Veterans with physical and cognitive disabilities with a record of in-service diving, mountain climbing, and flying in unpressurized aircraft may be eligible for VA disability for caisson disease
Caisson disease, also called the bends, decompression sickness, or DCS, is a physical condition that can affect service members from every branch. While it is most associated with deep-sea diving, decompression sickness can also occur during rapid ascent at high altitudes.
The effects of caisson disease are often temporary if treated quickly. However, repeated exposure to pressure changes and lack of access to hyperbaric chambers or other treatments could leave veterans with long-term difficulties. Moreover, some effects of diving and altitude-induced decompression sickness, like arthritis and bone infarct, may not manifest until much later in life.
Learn more about caisson disease and how the VA determines ratings and benefits for service members with caisson disease.
In This Article About Veterans and Decompression Sickness Effects:
- What is Caisson Disease?
- Health Effects of Caisson Disease
- Can You Receive VA Disability Benefits for Caisson Disease?
- Is Arthritis Considered a VA Disability?
- What is the VA Rating for Chronic Osteoarthritis?
- How Do You Prove Your VA Disability for Caisson Disease is Service Connected?
- Maximizing Your Rating for VA Disability for Caisson Disease
What is Caisson Disease?
Caisson disease is referred to by divers as “the bends” because one of its most characteristic symptoms immediately after it occurs is joint and abdominal pain that is so severe that it causes the diver to double over in pain.
Caisson disease earned its name from the watertight chambers construction workers used to work underwater. These chambers were pressurized to keep water out while building tunnels or bridges. The symptoms of caisson disease were discovered to be the result of the pressure change experienced by workers moving from the high-pressure chambers to the low-pressure environment at the end of their shifts.
The technical term used now is DCS (Decompression Sickness). This was adopted for a couple of reasons:
- It is a physical condition: Rather than being caused by disease-carrying parasites, bacteria, or viruses, the effects of DCS are caused by nitrogen gas bubbles that form in your bloodstream as the air pressure on your body drops.
- It can be caused by any decompression: Any drop in pressure can result in DCS, including depressurization of an aircraft, ascent of a depressurized aircraft, and rapid mountain ascent. The pressure difference between diving and ordinary flying can cause DCS if divers fly on a pressurized airplane soon after a dive.
Health Effects of Caisson Disease
Veterans who worked as divers or flew in unpressurized aircraft are particularly susceptible to decompression sickness and its long-term health effects. Some of these long-term health effects, such as osteoarthritis, manifest later in life and older saturation divers working from the 1960s-1980s are particularly susceptible due to the lack of safety equipment and procedures used today.
The health effects of DCS fall into two general categories:
- Physical effects: Nitrogen bubbles in the bloodstream can lead to skin rashes. Bubbles can also accumulate in joints, leading to joint pain, osteoarthritis, dead bone tissue, also called bone necrosis or bone infarct, breathing pain, and a cough.
- Neurological effects: Bubbles can affect the central nervous system leading to vision problems, headaches, confusion and memory loss, and seizures.
The purpose of VA disability benefits is to compensate veterans for loss of work capacity and the general reduction in quality of life due to service-connected disabilities. Veterans who suffer the physical effects, neurological effects, or both due to DCS may be unable to earn a living. As such, the VA offers disability benefits for veterans who were afflicted by caisson disease while in service and continue to suffer the effects after discharge.
What Other Conditions are Related to Decompression?
In addition to DCS, decompression can cause permanent spinal cord damage. This spinal cord damage can manifest as paralysis, strange or painful sensations in the extremities, muscle weakness, and bowel or urinary incontinence. While spinal cord damage may be limited or reversed with immediate hyperbaric treatment, failure to treat veterans after a decompression incident can lead to long-term disability.
Traumatic Brain Injuries can have an effect on PTSD symptoms. Learn more in this video.
Can You Receive VA Disability Benefits for Caisson Disease?
Yes. The VA’s regulations state that caisson disease should be “rated as arthritis, cord involvement, or deafness, depending on the severity of disabling manifestations.” However, these manifestations only cover a few of the disabilities that may result from caisson disease.
How is VA Disability for Caisson Disease Rated?
Even though the VA has a diagnostic code for caisson disease, it is rated on its residuals. This means that each individual health effect attributable to DCS is separately rated. Your overall caisson disease VA disability rating is the aggregate of the ratings using VA math.
What Conditions Caused by DCS Qualify for VA Disability Benefits?
It is impossible to be comprehensive, but any conditions attributable to DCS by competent medical opinion could be rated by the VA and included in your VA disability benefits.
For example, in one case, a navy diver submitted a claim for VA disability for caisson disease due to the memory loss and cognitive decline he experienced. Although the claim was denied on other grounds, the Board of Veterans’ Appeals accepted that memory loss and cognitive decline would have been ratable as a condition caused by DCS.
Is Arthritis Considered a VA Disability?
Yes. By far, the most common long-term effect of DCS is chronic joint pain and osteoarthritis in the shoulders, elbows, knees, and ankles, although any joint can be affected. Arthritis can be caused by gout, physical trauma, an autoimmune disorder, or wear and tear.
In the case of DCS, arthritis is caused by an accumulation of gas bubbles in the joint. These bubbles cause lesions in the joint, chewing away at cartilage and bone. Extreme cases of DCS may result in dysbaric osteonecrosis, in which the lesions caused by the bubbles cause bone tissue to die.
What is the VA Rating for Chronic Osteoarthritis?
The VA rating for chronic osteoarthritis will vary depending on the joint or joint group affected. The VA has a separate disability ratings table for rheumatoid arthritis but a VA disability rating for gouty arthritis is calculated the same as a VA disability rating for osteoarthritis.
Generally, the VA has a two-step process for rating osteoarthritis. First, it looks to the specific joint or joint group to determine how it has been affected. If the joint is frozen (ankylosis) or has limited range of motion (ROM) due to pain, swelling, or muscle spasm, the joint is rated based on the position it is frozen or the degree of ROM.
Second, if specific joints are neither frozen nor sufficiently limited in their ROM to receive a rating, an overall VA rating for osteoarthritis can be obtained. This rating is based on x-ray evidence of osteoarthritis. The rating is either 10% or 20% depending on the number of joints affected, whether they are major joints or minor joints, and if they suffer incapacitating episodes.
For example, the VA disability rating for arthritis in the hands may vary from 0% to 60% depending on the finger and joint involved. Similarly, the VA disability rating for arthritis in the shoulder may range from 80% for loss of function of the shoulder at the humerus to 10% for a loose or misaligned shoulder blade.
DCS can also affect the lower extremities. The VA disability rating for arthritis in the foot can vary from 10% to 50%. Factors the VA uses to rate arthritis in the foot include the position in which the foot or toes are frozen and the number of toes involved. Likewise, the VA disability rating for arthritis in the ankle ranges from 10% to 40% based on the position in which the ankle is frozen or the loss of ROM in the ankle. When rating arthritis in the lower extremities, the VA will also take account of whether one leg is shortened by the disability, causing you to walk with a limp.
How Do You Prove Your VA Disability for Caisson Disease is Service Connected?
Establishing a service connection for a claim for VA disability for caisson disease is relatively straightforward. If you suffered an accident while diving or flying that resulted in rapid decompression, the accident should be noted in your service records.
Moreover, the immediate symptoms of the bends are severe enough that most people seek medical treatment after the decompression incident. As a result, your military medical records should include treatment during your service for DCS.
The difficulties may come in connecting the later manifestation of a physical problem to the DCS suffered while serving. For example, if you worked in construction after your discharge, the VA may deny a claim for VA disability for caisson disease because it believes your arthritis was caused by your post-service career rather than DCS while serving.
Similarly, memory loss later in life is common enough that the VA could deny a VA disability claim for DCS on the grounds that your memory loss was a natural progression of cognitive decline due to age rather than a result of DCS.
However, the VA has two rules that tend to help veterans in these situations. The first is 38 C.F.R. § 3.102 which requires the VA to resolve reasonable doubt in the veteran’s favor. This means that if the evidence is equal on both sides of an issue, like causation, the VA is supposed to resolve the issue in favor of the veteran.
The second is 38 C.F.R. § 3.303 which states that a service connection for a chronic condition can be supported by a manifestation during service. While the VA warns against giving it too much weight, joint pain due to DCS that appears in your military medical records can support a later claim for osteoarthritis.
Maximizing Your Rating for VA Disability for Caisson Disease
Because the VA disability rating for caisson disease is based on the residuals ratings of the physical conditions caused by decompression, maximizing your rating will depend on including as many conditions as possible in your claim for VA disability for caisson disease. Moreover, for joints that suffer arthritis, but are neither frozen nor limited in their ROM, the number of joints and the importance of the joints are considered to assign a rating.
Service-connected physical disabilities can also lead to other secondary service-connected disabilities. For example, arthritis in the ankle due to DCS can lead to hip problems when you favor the arthritic ankle. As a result, you may be able to claim VA disability for osteoarthritis hip pain or ankylosis using the secondary service-connected disability principle.
Secondary service-connected disabilities do not necessarily need to be physical. Mental conditions like depression stemming from DCS-induced memory loss and confusion can also be claimed as secondary service-connected disabilities.
A claim for VA disability for caisson disease can face hurdles even with records that show a decompression incident during your service. Contact a VA attorney regardless of where you currently reside or whether you were deployed during your military service to discuss a VA disability claim for your long-term disabilities resulting from DCS.