathy) may occur in patients with lymphoma and metastatic disease. Manifestations of carcinoma of lymph glands/nodes may vary and depend on the type of cancer. Some common symptoms include:

• painless swelling in lymph glands/nodes in the neck, axilla, or groin;

• fever;

• night sweats;

• malaise;

• fatigue;

• anemia; and

• weight loss.

Physical examination includes palpation of lymph nodes starting with the preauricular lymph nodes and proceeding downward from the head and neck to the axillary and inguinal areas. Serologic tests may include blood chemistry studies and a complete blood count (CBC), as well as specialized blood tests such as radioimmunoassays (RIAs) for tumor markers. Other tests may include:

• x-rays;

• histologic analysis of tissues obtained by biopsy of lymph nodes;

• fluid aspiration tests of body fluid to evaluate a lymph node abnormality seen on x-ray;

• lymphangiography;

• ultrasonography;

• computed tomography (CT) scan; and

• magnetic resonance imaging (MRI).

Treatment may include

• chemotherapy, radiation, or both;

• antiemetics, sedatives, or antidiarrheals to combat adverse effects of chemotherapy and radiation;

• antibiotic, antifungal, or antiviral drugs and granulocyte injections to control infection; and

• possibly platelet and red blood cell transfusions.

Long-term treatment and follow up evaluations are required. During treatment, the patient may have complications that include:

• anorexia;

• nausea;

• vomiting;

• mouth ulcers;

• alopecia;

• fatigue; and

• bone marrow depression.

Counseling may be needed for emotional support.

• Consider service connection on a presumptive basis as a chronic condition (38 CFR 3.307; §3.309(a)).

• Consider service connection on a presumptive basis as a condition associated with ionizing radiation exposure (38 CFR 3.307; §3.309(d); §3.311).

• 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) – Total plus 60% – Special Monthly Compensation (SMC).

• For cancers with a high mortality rate, do not schedule a review examination unless the record clearly shows a long-term and stable remission.

• When Regional Offices (ROs) receive a claim identifying exposure to radiation, the existence of a radiogenic disease must be confirmed prior to transferring the claim to the Jackson Regional Office. The rating activity sends claims to Compensation Service for additional development only if there requirements under 38 CFR 3.311(b)(1) are met, and development is complete. 

• The American Cancer Society endorses the use of the Lugano classification, which is important when determining the grade, extent, and whether cancer has metastasized. It is also a factor when deciding whether a future exam is required or whether a total and permanent disability exists in accordance with 38 CFR 3.340 and 38 CFR 4.15.

• SC on a presumptive basis for cancer associated with an in-service exposure event may only be established if the cancer in consideration is the primary or originating site of the cancer. Most pathology reports will indicate if the cancer is primary or metastatic

• If SC is established for a primary cancer that metastasizes into a separate body system, then SC on a secondary basis should be established for the metastasized cancer in the separate body system. If doubt arises as to the medical cause or association of any symptoms or diagnosis, a medical opinion should be requested for clarification.

• A 100 percent evaluation shall continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 CFR 3.105(e). If there has been no local recurrence or metastasis, rate on residuals under the appropriate diagnostic code(s).