Vietnam Vets of America - Agent Orange Statement

{Following is a statement by Mr. Alan Oates, Agent Orange Committee chairman. I regret not posting it earlier but just received it today. We are grateful for his mention of our C-123 crews in his presentation. Mr. Oates first brought our aircrew concerns to the Vietnam Veterans of America leadership!)

Agent Orange/Dioxin Committee Report  Alan Oates An Update On September 29 2011 the Institute of Medicine (IOM) released the eighth biennial update of the Vietnam Veterans Agent Orange Review.You can read the report at http://www.iom.edu/ Reports/2011/Veterans-and-Agent-Orange-Update-2010.aspx There are several important changes from the 2008 update. Mary Paxton, the IOM staff director for the study, presented an overview of the update at the October meeting of the Agent Orange/Dioxin and Other Toxic Substances Committee. The first important change was a request from the VA that IOM, “when summarizing the evidence available to support the association of a health effect with exposure to the components of the herbicides used by the military in Vietnam, the committee address whether or not all the points that have rather imprecisely become known as the Bradford Hill (1965) ‘criteria’ for causality (strength, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, and analogy) had been satisfied by the information available.” This request was a result “arising from the decision-making at VA necessitated by the findings of Update 2008.” It is important to look at the events leading up to and after the VA’s request. After the 2008 Veterans Agent Orange Update was released, the VA Secretary declared three new diseases presumptively service connected to Agent Orange. The cost of adding these new diseases caused Sen. Jim Webb (D-Va.) To question the VA’s decision-making processes. That brought about a hailstorm of discussion, scrutiny, awareness, and even a hearing by the Senate Committee on Veterans’ Affairs. The end result was that the new diseases became presumptive, but the process opened the door for some legislators to target the Agent Orange Act of 1991, which was the basis for the Secretary’s decision. Sen. Tom Coburn (R-Okla.) Offered an amendment in late July that sought to change the law to block more conditions from being added to VA’s list of Agent Orange presumptive diseases unless medical science could show a causal effect and veterans could prove that they were exposed to the herbicide. This would have changed the current standards based on association and established a standard of proving final causation. It also would have taken the presumptive exposure away and required each veteran to prove his or her exposure to Agent Orange. It can never be proven that exposure to Agent Orange is the only scientific cause of any disease in Vietnam veterans. There are a lot of reasons for this. First, there was a failure to collect timely data, to document exposures, and to do the necessary studies. The studies that were done failed to examine all the exposures and only looked at the TCDD dioxin. You can’t go back and rebuild this data forty years after the fact.You can’t reestablish the conditions and environment to which each individual was subjected. You cannot establish if there were genetic changes that might have occurred. And you cannot subject humans to these toxins to gain better knowledge. IOM pointed out in the 2008 update that it wasn’t feasible for them to evaluate the impact of a combination of toxins on Vietnam veterans. So how can our government expect veterans to prove causality? The IOM Veterans Agent Orange Review Committee’s response to the VA’s request for a causality checklist approach was: “This committee gave careful consideration to the request from VA that, in addition to its usual discussion of biologic plausibility, the committee should state the degree to which each of the other ‘Hill criteria for causality’ are satisfied by the existing scientific information. As well known as these standards or those developed by the U.S. Surgeon General when first assessing the health consequences of smoking are, there is in fact no sufficient set of criteria for declaring that causality has been established. In accord with the current thinking of epidemiologists, the committee concluded that adopting a checklist approach would be inappropriate.” The Veterans Agent Orange Review Update 2010 Committee was right. The current political climate of reducing spending will bring attacks on veterans’ benefits. There will be many opportunities for legislators to incorporate unreasonable changes into the Agent Orange Act of 1991.Veterans need to stay vigilant. The second important item from the report deals with hypertension. This is the third report and the third IOM committee that has agreed there is an association between hypertension and “Agent Orange” herbicides. In the new 2010 report, the IOM committee concluded: “After carefully examining the new evidence, the present committee deemed that the new information justified the continued placement of hypertension (ICD-9 401–405)…in the limited and suggestive category.” By law, the VA Secretary must consider the positive association found by the IOM Agent Orange Review and any other credible evidence in granting presumptive service connection for an Agent Orange-related disease. He must apply the standards established by the Agent Orange Act of 1991. That standard says: “An association between the occurrence of a disease in humans and exposure to an herbicide agent shall be considered to be positive for the purposes of this section if the credible evidence for the association is equal to or outweighs the credible evidence against the association.”Without credible evidence against an association that outweighs the positive association in the Veterans Agent Orange Review updates, the Secretary of VA should not continue to deny presumptive status for hypertension. The third important change deals with acute and subacute peripheral neuropathy. In past reports only acute and subacute peripheral neuropathy (which occurs within one year of exposure) that was transit (that cleared up with in two years of onset) had an association. VA currently grants presumptive service connection for the transit acute and subacute, but not if it is persistent. This new update finds that both the transit and persistent acute and subacute peripheral neuropathy have an association.The update still finds that there is inadequate evidence to support an association between delayed onset chronic peripheral neuropathy, in which onset takes place later than one year from exposure.We hope that the Secretary grants presumptive service connection for persistent acute and subacute peripheral neuropathy. The last item I want to cover in the report comes out of the recommendations made by the committee: “Although progress continues to be made in understanding the health effects of exposure to the chemicals of interest and in elucidating the mechanisms under lying them, gaps in our knowledge remain.The scope of potential research on the chemicals is far reaching, and what follows here is not an exhaustive list of future research that might have value. There are many additional opportunities for progress in such areas as toxicology, exposure assessment, the conduct of continuing or additional epidemiological studies, and systematic and comprehensive integration of existing data that have not been explicitly noted here. It is the committee’s conviction, however, that work needs to be undertaken without delay, particularly to address questions regarding COPD; the potential for paternally mediated, clinically defined health outcomes in offspring; and the effective utilization of VA’s medical database.” What is important to note is the lack of action by the VA on the recommendations from past updates. VA must act on these recommendations in order for the system created by the Agent Orange Act of 1991 to work as intended. This committee urges all veterans to ask their U.S. senators to support and co-sponsor Senate bill S. 1629, The Agent Orange Equity Act of 2011, for blue-water veterans. Go to http://thomas.loc.gov/cgi-bin/ bdquery/z?d112:s.1629: There are many issues that deserve our support. They include the health effects of Agent Orange on our children and grandchildren, Agent Orange exposures outside Vietnam, the use of contaminated aircraft such as the C-123s that were used long after the war ended, and other environmental exposures such as TCE, solvents, and fuels. Let us not forget those veterans from every era who suffer from toxic exposures. Caring for these veterans is a cost of maintaining a military force and of war. Failing to provide the necessary funding cannot be an option