These eminent scientists and physicians spoke out in support of C-123 veterans' claims for Agent Orange exposure. The VA has spent this last year defying science, law, logic and justice in an effort to prevent C-123 veterans from making any claims for medical care for the Agent Orange exposure while flying and maintaining our airplanes which all government tests agree, were "highly contaminated" and "a danger to public health." The scientists and physicians who authored their joint letter aim to set right the VA on this issue! The letter should be a game-changer in our struggles with VA administrators.
Unlike the VA whose staff toxicologists were assigned the paid duty of creating arguments against veterans' claims, these independent scientists and physicians took time from their busy professional schedules, without compensation, and evaluated all the evidence and then put forth their views confirming the C-123 veterans' exposure and eligibility under law for Agent Orange service connection. We are fortunate that they have General Hickey to receive their letters, given her Air Force background as an aircraft commander before becoming Under Secretary for Veterans Benefits. Naturally, VA will immediately dismiss this letter using whatever spurious "reasons" that come to mind, whether or not such reasons are legal, just, or scientific.
What can we say to these independent experts except thank you. The scientists and physicians have asked that their names and institutions or federal agencies remain nameless except in the original letter sent General Hickey, but we know who many of them are likely to be. Our thanks. Our very profound thanks, especially to leaders in the effort like Dr. Stellman and others who've asked their involvement be confidential and thus objective, as is the standard in their profession. Thank you all for stepping forward to help us, just as our veterans stepped forward to serve in the military, flying these airplanes that left us exposed to deadly TCDD.
God Bless them from each of us!
-cover letter to joint letter submitted to Under Secretary of Veterans Affairs, General Hickey:
November 29, 2012
Brigadier General Allison Hickey USAF (retired)Undersecretary for Benefits
Department of Veterans Affairs
810 Vermont Avenue, NWWashington, DC 20420
Dear Secretary Hickey,
We have been asked by Major Wesley T. Carter USAF (retired) to comment on the October 12 letter in which you state that "VA is unable to extend the presumption of Agent Orange exposure to crew members of post-Vietnam C-123s or acknowledge Agent Orange-related disabilities as a result of this service." You based this statement on information provided to you by the VA Office of Public Health. We have carefully examined that Office's"Scientific Review of Agent Orange in C-123 Aircraft," and find it seriously flawed. We feel obliged to point out the scientific shortcomings in the VA appraisal and hope that you take our comments into consideration in any future decision-making with respect to post-Vietnam exposures in the C-123s.
In your letter you state that "the potential for exposure to dioxin from flying or working in contaminated C-123aircraft years after use in Vietnam, is unlikely to have occurred at levels that could affect health" and you base your statement on the VA Public Health Office conclusion that any dioxin present would be "biologically unavailable."Unfortunately, the Public Health Office, in turn, bases its conclusion on several erroneous assumptions about routesof entry of dioxin to the body, as well as other scientific misapprehensions.
The VA seems to dismiss skin absorption ("the skin would act as a barrier prohibiting further penetration of TCDD"). This is incorrect. Skin absorption is a primary occupational route of exposure for dioxin-contaminatedpesticides. Both the Air Force and Army technical assessments use a dermal absorption model, as do numerous other agencies and authorities. When the Air Force applied its skin absorption model to a 2009 assessment of contamination of the C-123s prior to their disposal, it found average concentrations in two of the aircraft to be"statistically near the risk-based screening level for dioxins/furans, based on a one-year industrial exposure scenario" (page 20). (A one-year industrial exposure scenario is probably reasonable for C-123 crew and maintenance personnel in the 1970's.) Please note that these measurements were taken nearly 40 years after sprayingended, and certainly represent a lower level than would have been present in the 1970s.
The levels measured in another Air Force assessment of the C-123s, in 1994, were significantly in excess of the screening levels proposed by the Army for office workers. The Army office worker exposure scenario provides forfar less opportunity for dermal contact than would have been likely for C-123 crew and maintenance personnel. Even with this very conservative exposure model, officials from ATSDR calculated "an average value of 6.36ng/l00cm2 for the three C-123 interior wipe samples collected on November 20, 1994", an average value that"exceeds the Army screening level by 182 times and is equivalent to a 200-fold greater cancer-risk than thescreening value." The 2009 Air Force reference levels would similarly have been exceeded.
There are additional difficulties with the VA's scientific appraisal. For example, the VA proposes, "Once TCDD dries on hard surfaces, such as on an aircraft, it does not readily cross through human skin." By contrast, Army technical guidance is specifically formulated for dioxin that is characterized as "dried-on surface" (p. 63). The VAminimizes the possibility of skin absorption "especially given that the sampling for TCDD on the aircraft surfaces required use of a solvent (hexane) to displace and dissolve any residue." Hexane-based wipe sampling is standard procedure. The VA seems to deride the notion of occupational exposure because "sophisticated laboratory techniques many years after its use" were used to detect dioxin. Dioxin is a tricky substance to measure and only expensive and sophisticated techniques are available for its detection.
We also think it important to note, as you do in your letter, "the 1991 Agent Orange Act ... provides a presumption of herbicide exposure" (emphasis added). This means exposure to 2,4,5-T, 2,4-D, picloram and dimethyl arsenicacid (another carcinogen), not just the notorious Agent Orange contaminant, TCDD (dioxin), are covered by the Act. Airborne phenoxyherbicides were measured in air samples taken in the C-123 aircraft in 1979, albeit at levels below the occupational exposure limits. It is difficult to extrapolate exposure levels back to 1972 because of an absence of data on applicable environmental temperatures and pressures, but it should be noted that there exists the likelihood of exposures to multiple environmental toxins in the C-123s, in addition to dioxin, and such multiple exposures generally require application of more conservative scenarios.
We hope that this letter may assist you in reconsidering your conclusion with regard to presumption of herbicide exposure for post-war C-123 crew and maintenance personnel. We would be particularly interested in learning the specific criteria used for determining that exposures to the dioxins were "unlikely to have occurred at levels that could affect health," since screening levels appear to have been exceeded and no safe level of dioxin exposure has asyet been agreed upon by regulatory authorities.
Please let us know if we may be of further assistance to you in your considerations.
[SIGNATORY LIST ATTACHED - confidential per their request]
 http://www.publichealth.va.gov/exposures/agentorange/scientific-review-residue-c123.asp"Dioxin and Herbicide Characterization of UC-123K Aircraft – Phase I." Prepared for Director of Operations,
505 Aircraft Sustainment Squadron and Hazardous Waste Program Manager, 75CEG/CEVC, Hill AFB, UT(prepared by Select Engineering Services, Layton, UT); 2009.(http://foundationforworkerhealth.wikischolars.columbia.edu/file/view/Reference+2_Hill+AFB_2009.pdf )
Technical Guide 312 -Health Risk Assessment Methods and Screening Levels for Evaluating Office WorkerExposures to Contaminants on Indoor Surfaces Using Surface Wipe Data (June 2009). (http://foundationforworkerhealth.wikischolars.columbia.edu/file/view/Reference+3_TG+312+%28Health+Risk+Assessment+Methods+and+Screening+Levels+for+Evaluating+Office+Worker+Exposures.pdf )
Consultative Letter from Capt Wade Weisman & Ronald Porter; Department of Air Force Armstrong LaboratoryMemorandum FOR 645 MedGrp/SGB Dated 19 Dec 94. (http://foundationforworkerhealth.wikischolars.columbia.edu/file/view/reference+4_Weisman_Porter_1994.pdf )
 Letter from Thomas Sinks, PhD, Deputy Director ATSDR to Maj. Wesley Carter (ret), Jan. 25, 2012. (http://foundationforworkerhealth.wikischolars.columbia.edu/file/view/reference+5_A TSDR+Letter+25+Jan+12.pdf)
Conway, William, September 1979, Aircraft Sampling Westover AFB, MA, USAF OEHL Technical Report 79-59. ( http://foundationforworkerhealth.wikischolars.columbia.edu/file/view/reference+6_Conway_1979.pdf )