16 May 2013

VA Violates Veterans Dioxin and Radiation Exposure Compensation Standards Act

"Scientific Review of C-123 Agent Orange" - quite unscientific!
VA has violated the Veterans Dioxin and Radiation Exposure Compensation Standards Act, in a deliberate manner to prevent veterans from receiving vital medical care! In particular, it has violated the section requiring the Secretary to produce and/or rely upon those guidelines which withstand peer review ("Peer review is the evaluation of work by one or more people of similar competence to the producers of the work"). And the VA's publications have manifestly FAILED peer review!
The guidelines required to be established in regulations
prescribed under this section shall include guidelines governing the
evaluation of the findings of scientific studies relating to the possible
increased risk of adverse health effects of exposure to herbicides
containing dioxin or of exposure to ionizing radiation. Those guidelines
shall require that, in the evaluation of those studies, the
Administrator shall take into account whether the results are statistically
significant, are capable of replication, and withstand peer review.
In 2012 the Department of Veterans Affairs prepared a document, claiming to be a "Scientific Review of C-123 Agent Orange," crafted to prevent successful claims by C-123 veterans who had been exposed to dioxin while serving aboard their aircraft between 1972-1982. Those warplanes had been used until 1971 for spraying Agent Orange in Vietnam. The VA review skillfully avoided references which would agree with the veterans' exposure, and selected only those which could argue against their exposure. Interesting, however, is the fact that one cited author (Dr. Linda Birnbaum, Director, National Toxicology Program) actually concluded veterans were exposed!

Response by the medical and scientific community was immediate, and negative. Acting on behalf of fifteen other scientists and physicians, Dr. Jeanne Stellman (Professor Emerita of the Mailman School of Public Health, Columbia University) submitted to the VA's Undersecretary for Veterans Benefits a scathing assessment of the VA's "Scientific Review". She and her colleagues termed their concerns with the VA "scientific apprehensions" and concluded the VA paper was "scientifically flawed" in many areas. 

Because the VA's "Scientific Review" was crafted to prevent C-123 veterans claims from being approved, it bears careful examination as to the failure to withstand peer review and thus violated the Veterans Dioxin and Radiation Exposure Act:

1. VA was challenged on errors regarding dermal exposure to dioxin
2.3. VA was challenged on errors regarding dermal absorption of dioxin
-VA was challenged on errors regarding failure to consider initial tests cited were completed on the aircraft seven years after the veterans started service aboard, and other tests up to forty years after the last Agent Orange spray missions, thus exposures were greater given the "fresher" dioxin
4. VA was challenged on errors regarding its dismissal of standard hexane and water wipe tests used to determine C-123 dioxin levels as "heavily contaminated"
5. VA was challenged on errors regarding failure to include reference to TG312, the acknowledged "gold standard" for evaluating surface contaminants
6. VA was challenged for deriding the concept of dioxin occupational exposure and for having incorrectly implied that only "sophisticated laboratory methods" could uncover the C-123 dioxin contamination of the warplanes, when in fact such sophisticated laboratory methods are the norm for all such examinations, and are standard in toxicology, and would be the same tests used in any civil, military or other setting where contaminants were suspected
7. VA was challenged on its incorrect statement that dried dioxin is biologically unavailable; further, it was noted that biological availability is not a requirement for veterans' claims for Agent Orange exposure per the Federal Register 8 May 2001 (page 21663)
8. VA was challenged for its failure to integrate the findings by the Director and Deputy Director of the Agency for Toxic Substances and Disease Registry, which were that C-123 veterans were exposed and further, had a higher cancer risk by far
9. VA was challenged for its failure to assess other contaminants present in Agent Orange, and for failure to address the broader issue of "military herbicides" as described in the 1991 Agent Orange Act and its various promulgations
10. VA was most directly, and most importantly, challenged for its baseless conclusion that exposure levels were unlikely to have subjected C-123 veterans to "levels that could affect health" since no regulatory standards exist, and generally accepted guidelines were greatly exceeded in this instance

The VA's so-called "Scientific Review," having failed peer review but nonetheless employed by the Under Secretary of Veterans Benefits to deny C-123 veterans' benefits claims, leaves the Secretary having violated the Veterans Dioxin and Radiation Exposure Compensation Standards Act, and to the terrible detriment of the veterans involved. Veterans thus are turned away from care for military cancers, heart disease and other Agent Orange illnesses, and forced to seek care elsewhere. Which was was the objective of the VA's Veterans Health Administration.

One must question what the internal process is for VA release of their "scientific" papers, which seem, judging by this low standard, mere mis-steps of policy statements wrapped in erroneous pseudo-science. And given the slanted perspective taken by the VA paper, those writing it should be called to account for their unprofessional involvement.

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