28 July 2013

"Exposure" - The VA's Amazing Shell Game

It couldn't be simpler, right? What could be easier to understand than the idea of exposure?

For C-123 veterans who flew this former Agent Orange spray airplane after Vietnam, it turns out "exposure" has had VA's own special redefinition, just for their own use VA against Agent Orange veterans. VA "newspeak" has the VA saying scientific words like exposure will mean only what the VA says they mean, not what science, medicine, law or common sense tells us it means! VA has manipulated a straightforward word to prevent claims. "Keeping the pigs from the trough" is how some mid-level staffers put it.

It begins with the law and ends with the VA skirting legal rights of C-123 veterans. Agent Orange-exposed veterans can turn to the Department of Veterans Affairs for medical care and other benefits related to a list of illnesses recognized by the Institute of Medicine and the VA as being "Agent Orange presumptive illnesses," diseases such as prostate cancer and about 20 other ailments. The 1991 Agent Orange Act, various promulgations such as Title 38 USC and the 8 May 2001 Federal Register all refer simply to the word "exposure." Exposure can be by breathing, ingestion or skin contact with a contaminant.

And the C-123 veterans do claim to have been exposed. The post-Vietnam airplanes tested positive and "heavily contaminated with dioxin on all test surfaces" as read one test series. The contamination was repeatedly established by the Air Force toxicologists who identified the poisonous part of Agent Orange, dioxin. The vets flew the contaminated airplane between 1972-1982 and claim to have been exposed, some for up to ten years of their service. Numerous federal agencies such as the CDC, NIH and US Public Health Service have officially confirmed the airplanes' contamination and the veterans' exposure. Thinking, logically enough, that the facts were on their side the veterans approached the VA, only to be met with that agency's routine denial...no exposures ever happened, say VA officials.

The VA strategy to prevent C-123 claims? They could't avoid the AF tests proving Agent Orange contamination, so they opted to argue that the veterans somehow weren't exposed. As a basis of their scheme to skirt the law by denying the fact of exposure, VA tried to slip this special, VA-only redefinition into the Society of Toxicology in San Francisco at that society's 2012 meeting that exposure now has a new definition. "Exposure=contamination field+bioavailability."

That's the line tossed in to the middle of their Agent Orange poster display and for months, nobody  noticed. Only in mid-2013 did more careful reading of that poster remind veterans of a telephone conference with Veterans Health Administration's Deputy Director for Post-Deployment Health She informed C-123 veterans that, despite the contamination of their old warplanes, no exposure occurred (in the VA's mindset) because the veterans couldn't prove "bioavailability," - the specific harm done by the dioxin on the planes. She further explained that by the VA's definition none of the ground soldiers in the Vietnam War had ever been exposed, either, and few of the aircrews which actually sprayed the herbicide!

Fortunately, scientists and physicians outside the VA's control have disputed this special, post-2012 redefinition of a standard word well-understood in medicine and toxicology. Exposure is, as the definition above confirms, simply the contact with a contaminant. In some definitions, contact between the outer boundary of an organism and a contaminant. Same thing. In no situation is "bioavailability" a component of exposure, but rather, it flows from exposure. Consider: you drink coffee and are thus exposed to caffeine. Your heart rate may or not go up, and you've then had bioavailability - but you were first exposed.
VA Shell Game - with veterans' health?

VA compounds this act of confusion perpetrated on American veterans with a very special shell game performed by their Compensation Services, the folks who evaluate claims. C-123 veterans had submitted a raft of supporting independent professional medical and scientific opinions establishing their claim for exposure. Included were findings from independent toxicologists, retired US Army Chemical Corps officers,  Columbia University School of Public Health, Boston University School of Public Health, University of Texas Medical School, Oregon Health Sciences University, the NIH/National Toxicology Center, the US Public Health Service, the EPA and even the Director, CDC/Agency for Toxic Substances and Disease Registry, Dr. Christopher Portier.

These scientists and physicians, acting independently and without compensation, all confirmed the C-123 veterans' exposure. In a stunning verbal shell game, VA junked each and every one of these experts' opinions! VA's Director of Compensation Services directed C-123 claims be denied even though supported with this evidence, stating that as scientists and not physicians (he conveniently overlooked the physicians' findings which the veterans submitted) they were not qualified to address medical nexus.  (Actually, toxicologists are professionally qualified to address issues of toxicity, exposure and often medical nexus as well, but that's another article.)

Did you get the VA switch? The scientists and physicians verified the question at hand -  the veterans' exposure, and C&P trashed the expertise of the world's leading Agent Orange experts by ignoring exposure and saying the were not qualified to discuss medical nexus. Two different issues, swapped around in his orders to regional offices sent out to insure all C-123 claims are denied.

However: Exposure is different than medical nexus. Medical nexus means being able to point to an illness as being caused by something...you drank heavily for forty years and have a bad liver. But that's not what the experts were addressing!

The law only requires veterans with Agent Orange-type illnesses to prove they were exposed. The medical and scientific experts confirmed the veterans were exposed. C&P denied the veterans' claims by ignoring overwhelming proof of their exposure by pretending the experts were discussing medical nexus.

Do you see which shell the prize is under? Wherever the VA says it is. Or nowhere. Just like VA's infamous "every benefit of the doubt to the veteran."

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