23 March 2012

Agent Orange 101 - the stuff you gotta know

Agent Orange FAQ 

What is Agent Orange?

Agent Orange was a herbicide, or defoliant, which was used in Vietnam to kill unwanted plant life and to remove leaves from trees which otherwise provided cover for the enemy. Agent Orange was a mixture of chemicals containing equal amounts of the two active ingredients, 2,4-D and 2,4,5-T (or TCDD). The name, "Agent Orange," came from the orange stripe on the 55-gallon drums in which it was stored. Other military herbicides, including Agent Purple, Agent White, and Agent Blue, were also used in Vietnam to a much lesser extent. Agent Orange and other herbicides used in Vietnam were tested or stored elsewhere, including, many military bases in the United States. Further, the C-123K (in the UC-123K version) remained contaminated with dioxin during the years it was flown until finally retired.

When and where was Agent Orange used in Vietnam?

Fifteen different herbicides were shipped to and used in Vietnam between January 1961 and 1971. Agent Orange accounted for over most of the herbicides sprayed in Vietnam. Agent Orange was used between January 1965 and April 1970. Herbicides other than Agent Orange were used in Vietnam prior to 1965, but to a very limited extent. However, a study released in April 2003 found that while relatively small amounts of highly dioxin-contaminated Agents Purple and Pink were sprayed in the early 1960s, these agents might have deposited a relatively large percentage of the total dioxin. The total area sprayed with herbicides between 1962 and 1965 was small, less than 7 percent of the total acreage sprayed during the Vietnam conflict. Rapid increases in the annual number of acres sprayed occurred from 1962 to 1967. The number of acres sprayed reached a maximum in 1967, leveled off slightly in 1968 and 1969, and declined rapidly in 1970 prior to the termination of spraying in 1971. During this time more than 19 million gallons of herbicides were sprayed over 6 million acres, some of which were sprayed more than once. More than 3.5 million acres of South Vietnam approximately 8.5 percent of the country were sprayed one or more time. Spraying occurred in all 4 military zones of Vietnam. Certain bases, such as Phu Cat, had especially heavy contamination.
Heavily sprayed areas included inland forests near the demarcation 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. Crop destruction missions were concentrated in northern and eastern central areas of South Vietnam.

Why are veterans concerned about Agent Orange?

In the 1970's some veterans became concerned that exposure to Agent Orange might cause delayed health effects. One of the chemicals (2,4,5-T) in Agent Orange contained minute traces of 2,3,7,8-tetrachlorodibenzo-p-dioxin (also known as TCDD or dioxin), which has caused a variety of illnesses in laboratory animals. More recent studies have suggested that the chemical may be related to a number of malignancies and other disorders. Several university studies, and the CDC/Agency for Toxic Substances and Disease Registry, have concluded C-123K aircraft were contaminated (a requirement for VA benefits) and the crews exposed therein (another requirement of the VA.)

What should concerned veterans do?

In 1978, the Veterans Administration, now the Department of Veterans Affairs (VA), set up a special examination program for Vietnam veterans who were worried about the long-term health effects of exposure to Agent Orange. This was as a result of a persistent VA employee in Chicago who realized the TCDD connection, and Mr. Bill Kurtis of CBS News who broke the story. Vietnam veterans and others who believe they've been exposed can participate in the Agent Orange Registry, and should contact the nearest VA medical center for an examination. Since September 2000, Veterans who served in Korea in 1968 or 1969 are also eligible for the examination. Furthermore, beginning in August 2001, VA has offered the Registry examination to all other U.S. veterans, such as our C-123 crews, aeromed, aerial port and maintenance personnel who may have been exposed to dioxin or other toxic substances in a herbicide during the conduct of or as a result of testing, transporting, or spraying of herbicides for military purposes...or as a result of the dioxin contamination of our planes.

What can a veteran expect from this examination?

Turn your head and cough! Commander's Call at the 439th!
Veterans who participate in the examination program are asked a series of questions about their possible exposure to herbicides in Vietnam. A medical history is taken, a physical examination is performed, and a series of basic laboratory tests, such as a chest x-ray (if appropriate), urinalysis, and blood tests, are done. If the examining physician thinks it is medically indicated, consultations with other specialties or clinics are scheduled.
No special Agent Orange tests are offered since there is no test to show if Agent Orange or other herbicides used in Vietnam caused a veteran’s medical problems. There are tests that show the level of dioxin in human fat and blood, but VA does not do such tests because there is serious question about their value to veterans. In January 1992, VA signed a contract with the National Academy of Sciences (NAS) under which, among other things, the NAS considered the feasibility and possible value of dioxin level blood tests for Vietnam veterans who apply for VA medical care or VA disability compensation. In its July 1993 report (published in 1994 as the Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam), the NAS concluded that individual TCDD levels in Vietnam veterans are usually not meaningful because of common background exposures to TCDD, poorly understood variations among individuals in TCDD metabolism, relatively large measurement errors, and exposure to herbicides that did not contain TCDD.

How does a veteran benefit from taking VA's Agent Orange Registry examination?

The veteran is informed of the results of the examination during a personal interview and gets a follow-up letter further describing the findings. Each veteran is given the opportunity to ask for an explanation and device where medically necessary, a follow-up examination or additional laboratory tests are scheduled. The examination and tests sometime reveal previously undetected medical problems. These discoveries permit veterans to get prompt treatment for their illnesses. Some veterans think they are in good health, but are worried that exposure to Agent Orange and other substances may have caused some hidden illness. The knowledge that a complete medical examination does not show any medical problems can be very reassuring or helpful to Registry participants. All examination and test results are kept in the veteran's permanent medical record. This information is also entered into the computerized VA Agent Orange Registry. So far, more than 425,000 Vietnam veterans have participated in this program. Finally, by taking the exam the veteran contributes to the body of knowledge about Agent Orange-related illnesses and veterans' overall health.

Can a veteran get treatment for Agent Orange-related illnesses?

Yes. Section 102, Public Law 104-262, the Veterans’ Health Care Eligibility Reform Act of 1996, provides that VA is required to furnish hospital care and medical services, and may furnish nursing home care to veterans exposed to military herbicides.. There are some restrictions. VA cannot provide such care for a (1) disability which VA determines did not result from exposure to Agent Orange, or (2) disease which the National Academy of Sciences has determined that there is “limited/suggestive” evidence of no association between occurrence of the disease and exposure to a herbicide agent. 

Can veterans get disability compensation for Agent Orange illnesses?

VA also pays disability compensation to many veterans with injuries or illnesses incurred in or aggravated by their military service. Vietnam veterans do not have to prove that Agent Orange caused their medical problems to be eligible for compensation. Rather, VA must determine that the disability is "service-connected." Non-Vietnam veterans have an uphill battle with the VA as they must prove to a reasonable degree of certainty that, if the veteran has an Agent Orange-presumptive illness, that illness was caused by the veteran's military service and herbicide exposure. A Veterans Services Representative, at any VA medical center or regional office, can explain the compensation program in greater detail and can assist veterans who need help in applying. For more information about the VA disability compensation program, call 1-800-827-1000.

What conditions have been “service-connected” based on evidence of an association with Agent Orange (or other herbicides)?

The number of diseases that VA has recognized as associated with, but not necessarily caused by, Agent Orange exposure has expanded considerably during the 2000’s. The following conditions are now presumptively recognized for service- connection for Vietnam veterans based on exposure to Agent Orange or other herbicides: chloracne (a skin disorder), porphyria cutanea tarda, acute or subacute transient peripheral neuropathy (a nerve disorder), Type 2 diabetes and numerous cancers [non-Hodgkin’s lymphoma, chronic lymphocytic leukemia, soft tissue sarcoma, Hodgkin’s disease, multiple myeloma, certain heart diseases, prostate cancer, respiratory cancers (including cancers of the lung, larynx, trachea, and bronchus), and chronic lymphocytic leukemia]. Note: AL Amyloidosis was added to this list May 7, 2009 and IHD in 2007.
In addition, Vietnam veterans’ children with the birth defect spina bifida are eligible for certain benefits and services. It remains unclear about what the VA will do about C-123 children once a final decision is made regarding the veterans' themselves.

What else is VA doing?

In addition to the efforts described above (that is, Agent Orange Registry examination program, medical treatment eligibility, and disability compensation), VA is doing research to learn more about the possible adverse health effects of Agent Orange exposure. The Environmental Epidemiology Service (EES), in Washington, DC, is the premiere office for Vietnam/Agent Orange-related research within VA. EES investigators have completed two studies about possible connections between Vietnam service and specific kinds of cancers called soft tissue sarcomas, a large scale study of mortality among Vietnam veterans, a study regarding the relationship between Vietnam service and non-Hodgkin's lymphomas, a study of dioxin in adipose (fat) tissue, several mortality study follow-up efforts, mortality studies of individuals in the Army Chemical Corps in Vietnam, an analysis of post-traumatic stress disorder (PTSD) among Vietnam veterans in the Agent Orange Registry, a study of the relationship between Vietnam service and Hodgkin’s disease, a study of the relationship between military service in Vietnam and the risk of death from trauma and selected cancers, an analysis of testicular cancer among Agent Orange Registry participants, a study of suicide among wounded veterans, and a study of the relationship between lung cancer and military service. EES had assistance from others on several of these research projects.
Girls of the 74th! Those were the years!

Only recently did the VA begin serious consideration of women veterans' issues, and little has been done regarding women and TCDD to learn if any health concerns develop differently than in the male veteran population.
In 1981, VA published a two-volume report reviewing scientific literature on herbicides in the United States and throughout the world. This publication was updated with an additional two volumes in 1984, 1985, 1986, l987, 1988, 1989, 1990, 1991, 1992, 1993 and 1994. (These annual updates were discontinued to avoid duplication of the ongoing scientific literature review by the National Academy of Sciences Institute on Medicine [IOM], a non-governmental organization under contract with VA.) Lay language summaries of the VA’s scientific reviews have been published to help non-scientists understand this complex issue...and VA is pressured to follow the IOM's findings! VA has also published a series of monographs regarding Agent Orange-related matters. From 1979 to 1994, VA was part of an interagency group monitoring and coordinating Agent Orange-related and dioxin- related research within the Federal government. 

What are other government departments and agencies doing?

Many other Federal departments and agencies have pursued and/or have also conducted scientific studies on this subject. The Centers for Disease Control and Prevention (CDC), Air Force (in particular the School of Aerospace Medicine), National Institute for Occupational Safety and Health (NIOSH), National Cancer Institute (NCI), and Environmental Protection Agency (EPA) have all been involved in research. The CDC published an important study, partially funded by VA, in 1984 regarding Vietnam veterans' risks of fathering babies with birth defects. CDC investigators found that overall Vietnam veterans were not at increased risk of fathering a child with birth defects. VA also funded the CDC Vietnam Experience Study published in 1997 and 1988, and the CDC Selected Cancers Study published in 1990. The Agency for Toxic Substances and Disease Registry (ATSDR), part of the CDC, released a "game changer" official letter on 26 January 2012 which concluded that the C-123 dioxin tests in 1979 and 1994 indicated dioxin contamination and that crews were most likely exposed - and at 200 times the threshold for cancer concerns! 
The USAF conducted a long-term study of mortality and morbidity among the men involved in the herbicide spraying missions. USAFSAM released an influential study of the C-123 contamination in April 2012, generally supportive of the claim AF veterans have regarding exposure aboard that aircraft.. NIOSH is maintaining a registry of individuals exposed to dioxins and other chemicals in the workplace. NCI has studied the health effects of herbicides on selected agricultural workers. EPA worked with VA on the determination of dioxin in adipose tissue. The Armed Forces Institute of Pathology collaborated with VA on soft tissue sarcoma research. Several States also have undertaken research efforts to learn more about the possible health effects of Agent Orange and the wartime experiences upon our nation's veterans. 

What is the National Academy of Sciences doing regarding this issue?

The National Academy of Sciences (NAS), a non-governmental organization, reviews all relevant scientific literature and provides advice to the Secretary of Veterans Affairs on a wide range of issues relative to herbicides and dioxin. The NAS project is being undertaken in accordance with Public Law 102-4, the Agent Orange Act of 1991, made law on February 6, 1991. The NAS reported its initial findings to VA and Congress in July 1993. The first update report was released on March 14, 1996. The second update was released on February 11, 1999. A special report on the relationship between herbicides used in Vietnam and Agent Orange was released on October 11, 2000. The third update was released on April 19, 2001. The fourth update was released on January 23, 2003. A second special report was issued on February 27, 2002 and another update released in 2005, followed by a 2011 report. One special report reassessed the relationship between herbicides and acute myelogenous leukemia in the children of Vietnam veterans. Future reports are anticipated biennially through 2014 under current law.

Where is additional information available?

A great deal of information can be obtained from www.va.gov/AgentOrange. There is an “Environmental Health Clinician” at each VA medical center who is responsible for the conduct of Agent Orange Registry examinations. These clinicians participate in regularly scheduled nationwide conference calls and receive periodic mailings from VA headquarters updating them on the latest developments on Agent Orange. Each facility also has an “Environmental Health Coordinator” to facilitate the Agent Orange program.
As indicated above, other Agent Orange Briefs provide additional information on specific Agent Orange concerns and issues.
The Environmental Agents Service, Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420, is another good source of information on this subject. The telephone number is 202-273-8580. The Environmental Agents Service used to be known as the Environmental Medicine Office. (It was also previously named the Agent Orange Projects Office.
Veteran’s service organizations (such as The American Legion, Veterans of Foreign Wars of the United States, Disabled American Veterans, Military Order of the Purple Heart, Vietnam Veterans of America, AMVETS, and VietNow) and State government entities (including Departments or Divisions of Veterans Affairs, Departments of Health) have also provided helpful information to individuals seeking information on this subject. In particular, Vietnam Veterans of America has particular expertise in Agent Orange issues and has taken a firm stand on the C-123 aircrews having been exposed and being deserving of VA benefits.
The initial NAS report, an 800+page document, and the updates are available for purchase from the National Academy Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055. The telephone numbers are 1-800-624-6242 and 202-334-3313. Copies of reports are in all VA medical center libraries and can be downloaded from the Internet. Congressional committees, especially the House Committee on Veterans’ Affairs and the Senate Committee on Veterans’ Affairs, have conducted numerous hearings regarding the long-term health effects of exposure to Agent Orange. A great deal of information has been gathered during these hearings. Both committees are located in Washington, DC. The zip code for the Senate Committee is 20510. The zip code for the House Committee is 20515. The staff of Senator Burr, Veterans Affairs Ranking Member from North Carolina, have been especially helpful to our C-123 veterans.

C-123 veterans have had very little interest in support from associations such as the Disabled American Veterans, Military Order of the Purple Heart, Veterans of Foreign Wars, Jewish War Veterans, Paralyzed Veterans of America and others. Only the American Legion and the Vietnam Veterans of America have reached out with strong helping arms, and only those two organizations have turned to the Secretary of Veterans Affairs with demand for our fair treatment.

1 comment:

  1. Charlotte Stubbs25 August, 2012 22:43

    The same thing is happening to soldiers and others who served at ?Ft. McClellan AL from 1935 to 199 when the base was shut down and turned into a Super Fund Toxic site. Anyone who thinks they might have been exposed need to join us in the fight for recognition at http://www.facebook.com/groups/veteranstoxicftmc/


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