03 March 2014

VA Definition of "Exposure" Unique, Created to Prevent C-123 Veterans' Agent Orange Claims

C-123 veterans are accustomed to resistance from VA in permitting our disability claims based on exposure to Agent Orange (or military herbicides, as the terms are frequently interchanged.)

To better form a basis for preventing C-123 claims, VA staff presented a poster about Agent Orange at the 2012 Society of Toxicology conference in San Francisco, and sneaked in a little line:
"exposure = contamination field + bioavailability."

This meant that VA would recognize veterans' claims for exposure only if there was also proof of some medical implication. No bioavailability equals no exposure, via the newspeak VA definition.

This redefinition is quite unique. It was implemented in the VA without peer review nor regulatory notice, by the staff of Post Deployment Health. The new definition is so unique it isn't found anywhere else in science or medicine, not even elsewhere in VA. Just...for denying C-123 veterans' claims.

Denying a veteran's claim is a big, big deal. Especially to the veteran of course, but to VA as well. It means one more claim off the desk of rating officials, but more importantly, it means lots of money saved! It costs a lot of money to try to keep alive a sick, elderly veteran with toxic exposures plus normal ailments of aging. Cancers, heart disease, hypertension, ALS, etc...better to prevent any access to care than to permit it, especially if the prevention can be as easy as redefining a word like exposure.

Why pick exposure to redefine? Because the VA acknowledged as recently as the 31 Aug 2010 Federal Register that it would treat veterans exposed to military herbicides the same as it treats Vietnam veterans. So "exposure" was an easy target...redefine away the veterans' exposure events and then deny the claims.

The worst that could happen to the VA with this verbal deception is the veteran appeals and three to four years later, if the sick veteran still survives, his claim can be corrected then but that still means years of savings by locking the hospital doors to them, and of course, the hope that the vet will die and the problem go away.

Now, nobody says any particular  VA staffer wants any particular, nice old veteran guy or gal to die. Not something so specific, but in general, yes. The VA view is the fewer pigs (that's us) at the trough (that's the VA) the better. Kept from applying, denied in their claims, or died off before any decision...works just fine for Post Deployment Health.

Judge for yourself the deception of VA in redefining exposure. Note also the DOD definition of exposure...and we were under DOD regs when we flew and became exposed. Neat...DOD says we were exposed but VA says, not on their watch! 

Besides DOD saying we were exposed, ATSDR, NIESH, National Toxicology Program, Boston University, Columbia University, Oregon Health Sciences University, University of Texas Medical School, EPA, US Public Health Service all say we were exposed...but no, Post Deployment Health whips out their redefinition of exposure and tells the guards to get those hospital doors locked...C-123 veterans aren't going to be allowed in!

 Definitions of Exposure Used By Different Authorities:

VA Post Deployment Health: Exposure = contamination field + bioavailability

Society of Toxicology:  In health matters, measurement of levels at which one encounters any substance

Defense Technical Information Center: Intensity, frequency and length of time personnel are subjected to a hazard.

EPA: Contact made between a chemical, physical, or biological agent and the outer boundary of an organism.

EPA (pesticides): Radiation or pollutants that come into contact with the body and present a potential health threat.

American Chemical Council: Occurs when an employee is subjected to a hazardous chemical in the course of employment through any route of entry (inhalation, ingestion, skin contact or absorption, injection), and includes potential (e.g., accidental or possible) exposure.

Lawrence Berkeley National Labs: contact with a toxic substance

US National Medical Library: Process by which a substance becomes available for absorption by the target population, organism, organ, tissue or cell, by any route.

ATSDR: Contact with a substance by swallowing, breathing, or touching the skin or eyes

EPA: contact between an agent and the visible exterior of a person

Web Taxonomy: Contact between a chemical and the skin

Johns Hopkins School of Public Health: Any condition which provides an opportunity for an external environmental agent to enter the body

The Law Dictionary: Contact or exposure to a chemical substance by touching, breathing, eating or drinking. 

Journal of Exposure Science and Environmental Epidemiology: event when a person comes into contact with a toxic material.

IPCC: nature and degree to which a system is exposed to significant variations

WHO, & IPCS: Contact between an agent and a target – Exposure does not automatically lead to an internal dose

OSHA: skin, eye, mucous membrane, or parenteral contact with potentially harmful materials that may result from the performance of an employee's duties 

OSHA (disease process, such as TB): in the presence of exhaled breath of infected individuals or in the presence of such individuals in situations where procedures are performed with any potential to develop airborne droplet nuclei.

California Environmental Health Hazard Assessment: transport of chemicals from a source to an individual or population

California EPA: contact by an individual or population with hazards through radiation, inhalation, ingestion or direct skin contact. Contact that does not involve transport of the hazard through an environmental medium is also possible, as when a child ingests chemicals used as plasticizers in pacifiers or lead in paint chips. The duration and frequency of exposures to harmful agents influence adverse outcomes. Exposure may be continuous; discontinuous but regular (e.g., once daily); or intermittent (less than daily, with no standardized, quantitative definition). The magnitude of exposure or dose determines how much of a hazard can be taken up by an individual or population, i.e. bioavailability.

Definition of Bioavailability: degree to which a material in environmental media can be assimilated by an organism, or: The ability of a substance to affect organism.

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