02 May 2013

C-123 & VA Science. Really science, or "weird science?"

Can something from the Veterans Affairs be called “scientific” if written solely to insure a group of veterans is excluded from coverage? Can something be called scientific if “researched” only to give voice to the policy requirements of the agency, cloaked in cherry-picked articles and not with an even-handed attitude of “let’s see where the evidence takes us?”  No…the VA didn’t want to allow the C-123 veterans to qualify for Agent Orange exposure benefits and set out to write a few Internet pages to give themselves a foundation for that injustice. So here VA gives us not science, but weird science. Science by policy. Science skirting around truth.

In this instance, C-123 Air Force veterans find it difficult to understand the “scientific review” and “investigation” to which the VA refers in their various Internet pages which deal with C-123
exposure, because those pages provide little detail and our Freedom of Information Act Request brought back the curious response that the VA insists it has no documentation dealing with the issue…and VA even denied their own Internet pages exist.

Do you see the question raised? How can “scientific review” and “investigation” be done adequate to compel the VA to take such a severe position as to deny service connection claims, and yet VA insists there are no documents, emails, marginal notes, presentations, publications, studies, investigations, reviews, letters…nothing at all on the subject! 

VA’s Public Health and Post-Deployment Health experts maintain C-123 veterans weren’t exposed to C-123 dioxin because there was no “bioavailability” – and yet have no materials at all. How can VA claim to have dealt with this issue “scientifically” and yet bar review of their materials for peer review? How does the VA's "Public Health", which is part of their Health Benefits Administration, come up with a conclusion veterans weren't exposed, yet the United States Public Health Service says veterans were?

No, this wasn’t science. Their "scientific review" was merely a policy statement wrapped around a prejudice against C-123 veterans. The VA has had enough of Agent Orange-exposed veterans lined up for care and benefits to which they are entitled, and VA managers clearly want to bring this to an end. How? By pretending no other veterans were exposed, regardless of evidence to the contrary and by simply citing VA “studies” which are instead policy announcements.

But lets look into what can be found. The only sources of the VA’s work on C-123 veterans’ exposure are their few Internet pages, and correspondence with veterans, congressional representatives, and outside experts.

So, lets first look at their Internet pages. The basic one is titled “Scientific Review of Agent Orange in C-123 Aircraft. Here VA Office of Public Health claims to have “reviewed” existing scientific studies and says post-Vietnam War veterans’ are unlikely to have been exposed at levels to affect health.

The first and most glaring issue is that none of the studies which might prove the C-123 veterans case are listed. Carefully, the VA selected only articles and studies they felt best destroyed the veterans’ case. Ignored were countless peer-reviewed articles, which we’ll detail in a moment or two. Next, the VA attacked and dismissed the multitude of Air Force tests over the decades that established dioxin contamination of the C-123 fleet. “Heavily contaminated” read one report, and “A danger to public health” another.  Even 29 years after their last Agent Orange spray missions the airplanes stored in the Air Force desert bone yard still showed trace to low levels of contamination of dioxin, for which any detectable levels are considered unsafe.

Therefore, to minimize or dismiss the most relevant evidence for veterans’ exposure, VA simply declared the Air Force tests, completed by both commercial expert firms and the military’s own toxicologists, to have been done incorrectly and in a manner that released toxins otherwise not available to expose the aircrews. Dismissed was the fact that the tests were completed by highly reputable experts with doctorates in the field, and that the tests were done using well-established standard procedures called hexane wipes. In tests completed in the 2000-2009 time frame, water wipes were also used with similar results, so the VA ignores these results so as to better focus on the hexane wipes which they then dismissed to provide a basis for trashing all the contamination test reports.

Having constructed such a barrier around the evidence, VA then turned to a claim to have consulted peer-reviewed literature. The first thing that stands out is the age of some VA references, ranging between ten to thirty years old. The next observation is the name of Dr. Al Young, well-known indeed among Agent Orange victims for his career spent developing military applications for Agent Orange, and also for his decades spent claiming Agent Orange is fairly harmless to humans. Dr. Young’s article cited by the VA was actually his claim that Vietnam veterans weren’t exposed and if they were, such exposure would allow little bioavailability. This point, and ones made subsequently in Dr. Young’s article, form the basis grasped by the VA to deny C-123 veterans’ disability claims,

Importantly, Dr. Young claims that actually no veterans were “exposed” or had “bioavailability” other than the crews actually handling or having direct contact with liquid herbicide. Of course, the National Academy of Sciences Institute of Medicine challenges this and Young’s position is not at all the generally accepted view among toxicologists and epidemiological scientists, but it provided VA something to wave as its “proof.”

Dr. Al Young has another point of contact regarding C-123 veterans. In 2010 the Air Force needed to resolve storage concerns about contaminated C-123s in storage. Dr. Young’s input was sought and he recommended immediate destruction of the airplanes and reminded Air Force leaders that unless the destruction was done quietly, veterans might learn of the contamination and their exposure in earlier years, and seek medical care for their Agent Orange illnesses.

Again that important point – these veterans had already been exposed and Dr. Young’s official recommendation, as the Senior Agent Orange Consultant to the Office of Secretary of Defense, was to quietly destroy the evidence before the victims learned anything. Dr. Young’s advice was repeated along the Air Force chain of command and provided the “final solution” for these toxic, aged warplanes in 2010.

Dr. Young’s advice was seemed NOT that of a neutral, independent observer in any of his activities. Referring to the C-123 veterans again, Dr.Young described them as “trash-haulers, freeloaders looking for a tax-free dollar from a sympathetic congressman. I have no respect for them.”

C-123 veterans, most of whom saw combat, and indeed, any scientist considering Dr. Young’s writings, must critically evaluate conclusions from this man who flaunts such a tainted perspective about the veterans he writes about.

What about the other references? Veterans managed to locate Professor (now Emeritus) L.W. Weber at Oregon State University, but Dr. Weber stated his study had nothing to contribute to any understanding of aircrew exposure and asked it not be used in that context.

Another reference cited was written by Dr. Linda Birnbaum, who is famous in the field of dioxin research, and now Director, National Institutes of Health/NEIHS and Director, National Toxicology Program. Dr. Birnbaum in recent years reviewed the Air Force test reports and other contemporary studies such as Technical Guide 312 from the Department of Defense, and has concluded that the C-123 veterans actually were exposed! So that has left the VA citing Dr. Birnbaum’s article to support their pretense veterans weren’t exposed, yet Dr. Birnbaum herself states veterans were indeed exposed!

The last element of the VA’s “scientific review” was the Air Force School of Aerospace Medicine C-123 Consultative Letter released May 2012. Here the Air Force basically disowned its own decades of testing and posited that C-123 crews were unlikely to have been exposed. This report has received very close scrutiny from scientists such as Dr. Birnbaum and others, who fault it for the basic statement of unlikely exposure yet also the Air Force statement that they didn’t have enough information or data to make any conclusion. So how could a conclusion be reached that veterans weren’t exposed when the Air Force admits not having enough data to make such as conclusion at all. Continuing examination of this Consultative Letter led to the Air Force Surgeon General stating that it must not be used by the VA to deny benefits to any veteran! Challenges to the Air Force C-123 Consultative Letter continue from many corners, including the National Institutes of Health and even the Air Force itself, and leave the whole issue an embarrassment for the Air Force and its earlier reputation for scientific integrity.

Now lets examine the errors of the VA’s “Scientific Review of Agent Orange in C-123 Aircraft” point-by-point. It might be helpful while watching this video to have first downloaded and printed the article, easily Googled using that title.

1 May be detected by sophisticated laboratory techniques many years after its use.” How deceptive! VA says “sophisticated equipment” is necessary to detect dioxin on these airplanes, yet standard equipment by qualified technicians is all that’s required…and that’s exactly what was done over the decades in which C-123 aircraft consistently tested positive, and “heavily contaminated” with Agent Orange. VA was also deceptive in using the word “may” when in fact, the proper word should be “was”. “May” in scientific reports implies only a possibility, or a vagueness or basic “less likely to than not” but the actual record with C-123 Agent Orange exposure reads WAS DETECTED! And “residual TCDD,” regardless of being residual or whatever was meant by that phrase, is still TCDD.

Finally, VA states that the available reports and studies lead their own Public Health officials to conclude there was a “low probability” of exposure. This was their objective, and so they concluded, as was their objective in the first place. Clearly, VA spent much more time with their clever wording of this Internet page than they did actually studying the potential for C-123 claims having any validity!

2.  The next point in the VA sheet is “unlikely to have occurred at levels that could affect health.” Here they have no foundation for the statement other than Young’s tainted views. In fact, other federal agencies such as the Agency for Toxic Substances and Disease Registry and the National Toxicology Program and the US Public Health Service disagree and opine C-123 veterans’ health is affected. ATSDR even states these veterans have a 200-fold greater cancer risk than the screening value! And in any case, the 1991 Agent Orange Act and other requirements only read “exposed” with no mention of levels, colors, flavors, kinds, bioavailability…nothing other than a statutory requirement to establish exposure. And the VA here agrees that inhalation of dust particles to which dioxin had become bound is at least a “low probability” – which other, more independent scientists maintain to be a high probability.
3.  Regarding routes of exposure, veterans claim dermal, inhalation and ingestion routes to have happened. VA dismissed inhalation of TCDD as an aerosol, yet dioxin binds readily to dust, which was ever-present. VA dismissed dermal exposure but there is a plethora of articles expressing scientific agreement for the skin being a likely route and both the Army and Air Force use dermal exposure models. Here VA uses more deceptive wording, stating that a solvent (hexane) was required to dislodge the dioxin in tested airplanes. In fact, hexane is the standard wipe test used in all such situations – for instance, it would be used today at Wal-Mart, at the Post Office, the local high school, or at any other setting where a surface contaminant needed to be studied. Further, testing by the Air Force and contracted laboratories done between 2000 and 2009 used both hexane and water wipes with similar confirming results.
4.  The VA claims it will continue to review new findings relevant to this issue as they become available. Many indeed have become available, including expert opinions confirming C-123 veterans’ exposure from a large number of other agencies, universities and independent medical and scientific experts. Ignored by the VA, or grouped by them in what they call “unacceptable lay evidence” are the following:
H: EPA – “concur with ATSDR” re: veterans were exposed

It strikes the observer that here, that so many conclude veterans have been exposed. None of these agencies have policies about exposure one way or another, and none of the persons providing opinions was paid to do so, unlike the VA staff paid to construct their barrier to veterans claims.

But, there’s more. In other VA Internet pages about the C-123, they claim to have “thoroughly reviewed all available scientific information.” Ignored, however, were all opinions, findings and other documents that would have supported the veterans’ claim for exposure, such as the standard guide for surface contamination, Technical Guide 312, considered the gold standard in this field. Other experts, using TG312, conclude C-123 veterans were indeed exposed. Ignored, also, was the CDC Dioxin Bulletin “Current Intelligence Bulletin 40. Perhaps the VA, eager to prove C-123 veterans could not have been exposed via dermal routes, did not favor the CDC observation that exposure was possible by simple contact, or the CDC observation that both water and hexane wipes are appropriate surface testing procedures. Nope…the CDC bulletin did nothing to support the VA position and everything to support that of C-123 veterans, so the VA authors of “A Scientific Review” obviously felt it best to be ignored to help make their point against veterans….consulted without mention perhaps, but ignored and not mentioned once it worked against the VA case.

Google Scholar and many other Internet resources provide more than enough support for the C-123 veterans’ claim for dioxin exposure, so VA didn’t cite them. In particular, to make sure dermal exposure was eliminated as a route of dioxin harming the veterans, even though most peer-reviewed scientific articles, such “Dioxins – Toxicological Overview” emphasize the dangers of inhalation, ingestion AND dermal exposure.  You can do it yourself…Google “dermal dioxin exposure” and you’ll see articles from EPA, NIH, foreign governments, state governments, commercial laboratories…the list is so very long!

Further, but totally ignored by the VA writers, dioxin articles frequently stress the fact that dioxin accumulates over time, and long-term exposure is more harmful than short-term, because the body can’t rid itself of the toxin fast enough before reintroduction by re-exposure. Why is this important to C-123 veterans? Because they flew the C-123 for ten years. Not only flew it, but ate in it, repaired it, loaded and unloaded, slept aboard during tactical deployments (so much more comfortable than some Army tent in the dirt alongside a runway!) Exposed and re-exposed, for a full decade.

In November of 2012, sixteen concerned physicians and scientists joined Dr. Jeanne Stellman of Columbia University in bringing their professional concerns about the scientific basis for VA decisions regarding C-123 veterans exposure to military herbicides. They explained problems with the VA approach denying dermal absorption, because dermal exposure to dioxin is well-proven and indeed skin absorption is a primary occupational route of exposure. In general, this respected group dismissed the entire VA policy prohibiting C-123 veterans exposure claims. 
“Unfortunately,’ they wrote, “the VA Public Health Office, in turn, bases its conclusion on several erroneous assumptions about routes of entry of dioxin to the body, as well as other scientific misapprehensions.” “We have carefully examined ‘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.”

VA’s Compensation Service rebuffed their letter. Noted for his denial of a veteran’s Agent Orange claim because, as C&P wrote, "no long-term harm has been shown to be caused by Agent Orange," the scientists were told that VA would stand by its C-123 position, regardless of any university, independent expert or other federal agency saying otherwise.

Clearly, however, C-123 veterans have established the validity of their Agent Orange claims to the satisfaction of the medical and scientific communities, and to the satisfaction of other federal agencies as well…including those with the statutory responsibility for making the call about the exposure! We earned combat pay for going to war in our airplanes over the decades we flew for the Air Force, but we didn’t know perhaps we should have asked for “Agent Orange Exposure Pay” for that hazard as well for the years we flew the toxic C-123!

A hard copy of this discussion can be downloaded at www.c123kcancer.blogspot.com, including hotlinks to cited references. The C-123 veterans don’t need any new laws or regulations, because we are fully qualified to receive VA medical care under the 1991 Agent Orange Act, various CFRs and in particular, the 8 May 2001 Federal Register in which VA explains that non-Vietnam veterans who were exposed to military herbicides will be treated the same as the Vietnam veterans.

We need your help. Your senators and congressional representatives need to contact Mr. Brooks Tucker of Senator Richard Burr’s staff. Senator Burr has taken the lead on this bicameral and bi-partisan issue with Mr. Tucker doing the hard work. Ask your representatives to insist to the VA that our veterans need only one thing from that agency
– that VA OBEYS the law!

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