17 September 2014

VA IG Changes Story – Delays in Phoenix "CONTRIBUTED" to Patient Deaths

Patient Scheduling Delays: They did, they didn't, and now...they did again.
Remember IOM C-123 Committee: You can trust everything the VA tells you.

By Jim Avila
Serena Marshall
Sep 17, 2014 6:16pm

Delays caused by secret waiting lists “contributed” to deaths at the Phoenix VA earlier this year, an assistant inspector general who helped draft a controversial Inspector General report admitted today under intense questioning by the House Veterans Affairs Committee.
The assertion by Dr. John Daigh comes less than a month after the Office of the Inspector General proclaimed in its official report that it is “unable to conclusively assert that the absence of timely care caused the deaths of these veteran.”
Rep. David Jolly, R-Fla., asked Daigh whether he could “conclusively assert that wait-lists did not contribute to the deaths of veterans?”
“No,” Daigh replied.
When asked whether he’d be “willing to say wait-lists contributed to the deaths,” Daigh responded,  “Yes.”
It was a startling admission, following complaints that the OIG softened the report at the VA’s request.  The sentence about being “unable to conclusively assert that the absence of timely care caused the deaths of these veterans” was not in the first draft of the report and only appeared in the final draft after the VA had a chance to review and comment privately on it.
Daigh also said that while he could not say “the delays caused the deaths,” he also could not say they didn’t.
That caused Jolly to ask him whether such was the case, and why put one assertion in the report but not the other.
“The issue is cause or, of course, a direct relationship, how tight of a relationship do you want? That’s where the difficulty is here,” Daigh said.
Daigh said earlier in the testimony “I’m not clairvoyant. It’s very difficult to know how someone died.”
The acting inspector general, Richard J. Griffin, added “We don’t know how they died or why. Nor do you, I would say that it may have contributed to their death, but we can’t say, conclusively, it caused their death.”
The Inspector General’s Office also suffered severe criticism from two whistle-blowers testifying before the Veterans Affairs committee. Dr. Samuel Foote and Dr. Katherine Mitchell scolded the OIG for downplaying the causation and link between wait times and deaths.
“I would like to use this statement to comment on what I view as the foot-dragging, downplaying and, frankly, inadequacy of the Inspector General’s Office,” Foote said.

"Toxicity" - great name for a great little group. Good listen.

(This is mostly off-topic) "Toxicity" is unique and great listening. Three young women created a fantastic original sound and the coincidence of their name only adds to the enjoyment. Have some fun today - Take a listen...click and enjoy.

16 September 2014

Dr. Linda Schwartz, Former Flight Nurse, Confirmed as Assistant Secretary of Veterans Affairs!

VA Press Release: September 16 2014

From all who flew with her, our warmest congratulations!
 Veteran, Connecticut Veterans Commissioner, Nominated by President Obama in August 2013
Secretary of Veterans Affairs Robert A. McDonald today welcomed the confirmation of Connecticut Veterans Commissioner Linda S. Schwartz as Assistant Secretary of Veterans Affairs for Policy and Planning. 
In this post, Dr. Schwartz will help develop and review VA departmental policy, analyze Veteran trends and statistics, and evaluate VA transformation initiatives. She will play a critical role in guiding VA’s strategic planning and work to implement Secretary McDonald’s vision to transform VA into a nimble, high-performing and responsive organization.
“I welcome Dr. Schwartz to our leadership team,” said Secretary McDonald. “Based on her decades of devotion and hard work on behalf of Veterans and Veterans’ causes, I know she will have an immediate impact in the Agency’s continued mission of serving the great men and women who have proudly worn this Nation’s uniform.”
Dr. Schwartz, a disabled veteran, is currently the Commissioner of the Connecticut Department of Veterans Affairs, a position she has held since 2003.  She concurrently serves as an Associate Clinical Professor of Nursing at the Yale School of Nursing, where she has been on Faculty since 1999, and was appointed Associate Research Scientist and Scholar.  

From 1980 to 1993, she taught at several University and College Schools of Nursing and held leadership roles in nursing organizations in Connecticut.  From 1979 to 1980, she was a caseworker in the Office of the Field Director of the American Red Cross at Rhein-Main Air Base in Germany. 
Dr. Linda Schwartz
Dr. Schwartz also served in the United States Air Force (USAF) Nurse Corps from 1968 to 1986, both on Active Duty and as a Reservist. She retired as a Flight Nurse Instructor, with the rank of Major after sustaining injuries in a USAF aircraft accident.  

She received her Bachelors of Science degree in nursing from the University of Maryland School Of Nursing; a Master’s of Science degree from Yale University School of Nursing; and a Dr. PH from the Yale University School of Medicine.

13 September 2014

VA Invents (But Ignores) Rules About Agent Orange Exposure

Faced with disability claims from C-123 veterans exposed to Agent Orange aboard our former Agent Orange spray aircraft, officials in Veterans Health Administration and Veterans Benefits Administration have been energetic in barring veterans from essential health care. And also very selective about which rules VA follows, when they ignore those rules, and how to create new ones as the occasion warrants.

Not only does VA's Office of General Counsel and VHA Post Deployment Health create unscientific redefinitions of exposure to block exposure claims, but they simply ignore the law and their own rules and regulations. Of course, at some point, justice prevails and claims are appealed and corrected...but the veterans are forced wait years while somehow finding health care elsewhere. 

Here's how VA ignores the law and breaks the President's and the Secretary's promises to veterans, forcing vets into the black hole of appeals...three to four years waiting, with a 25% chance of the claim being approved (so far, all C-123 claim reaching BVA have won,) but a 45% chance of the claims having errors forcing the claim to be remanded for more work and still more delays by the regional office.

• "A veteran who was exposed to herbicides in service and who develops one of these diseases within the applicable presumption period, if any, is presumed to have incurred the disease in service, without the necessity of submitting proof of causation."    Testimony of Dr. Leo McCay, Deputy Secretary  IGNORED

• "Presumption of service connection. VA will presume service connection where a veteran who was exposed to an herbicide agent during active military service is diagnosed with a disease listed in paragraph (e) of this section that becomes manifest to a degree of 10 percent or more within the time period"      Federal Register July 27, 2004  IGNORED

• ‘‘Evaluation of studies relating to health effects of dioxin and radiation exposure."  38 C.F.R. 1.17 IGNORED!

• Finally, we wish to make clear that the presumptions of service connection provided by this rule will apply to any veteran who was exposed during service to the herbicides used in Vietnam, even if exposure occurred outside of Vietnam. A veteran who is not presumed to have been exposed to herbicides, but who is shown by evidence to have been exposed, is eligible for the presumption of service connection for the diseases listed in § 3.309(e), including the three diseases added by this rule.   VA announcement in Federal Register 31 August 2010.    IGNORED, and the reason VHA scrambled to create its redefinition of exposure to block exposure claims.

Does the VA even have the authority to order, and then evaluate, a IOM C-123 Agent Orange study addressing bioavailability, relative to veterans' benefits under the 1991 Agent Orange Act? 

No. C-123 veterans with proof of duty aboard "Patches" or any of the other former Agent Orange spray aircraft are fully eligible right now for presumptive service connection, and for treatment of those illnesses. Indeed, it will take a new law or regulation to disqualify them.

Instead, 38CFR spells out the procedures the VA should employ evaluating outside scientific studies about the association of herbicide exposure with different illnesses, but not of the fact of exposure or the paths by which exposure may occur.  (Chapter 1, Section 1.17 (c), p. 14) Nothing indicates any procedure by which exposure itself may be denied, defined or by which VA can require bioavailability. So VA decided to invent a basis denial and a redefinition to block claims. 

VA has a very aggressive defense, and very anti-veteran. VA seeks out, or simply creates, barriers to claims rather than permitting eligible veterans to receive care for hazardous service and injuries.

• Indeed, based on current statute, the VA is not required to consider evidence on exposure magnitude or duration and all exposures are to be given equal weight when determining health effects. There is no qualification for amount of exposure, bioavailability, color, flavor or even whether it makes one robust and improves the humors – the only qualifications are (1) proof of exposure and (2) a recognized AO illness. That foundation...exposure...is exactly why VHA and the VA Office of General Counsel simply redefined exposure to block claims. Other government agencies more correctly use the CDC definition, by which there is no question as to the C-123 veterans' eligibility. CDC says exposure is contact with a substance by swallowing, breathing, or touching the skin or eyes.     IGNORED

In meeting its pro-veteran, non-adversarial obligation, VA has failed. The Law:      IGNORED

(for background, read the Congressional Research Service "Presumptive Service Connection" report)

Army Times: VA Attorney Testifies on Board of Veterans Appeals Corruption

Army Times: September 10  By Leo Shane III 
Staff writer

A senior attorney at the Board of Veterans Appeals told lawmakers Wednesday that managers at the agency covered up delays in appeals processing and doctored records to protect their performance bonuses.

Lawmakers said they were dismayed not just at the allegations but how closely they echo earlier VA scandals of case manipulation and whistleblower retaliation that have been the source of months of oversight and criticism.

In testimony before the House Veterans’ Affairs Committee, Kelli Kordich, an Army veteran and 15-year employee at the board, described “corruption and blatant disregard for our nation’s veterans” and “a toxic management system that uses a culture of fear and intimidation to attain its goals.”

Leaders at the board denied the charges, saying lengthy delays in processing appeals — an average three year wait — are a result of the complexity of the issues involved and the increasing workload of the board.

But the allegations cast doubt on reports from the board that it’s processing cases at record rates, and represent more headaches for VA officials who are trying to restore public confidence in their work and data.

Kordich detailed problems with cases that sat on senior leaders’ desks awaiting final signatures for hundreds of days. When VA leadership was alerted to the problem, Kordich said, board officials changed records to cover up the wait times.

She also said lawyers were forced to rush through other appeals to help meet annual workload goals, possibly compromising veterans’ cases. And she claimed that when she brought the problems forward, she received retaliation in the form of reassignment to a windowless office with limited responsibilities.

Board of Appeals Executive in Charge Laura Eskenazi denied those charges, saying the problems stem from an increase in appeals and not mismanagement by senior officials. The board has processed more than 50,000 appeals so far this fiscal year, but Eskenazi said another 60,000 are still in the pipeline.

Rep. Mike Coffman, R-Colo., called the delays and allegations “alarming” and said he now questions if any data coming from the board can be trusted.

In recent months, VA employees have come before the committee to testify about manipulation of patient wait time data, claims backlog figures and performance bonus metrics.

New VA Secretary Bob McDonald has promised to have outside auditors review department record keeping practices and instill a veterans-centered culture at the department

12 September 2014

USAF Conceals All C-123 Agent Orange Exposure Information

Yesterday, in response to our suit in the US District Court of Washington DC, the Surgeon General of the Air Force determined which materials relating to C-123 Agent Orange exposures are to be publicly released.


Certainly, a loud echo of the 1996 memo from JAG attorneys in the USAF Office of Environmental Law which directed all C-123 Agent Orange information "be kept in official channels only."

In an action very unusual for involving a lieutenant general, he insisted AF would not release anything explaining his decision. VA recently did the same, releasing blank pages and withholding virtually everything.

You see our conundrum: The VA and the USAF say, without any basis, that C-123 vets were not exposed. Neither will explain anything about their research, references, correspondence, emails, staff contributors, reviews, approvals, reports, manuals, orders, regulations, notes, recordings, conclusions – all restricted from us, other than VA providing a contractor's selected monographs. 

The Air Force will not release any of its correspondence with VA, NIH, or CDC/ATSDR. ATSDR, like the others, continues to insist we were exposed and were harmed aboard our C-123s. Yet the Air Force has told Senator Burr its report was somehow "consistent" with ATSDR.

Exposed (CDC/ATSDR) is "consistent" with not exposed? (USAF)

What is the justification for any secrecy involving a 60-year old airplane, and our duties aboard it three to four decades ago? Since VA has decided in advance to refuse us care for our Agent Orange exposures, don't we have the right to insist they reveal completely their justification?

It seems neither agency is in tune with the President's executive order on transparency in government! The 2009 memo instructed federal officials "to make discretionary FOIA releases of documents that might be technically exempt from release (especially with respect to the "deliberative" b(5) exemption), to proactively post records of interest to the public, and to remove "unnecessary bureaucratic hurdles." General Travis somehow concluded the President did not include the military in his FOIA rule, and on his authority redacted virtually everything that might be relevant.

It is clear that DOD or VA place veterans ahead of whatever policy or hidden agenda they have regarding this problem of C-123 aircrew exposure.

Here's the ranking of federal agencies' FOIA compliance:

11 September 2014

VA "Cherry Picks" Scientific Definitions Against Veterans' Claims, Invents Others

It is right there for all to read, in three separate statements in the Federal Register, including rule making. VA assures Congress, the public and all veterans it will consider all non-Vietnam exposures to Agent Orange with the same presumptive service connection as it does with "boots on the ground" veterans. "No new legislation needed," says VA.

After all, the Federal Register is an agency's implementation of its own rules and procedures.

But faced with C-123 veterans' claims which VBA insists be denied, the VA Office of General Counsel threw an end run to nullify the Federal Register. VA OGC expects to redefine exposure to prevent exposure claims! VA will develop a unique redefinition of exposure, different than the one used by all other federal agencies such as ATSDR.

In concert with the Veterans Health Administration's Post Deployment Health Section, OGC has opted to challenge VA's own Federal Register postings...not by modification, but by redefinition of the word "exposure."

Presently, Post Deployment Health has invented its special redefinition to block C-123 veterans' Agent Orange exposure claims, stating: "Exposure = contamination field + bioavailability." No other definition of exposure used in science or medicine includes bioavailability as a component. Actually, these are separate toxicological terms.

Here is where creative and anti-veteran "cherry picking" takes place. Throughout its administrative documents, in the Federal Register, the Board of Veterans Appeals and even the United States Court of Appeals for Veterans Claims, VA cites Dorland's Medical Illustrated Dictionary (32nd Edition) in the Federal Register as well as in many other administrative documents. And Dorland's defines exposure as:                                                                        Nowhere is bioavailability mentioned or implied.

Get it? VA uses Dorland as the authority – but VA is just as happy to invent other creative, unscientific definitions as the need arises to better block veterans' claims. VBA even cites Dorland definitions against veterans in appeals, yet drops Dorland when Dorland's definitions enforce the veteran's claim.

Who is the client of VA's Office of General Counsel? Not the veterans!

10 September 2014

VA IG Report: "VA Managers Lied to Federal Investigators"

By Associated Press September 9 at 3:25 PM
"WASHINGTON — Managers at more than a dozen Veterans Affairs medical facilities lied to federal investigators about scheduling practices and other issues, the department’s inspector general said Tuesday. (Altogether, nearly 50% of VHA management lied to federal investigators, which is a crime.)

Richard Griffin, the VA’s acting inspector general, said his office is investigating allegations of wrongdoing at 93 VA sites across the country, including 12 reports that have been completed and submitted to the VA for review."

That was the bad news from September 9. It shows the breakdown of integrity at the VA's Veterans Health Administration. It leaves veterans convinced that Post Deployment Health and VA National Center for Ethics in Heathcare, both components of the Veterans Health Administration, cannot avoid sharing in this scandal. 

For Post Deployment Health, the failure is their dedication and creativity in obstructing veterans' exposure claims, even in the face of "as likely as not" medical and scientific evidence. The result of their actions has been the denial of VA medical care to an unknown number of post-Vietnam C-123 veterans.  

For VA's National Center for Ethics in Healthcare, their failure is avoiding action on ethical concerns brought to them regarding patient privacy and other issues. Instead of careful investigation in line with their mission statement, their response was to defer concerns to VA's IG which the Center knew had no jurisdiction, or other buck-passing non-solutions.

Other VA agencies have also failed veterans. VBA's Compensation and Pension Service failed Secretary Shinseki by drafting a crafty, disingenuous and error-ridden response to Senator Burr's C-123 inquiry. This is a perfect example of what General Shinseki meant by trusting in the honor and integrity of those helping him meet the needs of America's veterans.

For VA's Office of General Counsel, their failure is willingness to support Post Deployment Health in obstructing veterans' exposure claims by seizing non-existent authority to redefine fundamental scientific and toxicological terms. OGC, rather than guiding the Department in using the breadth of law and regulation to include veterans, instead created barriers to exclude otherwise eligible veterans. Responding to the Yale Law School brief on C-123 veterans, OGC attacked rather than welcomed legal research and scholarly confirmation of the veterans' eligibility for VA care.

For Veterans Benefits Administration Compensation and Pension Service, their failure is also obstructing eligible veterans' claims for exposure care. From preventing input to the JSRRC body of knowledge, from denying claims on the basis that TCDD (a known carcinogen) is harmless, to refusing to accept scientific and medical input supporting veterans' disability claims, Compensation and Pension has faithfully kept in step with VHA's insistence that "We cannot permit C-123 claims." Faced with scientific argument supporting C-123 veterans' exposure claims, VBA instead contracted for $600,000 to create obstruction and confusion, and also failed to follow its own regulations and honor commitments published in the Federal Register.

09 September 2014

1979: DOD Informed VA C-123 Aircraft Contaminated, Crews & Mechanics "At Risk"

The Department of Defense has always worked closely with the Department of Veterans Affairs, with both agencies concerned about the rising number of veterans' claims for illnesses associated with Vietnam service from the earliest days. Both agencies wanted to both understand the medical situation facing the vets, and avoid approving disability claims soon associated with Agent Orange.

Well into the 1980s, VA encouraged its physicians to classify veterans' complaints for these mysterious maladies as psychiatric illnesses. This both resolved the question as to how to classify the vet and also made many veterans, afraid of the stigma of a mental illness allegation, shy away from pursuing any claims.

Many veterans bought the story, and believed they needed to simply man up to their "imagined" illnesses. Pretending away real-world cancers, heart disease and other physical problems is certainly a path leading to mental illness, and it took decades for VA to do a mind-shift to better science.

A large part of VA's resolution to block pre-1991 claims, to pretend as an agency that no illnesses were associated with Agent Orange, were DOD reports that none of the Vietnam veterans were exposed, other than Ranch Hand and others who'd handled liquid Agent Orange. A principal such report from VA to DOD was dated 12 December 1979, and titled "Criteria for Estimating Exposure Levels of Military Personnel to Dioxin and Herbicide Orange During the Vietnam War."

Post-Vietnam C-123 veterans will be interested in the report's details of mechanics being among those acknowledged to be exposed to Agent Orange,  along with crews flying contaminated former Ranch Hand airplanes. This is a very telling statement with meaning for us today: The Air Force acknowledged both the contamination of the aircraft and the exposure to both mechanics and aircrews flying former spray planes. because once C-123 veterans began seeking VA disability coverage, the Air Force quickly changed its claim and denied both.

Please see the point: The 1979 investigation showed aircraft remained contaminated after spraying Agent Orange, and mechanics and aircrews were exposed. With the first C-123 vets' exposure claims in 2011, both VA and USAF immediately reversed themselves, preventing all C-123 veteans' claims. This was done by VBA on input from VHA Post Deployment Health which predetermined that none of the veterans were exposed, and that VA "could not permit C-123 veterans' claims." (VHA statement to Army Major Terry Rudd.) Apparently written promises by the Secretary and Under Secretary Hickey that "all claims will be considered on a case-by-case basis" were strictly for show – in fact, VBA simply ordered all C-123 claims denied.

In 2006, DOD cooperated with the Department of Veterans Affairs once again, this time by producing a selected list of Agent Orange sites outside Vietnam. Titled, "The History of the US Department of Defense Programs for the Testing, Evaluation, and Storage of Tactical Herbicides," Battelle and its subcontractor chose certain locations where "tactual herbicides" as defoliants such as Agent Orange became known, listing them for submission to the DOD and from DOD to the Department of Veterans Affairs.

Although comprehensive, including even little-known sites such as Van Nuys, California, the DOD isn't perfect. The lack of perfection is a fatal blow...literally, not figuratively to many veterans who've found themselves in locations which Battelle opted to leave off their list, or which became known after 2006 only to find DOD reluctant to consider any additions.

Why such importance to veterans? Because unless an Herbicide Orange claim is from "boots on the ground" Vietnam vets, or from vets whose claims for exposure are substantiated by this DOD list, VA refuses to acknowledge the exposure and denies the claim. VA simply cites the DOD list as the sole authority. A related agency, the Joint Services Records Research Center, is often sought out by VA for validation of exposure claims, however JSRRC often refers to the same DOD list.

Why is all of this of such importance to C-123 veterans? Because DOD has refused list C-123s formerly used for spraying Agent Orange during the Vietnam War as part of Operation Ranch Hand. Air Force testing established the contamination of many aircraft at many times during the decades after Vietnam.

DOD, however, has twice refused formal requests to retrospectively add the already-destroyed C-123s to its list. Lieutenant General J. Fedder (Deputy Chief of Staff for Logistics, Installations and Mission Support) has refused veterans appeals to consider placing on the those C-123s with tail numbers identifying their Vietnam spray history.

DOD has also denied a formal Inspector General complaint regarding General Fedder's decision to block the C-123 addition. There the DOD list concern rests for the moment, but the discovery of the 1979 DOD exposure criteria report helps, if only to show that both DOD and VA change their stories as necessary to prevent C-123 exposure claims.

VA and DOD? So far, a win-win situation for them, with but a single C-123 veteran's claim accepted.
C-123 veterans: We place great hope in the IOM process, although we realize that VA has already stacked that deck, also. They generated reports to their liking, had an expert speaker present their interests to the committee have a full, talented staff dedicated to opposing vets' claims, and also were able to select the wording for the "charge" given the IOM committee.

Veterans service organizations were surprised to see VA submit a charge to the committee, and then vigorously oppose the veterans rather than assume the required non-adversarial role.

"I'm Bob." Secretary McDonald Briefs the Rebuilding of VA

06 September 2014

Korea's Vietnam Veterans' Agent Orange Exposure Study Released 9/5/2014

International Journal of Epidemiology, 09/05/2014  Clinical Article:

Yi SW, et al. – Agent Orange (AO) was a mixture of phenoxy herbicides, containing several dioxin impurities including 2,3,7,8–tetrachlorodibenzo–p–dioxin (TCDD). In this study, the authors aim was to identify the assoc . iations between the AO exposure and mortality in Korean Vietnam veterans. This study suggests that AO/TCDD exposure may account for mortality from various diseases even several decades after exposure

Note: in 2013 Dr Mark Garzotto, a physician researcher at the Portland VA Hospital and Oregon Health Sciences University, published research in the journal Cancer showing that Agent Orange-exposed veterans (assuming Agent Orange to be the source) had twice the rate of highly aggressive prostate cancers. Dr. Garzotto was my treating physician at the Portland VA hospital and he associated my own cancer wtth C-123 exposures

Comments from a VA Agent Orange consultant:The difficulty for the Koreans is that 350,000 men served over a seven year period in II Corps and their philosophy was to work closely with the Vietnamese (probably more successful than either other nation in Vietnamization). The use of defoliants and crop denial efforts were strongly rejected by the Koreans in their tactical area of responsibility in II Corps. 
Thus, there was only limited use of tactical herbicides, some sprayed by the Korean Chemical Corps, but most of the little amount sprayed was by our Chemical Corps or in some cases RANCH HAND. The analytical studies for TCDD were essential the same for Korean veterans who had served in Vietnam, as for Korean veterans who served the homeland. The present study uses the criteria of our IOM and their acceptance of  the same associated diseases.  Such Mortality studies do not establish cause and effect, hence, their statement "suggests" that AO/TCDD exposure may account for mortality from various associated diseases.

VA Cites VA Researcher's 2013 Agent Orange-Prostate Cancer Study But Not Acceptable for Claims

When I was first diagnosed with prostate cancer, my oncologist was Dr. Mark Garzotto of the Portland VA Medical Center's Urology Oncology service. With his co-authors, Dr. Garzotto's article in the prestigious Cancer journal from the American Cancer Society revealed the disturbing conclusion that Agent Orange-exposed veterans are twice as likely to suffer highly aggressive forms of prostate cancer than vets without such exposures.

Dr. Garzotto provided his medical opinion that my own prostate cancer is, more likely than not, associated with Agent Orange exposure aboard the C-123s.

Dr. Garzotto's opinion in support of my claim for service connection has been dismissed by Portland VA Compensation & Pension as unqualified input because VAROs are directed by VBA to deny all C-123 claims.

VA respects Dr. Garzotto's findings about Agent Orange and prostate cancer, but disregards his medical finding about me as a patient under his care. Surpisingly, VA recently cited Dr. Garzotto's article on their web site and wrote:

 Research on prostate cancer and herbicides  
"The Institute of Medicine (IOM) of the National Academy of Sciences concluded in its 1996 report Veterans and Agent Orange: Update 1996 and in future updates that there is limited/suggestive evidence of a positive association between prostate cancer and exposure to herbicides used in Vietnam. 
A 2013 study conducted at the Portland VA Medical Center and Oregon Health and Science University found that Veterans exposed to Agent Orange are not only at higher risk for prostate cancer, but they are more likely to have aggressive forms of the disease. Read the abstract for the publication, Agent Orange as a risk factor for high-grade prostate cancer. View more research on health effects of Agent Orange."
- See more at: http://www.publichealth.va.gov/exposures/agentorange/conditions/prostate_cancer.asp#sthash.RM5zHRwG.dpuf

05 September 2014

Congress to Grill VA on Disability Claims Appeal Process

Sep 05, 2014 | by Bryant Jordan to military.com

Congress will meet with Veterans Affairs Department officials next week to demand answers on how the agency is handling appeals filed by veterans whose compensation claims were denied. The focus on the Board of Veterans Appeals comes as the VA works at restoring trust to a department seriously shaken by confirmed reports of secret wait lists, systemic manipulation of patient data and instances of veterans dying before getting to see a doctor.

Rep. Mike Coffman, R-Colorado, told Military.com on Friday that the VA's problems go beyond the Veterans Health Administration.

"It is imperative that Americans understand that the culture of corruption within the VA expands far beyond patient wait times and I have serious concerns about the mismanagement in the Board of Veterans Appeals process," he said.

Coffman said the VA needs to "ensure a veteran's appeal claim is processed expeditiously and accurately so they receive the care they need and deserve."

Much of the attention on a disability claims backlog over the past four years has been on first-time applications, which exploded in part because hundreds of thousands of Vietnam veterans who were able to file for a number of illnesses finally recognized as linked to their service. Additionally, veterans of the Iraq and Afghanistan wars, when they did file a claim, generally filed for multiple conditions, VA officials have said.

Former VA Secretary Eric Shinseki determined early on in his tenure that a claim not acted on within 125 days of being submitted was part of a backlog. As recently as a year ago, the backlog was more than 600,000 claims. The backlog has since dropped to below 300,000 and is on schedule to be eliminated next year.

But appealed claims – those submitted if the initial one was denied or if the veteran sought an increased rating or additional benefit – also grew.

There are now more than 250,000 of those claims before the Board of Appeals. These may take an average of four years to decide, said Glenn Bergmann, a former VA lawyer who now represents veterans seeking compensation from the department.

Some veterans as well as lawmakers have accused the VA of reducing its backlog of initial claims by denying them, getting them off the backlog but forcing the veteran to file an appeal. Some veterans have also slammed the VA's slow processing of and denial of claims as intended to wait for the veteran to die.

Coffman said the Sept. 10 hearing will address those wait time concerns for veterans with a claims appeal.

"The purpose of this hearing is to address problems occurring at VA's Board of Veterans' Appeals ... related to various forms of data manipulation," he said. "It will address the excessive delays in processing claims and the various methods used to shift cases around in order to hide the amount of time cases are sitting without being processed or [adjudicated]."

Secretary's Promise to Veterans of All Conflicts

We will not let our Veterans languish without hope for service-connected disabilities resulting from their service. (then-Secretary Shinseki, August 2010)

C-123 veterans have not only been "languishing," but have been actively opposed in our seeking medical care for proven exposures. ("We cannot permit C-123 claims." "We have to draw the line somewhere." - VA Public Health Post Deployment Health)

VA has even redefined exposure to its own purposes to prevent exposure claims, and disregarded obligations repeated three times in the Federal Register to treat all veterans exposed to military herbicides with presumptive service connection.

Secretary of Veterans Affairs: "Agent Orange and Vets: A 40-Year Wait

Agent Orange and Veterans: A 40-Year Wait (first published August 30, 2010.) The Secretary states VA policy about Agent Orange being harmful, a position now disputed by VA consultants and by Veterans Health Administration.

Secretary Eric K. Shinseki
August 30, 2010

With the unwavering support of President Obama, VA is transforming to meet its 21st Century responsibilities.  Advocacy, on behalf of every generation of Veterans, is central to this transformation.

Agent Orange was a blend of herbicides used by the U.S. military, during the Vietnam conflict, to deny concealment to enemy forces.  More than 19 million gallons of herbicides were sprayed to remove foliage and undergrowth.  The most common, Agent Orange, was sprayed in all four military zones of South Vietnam.

Heavily sprayed areas included the inland forests near the Demilitarized Zone; inland forests at the junction of the borders of Cambodia, Laos, and South Vietnam; inland forests north and northwest of Saigon; mangrove forests on the southernmost peninsula of Vietnam; and mangrove forests along major shipping channels southeast of Saigon.

The issue of Agent Orange’s toxic effects on Veterans, who served in Vietnam, has simmered for decades.  Its insidious impact on those exposed to it has become increasingly apparent. (emphasis added) That growing awareness has resulted in the Congress’, this Department’s, and the Institute of Medicine’s previous validations of some 12 diseases, which, to date, have been granted presumption of service connection for those exposed to Agent Orange.

Last October, based on the requirements of the Agent Orange Act of 1991 and the Institute of Medicine’s report, “Veterans and Agent Orange: Update 2008,” I determined that the evidence provided was sufficient to support presumptions of service connection for three additional diseases: Parkinson’s Disease, Hairy Cell and other Chronic B-Cell Leukemia, and Ischemic Heart Disease.  After a public rulemaking process, we are now issuing a final regulation creating these new presumptions.

This action means that Veterans who were exposed to herbicides in service and who suffer from one of the “presumed” illnesses do not have to prove an association between their medical problems and their military service.  This action helps Veterans to overcome the evidentiary requirements that might otherwise make it difficult for them to establish such an association in order to qualify for healthcare and other benefits needed as a result of their diseases.  The “Presumption” simplifies and accelerates the application process and ensures that Veterans will receive the benefits they deserve.

As many as 150,000 Veterans may submit Agent Orange claims in the next 12 to 18 months. Additionally, VA will review approximately 90,000 previously denied claims from Vietnam Veterans for service connection for these three new diseases. All those who are awarded service-connection, and who are not currently enrolled in the VA health care system, will become eligible for enrollment.

Veterans who served in the Republic of Vietnam, including its inland waterways, between January 9, 1962 and May 7, 1975, are presumed to have been exposed to herbicides.  If you know a Veteran who may have been exposed to herbicides in service and who suffers from one of the diseases that may be presumptively service connected, the Veteran or the Veteran's family can visit our website to find out how to file a claim for presumptive conditions related to herbicide exposure, as well as what information is needed by VA to determine disability compensation or survivors’ benefits.  Additionally, VA’s Office of Public Health can answer questions about Agent Orange and VA’s services for Veterans exposed to it. (blogger: Actually, they construct redefinitions of exposure to prevent exposure claims.)

This rule is long overdue.  It delivers justice to those who have suffered from Agent Orange’s toxic effects for 40 years.  I have been invited to testify before the Senate Veterans Affairs Committee on 23 September to explain these decisions, and I am happy to do that.  It was the right decision, and the President and I are proud to finally provide this group of Veterans the care and benefits they have long deserved.

VA is committed to addressing the health care needs of Veterans from all eras.  Forty years from today, a future Secretary of VA should not be adjudicating presumptive disabilities associated with our current conflicts.  Change is difficult for any good organization, but we are transforming this Department to advocate for Veterans.  We will not let our Veterans languish without hope for service-connected disabilities resulting from their service.

VA Has a Penchant for Denial

However, the VA has taken an official position that there is no evidence of any long-term problems associated with these incidences. The laissez faire opinion from the VA shows a shocking lack of respect for the issue itself, let alone the disturbing disregard for our veterans.

During Vietnam, soldiers were informed that Agent Orange was safe. The truths about Agent Orange are still being revealed today, even after 51 years of the war’s ending. Our veterans, their children, and the Vietnamese people have suffered from cancers to physical deformities.

Ironically, the VA does acknowledge that, “Veterans who were closer to burn pit smoke or exposed for longer periods may be at greater risk. Health effects depend on a number of other factors, such as the kind of waste being burned and wind direction.”
Eric K. Shinseki was Secretary  of Veterans Affairs until replaced by Secretary McDonald

REVIEWS: The History, Use, Disposition and Environmental Fate of Agent Orange

Following is a 2010 review of a text addressing Agent Orange and its use during the Vietnam War, and the public policies which followed the veterans complaints. Dr. Young is a frequent contributor to numerous journals, has published several books, is a court-recognized expert witness on Agent Orange, and is a consultant to the Department of Veterans Affairs on the subject of post-Vietnam Agent Orange issues. Both he and Dr. Jeanne Stellman, co-author of this review, also contributed to the current C-123 study being conducted by the Institute of Medicine. Dr. Young's perspective is that C-123 veterans were neither exposed nor harmed, while Dr. Stellman's perspective is that exposure and harm were both likely. This review was published in Environmental Health Perspectives. Dr. Young's book is available at Amazon and other sources.

The History, Use, Disposition and Environmental Fate of Agent Orange

By Alvin L. Young, PhD (Colonel, USAF Retired)
New York: Springer, 2009. 339 pp. 
ISBN: 978-0-387-87485-2, $99

It has been nearly 50 years since the United States initiated a military operation that sprayed approximately 20 million gallons of phenoxy herbicides and arsenicals on South Vietnam including Agent Orange, a formulation that was contaminated with dioxin.

Alvin Young has been a major player in measuring and monitoring these herbicides since the 1960s. Retired from the Air Force (AF) and now receiving support from the herbicide manufacturers Dow and Monsanto, Young remains a governmental spokesman in post-conflict remediation dealings with Vietnam. His “new” book on the issue—actually, a largely unacknowledged compilation of his and others’ writing and research—contains some valuable information. This value though, must be weighed against a number of serious deficiencies in scholarship.

Young’s book contains a gold mine of data on the herbicides, some of which have been out of public view until now. But caveat emptor: Page after page of text and many illustrations and photographs are taken directly from Young’s prior publications without proper citation. There are also many lengthy direct quotations from other authors that appear without quotation marks or indents. Setting aside issues of copyright, the difficulty for users who wish to cite this book’s contents will be the absolute requirement of locating all references to distinguish original from reproduced text.

A second caveat: Many quotations are taken out of context, emphasis has been added without acknowledgement, and other authors’ work has in some cases been misinterpreted. For example, Major General John Murray—who evaluated military records aspects of the now abandoned Agent Orange Study—is quoted as seeming to urge abandonment of all military records–based studies with Young’s emphasis-added, capitalized, and boldfaced “NOT.”

A check in the source material, though, will show that Murray’s very next sentence reads “It is, of course, understood that eight (8) other studies which require determinations of the likelihood of Agent Orange exposure conducted by the Veterans Administration and for which the Joint Services Environmental Support Group will provide exposure determinations and military record abstractions will rigorously continue” (Murray JE. 1986. Report to the White House Agent Orange Working Group Science Subpanel on Exposure Assessment. Washington DC: Office of Science and Technology Policy).

Palmer’s work is cited as supporting the notion that science cannot contribute to understanding health effects of Agent Orange, because there are too many “quality of life issues.” A check of source material (Palmer MG. 2005. The Legacy of Agent Orange: Empirical Evidence from Central Vietnam. Soc Sci Med 60:1061–1070) reveals that Palmer did not say this; further, the year of his paper is incorrectly cited. More recently, Young has proposed a new theory to support his contention that no U.S. troops were directly sprayed upon.

He asserts that because there were no reports of U.S. casualties resulting from attacks by the fighter planes that escorted the spray planes, no troops could have been in harm’s way, and he cites Flanagan, a retired AF pilot who wrote of his varied experiences in Vietnam. In fact, Flanagan’s description of a spray mission disparages the Army recordkeeping on which Young relies: “Failure was never recognized … friendly casualties could be failures, but they, too, were never identified” (Flanagan JF.1992. Vietnam Above The Treetops: A Forward Air Controller Reports. New York: Praeger)

In the interest of full disclosure, Young describes our methodology for updating and correcting herbicide spray records as demonstrating a “woeful lack of understanding” of AF reporting procedures. We must point out in response that our work (Stellman JM, Stellman SD. 2003. Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Final Report. Washington, DC: National Academies Press) was performed in collaboration with the persons at the Department of Defense (DoD) who were the most knowledgeable about these procedures—the Center for Research on Unit Records—and co-authored by Col. Christian (retired), former director of the DoD Joint  Services Environmental Support Group. Young discounts the ability of spray plane navigators to know where they were or pilots to accurately spray their targets—thereby dismissing the utility of the voluminous spray records available, despite much evidence to the contrary.

Some assertions in the book either are disingenuous or contradict Young’s earlier work. Young rationalizes in this book that the omission of maximum dioxin contaminant levels from the military specifications for herbicide quality occurred because not enough was known and measurement was difficult; but two decades ago his edited volume stated that “the manufacturers of trichlorophenol and of 2,4,5-T had been aware for many years that this class of compounds and particularly their impurities produced a toxic reaction in humans … the same manufacturers had developed, as early as 1941, a … bioassay … to monitor the production of the herbicide” (Young AL, Reggiani GM. 1988. Agent Orange and Its Associated Dioxin: Assessment of a Controversy. New York:Elsevier).

Indeed, in 1965 Dow Chemical Company’s V.K. Rowe convened a highly unusual meeting of his toxicology counterparts from competitor companies to warn that the herbicide was dangerous and that processes  needed cleaning up. Dow closed down and rebuilt its own feedstock operations to manage the problem. The military specifications never once mentioned dioxin for the duration of the war.

Science also seems to have ended in the 1970s and early 1980s for Young. Johnston Island, the final resting place for Agent Orange before its incineration at sea, had no important problems in 1978
according to Young. However, a 1986 AF reassessment found marine biota with up to 472 ppb dioxin, subsoil with 510 ppb dioxin, and 682,247 ppb of 2,4,5-T (Huse G, et al. 1991. Preliminary Public Health, Environmental Risk, and Data Requirements Assessment for the Herbicide Orange Storage Site at Johnston Island. Brooks Air Force Base, TX: Occupational and Environmental Health Directorate).

Finally, how very much beside the point is the book’s quibbling about whether spray estimates differ by a few percent? Here we are in 2010, some 38 years since the last spray mission overflew hamlets and fields of our ally, the South Vietnamese, and we still cannot answer these questions: Were there health consequences? Just how many “hot spots” are there? Were veterans who served in heavily sprayed areas more likely to contract illnesses than those who did not? Are there adverse effects among the people of Gulfport, Mississippi, through which millions of gallons passed, too much of it in leaky barrels? The Institute of Medicine, the editors of Nature, Congress, and many others have repeatedly requested that studies be done—to no avail.

These are profoundly important questions still awaiting an answer. Young contends that science is being “filtered” through the public’s confused perceptions. But while some confusion may exist, the predominant sentiment is dismay. If there is one thing that this compendium of reprinted materials shows us, it is that there is a wealth of data that can be used to answer the many open environmental questions.

Jeanne M Stellman is Professor Emerita, Mailman School of Public Health, Columbia University. She was principal investigator of a major National Academy of Sciences project to develop exposure methodologies for military herbicides used in Vietnam. She is a Guggenheim fellow and Editor-in-Chief, ILO Encyclopaedia of  Occupational Health and Safety (4th ed). She is currently a professor at SUNY Downstate Medical Center, Brooklyn, New York.
Steven D. Stellman is Professor of Clinical Epidemiology, Mailman School of Public Health, Columbia University. He holds a doctorate in physical chemistry.

This is a summary from Springer:

For almost four decades, controversy has surrounded the tactical use of herbicides in Southeast Asia by the United States military.  Few environmental or occupational health issues have received the sustained international attention that has been focused on Agent Orange, the major tactical herbicide deployed in Southern Vietnam.  With the opening and establishment of normal relations between the United States and the Socialist Republic of Vietnam in 1995, the time has come for a thorough re-examination of the military use of Agent Orange and other "tactical herbicides" in Southern Vietnam, and the subsequent actions that have been taking place since their use in Vietnam.

The United States Department of Defense has had the major role in all military operations involving the use of tactical herbicides, including that of Agent Orange.  This included the Department's purchase, shipment and tactical use of herbicides in Vietnam, its role in the disposition of Agent Orange after Vietnam, its role in conducting long-term epidemiological investigations of the men of Operation RANCH HAND, and its sponsorship of ecological and environmental fate studies.  This book was commissioned by The Office of the Deputy Under Secretary of Defense (Installations and Environment) with the intent of providing documentation of the knowledge on the history, use, disposition and environmental fate of Agent Orange and its associated dioxin.

And a review:

“This book is a distillation of thousands of pages of written government and scientific documents, oral histories, spraying records, medical records, and pictures and is organized into eight chapters … . Young presents a dispassionate review, a feat difficult for anyone who touches this sensitive topic and especially laudable for an author who has devoted a major portion of his professional career to the subject over 40 years. … Thank you, Dr. Young, for this much-needed book.”­­­ (Mitchell D. Erickson, Environmental Sciences and Pollution Research, Vol. 17, March, 2010)

04 September 2014

VVA Leadership Brings Vietnam-Era Discharge Reviews for PTSD

Thanks to the leadership of the Vietnam Veterans of America, and their compassionate embrace of all veterans of the Vietnam-era with less-than-honorable discharges, justice seems just around the corner! From the New York Times.
Thousands of Vietnam-era veterans barred from receiving benefits because of less-than-honorable discharges may be eligible for upgrades under a new set of guidelines released by the Defense Department on Wednesday.
The new rules offer the first guidance to military discharge review boards on how to address post-traumatic stress disorder. Many experts and veterans’ advocates assert that the disorder may have contributed to misconduct by veterans who were later kicked out of the military and stripped of benefits.
The guidelines call on the independent boards that review petitions from veterans seeking upgrades to give “liberal consideration” to any symptoms of PTSD now or at the time of the veterans’ discharge, and “special consideration” to findings of PTSD by the Veterans Affairs Department. In a statement, Defense Secretary Chuck Hagel said the guidelines were intended to create “fair and consistent results in these difficult cases.”
“This is our responsibility and the right thing to do for veterans,” said Mr. Hagel, a former Army infantry sergeant who was wounded in Vietnam. “This new guidance reflects our commitment to those who served our country during times of war many decades ago.”
The announcement comes in the wake of a class-action lawsuit filed in federal court by a group of Vietnam veterans and the advocacy group Vietnam Veterans of America, alleging that the military systematically denied applications for upgrades involving PTSD.
The lawsuit estimated that 250,000 Vietnam-era veterans had received other-than-honorable discharges, and that up to 80,000 of them may have had PTSD.
“This is a long-overdue recognition for a wound of war that was denied for decades,” said Jennifer McTiernan, a Yale Law School student who helped file the suit as part of the school’s Veterans Legal Services Clinic.
The suit will still go forward, Ms. McTiernan said, because it is unclear how the new policy will be carried out. “We’re optimistic, but we’ve seen as far from ‘liberal’ as you can imagine,” she said.
Under the new rules, veterans applying for an upgrade will have to show that they had symptoms of PTSD at the time of their misconduct, that the PTSD was related to military service, and that it contributed to their less-than-honorable discharge. Veterans with so-called “bad paper” are ineligible for education, disability and housing benefits, and are sometimes barred from Veterans Affairs health care.
In the past, veterans say, review boards have been hesitant to upgrade discharges based on claims of PTSD.
Conley F. Monk Jr., one of the veterans named in the lawsuit, served in Vietnam in 1969 and came under enemy fire almost daily, he said. He was given an other-than-honorable discharge in 1971 for fighting and drug use that he said was caused by PTSD.
The same year, the Veterans Affairs Department denied him benefits, citing his discharge.
Though the department has long recognized PTSD’s contributions to substance abuse and other misconduct in veterans, Mr. Monk said the Naval Discharge Review Board that ruled on his case last month did not.
“I had two psychiatrists, one from Yale, one from the V.A., both saying what happened was PTSD,” Mr. Monk said. “The board just said the doctors didn’t know what they were talking about.”
The new guidelines urge boards to listen to doctors, but to “exercise caution” in cases of serious misconduct, especially any crimes involving premeditation.
It is unclear whether the guidelines will lead to an increase in upgrades. But if they do, it could mean a windfall for veterans long denied benefits. A spokeswoman for the department said those veterans would be eligible for benefits dating back to their first denied claim.
For Mr. Monk, that would be 1971.
“I just pray they give us a chance,” he said. “We deserved to be treated fairly, and it never happened.”

01 September 2014

Bill Gifford Passed, September 1, 2014

William Gifford, fellow veteran of the 74th Aeromedical Evacuation Squadron, Westover AFB, Massachusetts, passed away today at Baystate Medical following heart surgeries. He'd not done well this last week, losing kidney function and he "signed the final Form 40" this morning.

Giff was a flight instructor on the C-123. What a character and what a squadron legend!

Steve Caraker will send details when available. God bless and keep Bill and his family.

Our Blog – Disrespectful? Let's Hope Not!

 Carter Blog: "Truth cannot be found, only exaggeration, misinformation and propaganda?"   
Having been challenged to do so, I'm thinking through my blog perspective and re-reading the entries. A suggestion was made that I'd not had respectful comments regarding one individual, perhaps even more.

Obviously we have a pro-veteran perspective here, trying to argue the eligibility of post-Vietnam C-123 veterans' VA Agent Orange exposure benefits. The VA, its consultant, both Dow and Monsanto, and perhaps other veterans with different views argue otherwise...and that's the perfect system for civil discourse. We believe we're right, as do so many scientists, physicians, legal scholars and other federal agencies who've spoken up for us.

Our opponents have the advantage of experience, unrestricted access to VA and AF documentation, greater scientific understanding, federal funding, the opportunity to carefully word the charge to the IOM, and the final decision-making authority.

We do not argue any science, not having the qualifications for that, but we do try to put forward the various ways in which we believe ourselves eligible through the opinions of others such as the CDC/ATSDR and NIH. At time, this means that we say our opponents are wrong on an issue, or fail to interpret issues in a pro-veteran, pro-claimant manner as required by law,  or seek to implement unofficial policy or personal agendas rather than help us.

Each side has stated its objectives. VA: "We cannot permit any C-123 claims." (VHA.) And, "C-123 veterans have been subjected to long-term/low intensity AO exposure and are due care for Agent Orange-recognized illnesses." (Wes Carter.)

So once again, I'll ask for comments, corrections, anything. If I have erred in facts, I'd like to correct those facts because otherwise the value of our entire effort is diminished. If I have erred in a more subtle way, perhaps over-emphasis or sarcasm, I welcome suggestions for improvement there as well.

The fact does remain, however, that VA and its consultant actively oppose every argument we put forward. We have never had a helping hand offered us, other than three quite polite conferences at which we were told none of our claims would ever be approved. Great sums have been spent by VA to insure our claims remain denied and to influence the IOM report. Our requests for VA assistance in research are all denied, and VA even recently reserved the right to redefine "exposure" to prevent exposure claims such as ours.

Of course, VA personnel and their contractor have always been very courteous, but courtesy does not make up for locking VA hospital doors against us.

We've been asked by VA's contractor, what's our agenda? Simple...we'd like our illnesses associated with Agent Orange exposure to be treated. Until such time as the law changes, we're eligible for this care and the decision to withhold it is wrong.

I trust this entry, at least, is not "exaggeration, misinformation or propaganda."