Cancer or malignancy is defined as a proliferation of cells resulting in unregulated growth, lack of differentiation, local tissue invasion, and metastasis. Types of bone cancer include: osteosarcoma, fibrosarcomas, chondrosarcomas, Ewing's tumor, and malignant lymphoma of the bone.

Predisposing factors associated or linked to cancer include: a family history of cancer; environmental factors, including viruses and environmental exposure, such as chemicals, drugs, alcohol, and tobacco; prior illness, such as an autoimmune disease; previous immunosuppressive therapy; and acquired immunodeficiency syndrome (AIDS).

Persistent or unexplained pain in the trunk or extremities, and the presence of a mass are the usual signs and symptoms. There may also be limited motion in adjacent joints, and spontaneous fractures may occur. Other signs and symptoms of the condition which may be present include: fatigue, weight loss, fever or night sweats, cough, and persistent pain. Osteosarcoma, the most common primary bone tumor, is highly malignant. Most of the lesions are often located in the region of the knee.

A complete history and physical examination are necessary for early diagnosis and treatment. Tests include: computed tomography (CAT) scan, magnetic resonance imaging (MRI), needle biopsy of the bony lesion and regional lymph nodes, histological studies of bone marrow. X-ray of the bone, positron emission tomography (PET) scan, bone scan, and angiogram. Additional tests may be done to determine the extent of the disease (staging), bone marrow biopsy, and serum/blood chemistries. X-rays may show suspicious areas of bony enlargement, test may be conducted to determine if the cancer has involved other sites such as the lungs.

Treatment depends on the type of primary tumor and the organs or bones involved. Treatment may include: surgery, radiotherapy, antineoplastic chemotherapy, hormone therapy, surgery (to include cryosurgey), and targeted therapy or a combination of surgery and other therapies. Mild to moderate pain may be treated with nonopioid analgesics, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Opiods and NSAIDs are used for bone pain, with corticosteriods used for severe bone pain.

Residuals depend upon the location and type of tumor, the responsiveness of the tumor to treatment, and the extent of the surgery, if performed. The person may have an amputation, requiring long-term rehabilitation. Reconstructive surgery with a fitted prosthesis may be indicated particularly in the very young. Counseling and occupational therapy may be required. Pain management may be long-term.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• 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).

• The disease must have become manifest to a degree of 10 percent or more within 1 year (for Hansen's disease (leprosy) and tuberculosis, within 3 years; multiple sclerosis, within 7 years) from the date of separation from service as specified in paragraph (a)(2) of this section. See 38 CFR 3.307 (a) (3)  [chronic disease].

• Malignant neoplasms of the bone and multiple myeloma shall be service connected if the veteran was in a radiation risk activity as defined by CFR 38 CFR 3.309 [Disease subject to presumptive service connection, 38 CFR 3.309(d) [Diseases specific to radiation-exposed veterans] provided the rebuttable presumption provisions of 38 CFR 3.307 of the part are also satisfied; or as defined by 38 CFR 3.311 [Claims based on exposure to ionizing radiation], and 38 CFR 3.311(b) [Initial review of claims]. Under 38 CFR 3.311(b)(5)(i) bone cancer must become manifest within 30 years after exposure. 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 musculoskeletal tumor society (MSTS) staging system, also know as Enneking system, is important when determining the grade, extent, and whether bone cancer has metastasized. It is also a factor when deciding whether a future exam is required or whether a total and permanent disability exists consistent with 38 CFR 3.340 and 38 CFR 4.15. 

• The 100 percent rating will be continued for 1 year following the cessation of surgical, X-ray, antineoplastic chemotherapy or other prescribed therapeutic procedure. If there has been no local recurrence or metastases, rate based on residuals.