26 June 2014

Institute of Medicine C-123 Agent Orange Committee Audio

The first panel consisted of Wes Carter, representing the C-123 veterans, and Dr. Al Young, discussing the Department of Veterans Affairs. We each had a five minute intro followed by questions from the committee for about an hour. Two other panels followed, with representatives from Sandia Labs, UC Berkeley, Columbia University, Rutgers University and others.

After lunch the committee arranged five-minute open mike sessions. The most interesting and passionate was from Dr. Peter Kahn of Rutgers University, who not only has spent his life as a scientist but was also leader of New Jersey's Agent Orange Commission for years.

To put it mildly, Dr. Kahn took on the VA (not the IOM) for its intransigence. In the recording, his presentation begins at 3:17:00 and runs about four minutes. Also heard is the C-123 representative, Dr. Loren Erickson who is the new director of Pre 9/11 Post-Deployment Health in the VA's Public Health Section, and finally Mr. Rick Weidman, Legislative Director of the Vietnam Veterans of America.

A couple points. As expert listeners will note, VA makes Agent Orange sound innocent...as innocent as kool-aid in the jungles of Guyana as Rev. Jim Jones hands you a cup and says, "Drink this..good for you!" VA has been a defender for VA/Dow/Monsanto for decades and nothing changes. VA has paid $600,000 for a series of reports, some of which were shared with the IOM.

VA materials also wrongly emphasized the refurbishment of the C-123s before use by the Reserve. VA was wrong in submitting photos of C-123 #664 (Ponderous Polly) of the flight deck and the cargo deck, saying and writing that they were taken as the aircraft came out of Dothan AL on return from Vietnam in 1972. Actually, the photos seemed clipped from the Air Heritage Museum's web page and were taken in recent years, not back in 1972.

At least one committee member challenged VA emphasis on the refurbishment of the C-123s, asking if they'd been so thoroughly redone, why did Patches still test so toxic in 1994. I hope the committee understands that the dioxin was more intense in 1972 when we got the first C-123s than when tested decades later. In one of the VA reports the Department stressed the deterioration of dioxin on the Boneyard aircraft by 2010 but in the committee switched and said there would be very little, if any, deterioration and that the 2009 test results should be interpreted to equal what would have been the case in 1972.

Clearly, all the VA cares about is blocking claims. Any way they can!

All the VA's documents are available to review here.
Our responses to VA documents thru June 16 to the IOM are available to review here.
All the materials submitted at the last minute or after the 16th are available here.
We did a super-rush job clipping a video together, seen here.

The first voice at 00:00;00 is the committee chair, Professor Henrick of Harvard. The second is Wes Carter, then Dr. Al Young, followed by questions from the committee, then another panel, etc.

We tried hard, just as we've done for three hard years (so far.) Now the committee meets over the next couple months to complete their report and submit it for review of the National Academies of Science. Expect it to be several hundred pages. It then should be on the Secretary's desk by the end of September and we'll keep pushing for a prompt decision. Any of our pilots or flight engineers would have done better, but I feel I did okay (for an AME.)

Other efforts continue. We're now going to have time to help individual members get their claims and appeals in with supporting information. We have friends in Congress who are pushing VA and its staffers HARD on their illogical position. We have friends in science, and in government, doing the same on our behalf.

What should you be doing?
1. Get your request in to VA for an Agent Orange Registry exam
2. Watch your PSAs
3. Get your claims in for Agent Orange-associated illnesses...benefits date from the application, not when VA approves!
3. Find other C-123 veterans. We have done a miserable job connecting with folks from Pittsburgh and Richenbacker...they are in the same situation as us but need to get in touch with us – I can't believe they simply aren't interested. Their illnesses must be similar to ours, and they even had one or two maintenance folks win their Agent Orange claims on appeal.
4. Have a great summer and take care of yourselves!

VA Mess a Failure in Management

Had Army friends visit Monday evening...had to be on our best behavior and remember this former Ranger would rather eat snakes than the tuna steaks we offered. Good, old friends. Last Thursday had my 14th surgery since leaving Active Duty.

VA Hospital Scandal, Above All, Is
a Failure of Management
by Victor Lipman, Forbes

I’ve followed with grim interest the VA hospital scandal and it seems to me a failure of many things.  Underlying the preventable deaths for patients awaiting care, the endless waiting times for appointments, and the army of veterans (40,000+) who requested appointments and never got them, are multiple failures.  There are failures of government, failures of bureaucracy, failures of communication and failures to care for our veterans – who of course deserve far better.  But at its core I’d argue that this medical train wreck is, above all, a failure of management.

Always interested in management performance, I was struck in particular in this instance by the vast disconnect between the perceived performances of the VA hospital system as a whole and the individuals who are managing the system.   According to the macro-level VA data – the preventable deaths, the chronic slowness, the overall inefficiency – the system appears broken.  Yet contrast this to the consistently glowing performances of the individuals responsible for managing these failing operations.
According to Rep. Jeff Miller (R-Fla.) the chairman of the House Committee on Veterans’ Affairs, whose hearings and comments have been widely reported in the media, of the VA’s 470 senior executives none received the two lowest ratings in the five-grade VA evaluation system over the past four years – while approximately 80 percent received the top two grades for being outstanding or fully successful.  The same percentage, around 80 percent, received performance bonuses last year.
English: Part of the Veterans Administration H...
Photo: Wikipedia
Simply put, this is Lake Wobegon-style management.  One of the Veterans Committee members, Rep. Ann McLane Kuster (D-N.H.), noted wryly that in the VA environment, as humorist Garrison Keillor would say, “all of the children are above average.”
Unfortunately, as shameful and dysfunctional as this sounds, it’s not that wildly different from other management data that is out there.  Harvard Business Review has reported a study indicating that  46 percent of high-level managers perform poorly at holding people accountable.   A Towers Watson study showed that 24 percent of companies awarded bonuses to employees “who fail to meet even the lowest possible performance ranking.”
In short, effective management is plenty difficult – laden with conflict, confrontation and hard painful decisions.   It’s much easier to avoid them than deal directly with them.
But dealing with them, after all, is the job of management.
The VA scandal has saddened me on a personal level as well.   Throughout the early and mid-1990s, I had considerable interaction with the VA system, as my father, a World War II veteran, was in and out of VA hospitals frequently during the final years of his life.  Back then the VA system worked.  We never had trouble getting my father into a facility when he needed it, and the care he received always seemed high quality.   We were grateful for the VA hospitals.  They provided a safety net for those who needed it – and a functional one.
Clearly, in the ensuing years, as Joseph Heller might have said, “Something Happened.”    The VA system I follow in headlines today bears no resemblance to the one I knew two decades ago.
I don’t know exactly what happened.   But one thing I do know is that management plays a vital role in any operation’s integrity and long-term sustainability.   And management needs the fortitude to make hard decisions when required:  to call a spade a spade, to acknowledge problems when they exist, to hold people accountable for fixing them, to remove people when they’re not doing the job, and at all times to communicate honestly and take corrective actions when needed.
In the absence of such candor, management life will be pleasant and conflict-free while it lasts.  But it won’t last.

13 June 2014

Monsanto & Dow Sponsor New Challenges to Veterans' Exposure Claims

Two scientists sponsored by Dow Chemical and Monsanto, the manufacturers of Agent Orange, recently submitted challenges through the Department of Veterans Affairs to an article published in Environmental Research. The peer-reviewed article which Dow and Monsanto challenged reviewed military tests from 1979 through 2009 and concluded C-123 veterans were exposed. This did not sit well with either the VA or the chemical manufacturers.

Given their sponsors, it is no surprise that the Dow and Monsanto challengers eagerly concluded veterans who flew C-123 transports in the decade after Vietnam were unlikely to have been exposed to deadly dioxin.

What upset them was the article from April's Environmental Research by Drs. Peter Lurker, Jeanne Stellman, Richard Clapp and Fred Berman, titled "Post-Vietnam military herbicide exposures in UC-123 Agent Orange spray aircraft." Before publication, the article was reviewed by a critical panel of experts for scientific accuracy, to be accepted as part of the body of scientific literature. Dow and Monsanto's challenge, on the other hand, was a simple letter to the editor, lacking scientific standing.

The transports' spray tanks were removed after the war. Dioxin is a contaminant of Agent Orange used in Vietnam. Many of the veterans' fleet of C-123, were tested repeatedly between 1979-2009 and the lingering dioxin contamination verified in seventeen C-123s. Tests were performed by Air Force and civilian toxicologists. All the planes were retired from service in 1982, and stored in desert HAZMAT quarantine.

After 27 years in quarantine, and concerned about a threatened EPA $3.4 billion fine for illegal HAZMAT storage, the Air Force approved destruction of the toxic aircraft. All were shredded and smelted, and certified as destroyed by Air Force experts, in June of 2010.

Dow and Monsanto's challenge of the Environmental Research's article was needed by the Department of Veterans Affairs. Traditionally, VA has opposed all efforts by veterans to qualify for exposure benefits, a record of intransigence that compelled Congress to enact the 1991 Agent Orange Act and its supporting legal regulations. VA welcomed the effort by Dow and Monsanto, the better to challenge C-123 veterans' claims for Agent Orange benefits. Which is why Congress enacted the 1991 Agent Orange Act.

VA provided the Dow/Monsanto letter to the Institute of Medicine by the Department of Veterans Affairs, which released the scientists' challenge along with some 80 other documents. Unlike the Dow and Monsanto contractors, Lurker et. al. were uncompensated for their research, motivated by their desire to evaluate veterans' exposure experiences aboard the C-123s.

No effort was made, no money was spent, by the Department of Veterans Affairs to sponsor research which would support the C-123 veterans' exposure claims, but several contracts were issued to pay selected consultants to write a series challenges to veterans' claims. Post Deployment Health immediately denied any Agent Orange exposure when C-123 veterans first approached with the question in 2011, and ever effort by VA since then has been to block all evidence which supports veterans claims.

07 June 2014

VA Scolded For Ignoring VA Manuals

An Army vet claiming non-Vietnam Agent Orange exposure successfully challenged the VA for failure to follow the Department's own manual of procedures. We didn't catch this 2012 decision until last week.

In a situation paralleling the C-123 vets, this claim asserted exposure outside Vietnam, but the VA was over-eager in denying the application, opting to refuse it without checking with the Joint Services Records Research Center for verification of the facts.

Here is what the Board of Corrections determined: 
"VA has developed specific procedures to determine whether a veteran was exposed to herbicides if such herbicide exposure is claimed to have occurred in a vicinity other that the Republic of Vietnam, the demilitarized zone (DMZ) in Korea, or Thailand. VA's Adjudication Procedure Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C, para 10(n) directs that the Veteran should be asked to provide the approximate dates, locations, and nature of the alleged exposure. The paragraph further directs that if the Veteran provides such information, then the Veteran's detailed description of the exposure should be furnished to the Compensation and Pension (C&P) Service via e-mail at VAVBAWAS/CO/211- /AGENTORANGE, and request that they review the Department of Defense's (DOD's) inventory of herbicides operations to determine whether herbicide were used as alleged. The paragraph further directs that if C&P's review confirms that herbicides were used as alleged, then determine whether service connection is otherwise in order. But if that review does not confirm that herbicides were used as alleged, in other words that the exposure is not verified by the C&P Service's review, then the RO is to submit a request to the U.S. Army and Joint Services Records Research Center (JSRRC or USASRRC) for their verification of the Veteran's exposure to herbicides as alleged. With respect to the claimed exposure to herbicides at Fort Ord, California, and at Anderson Air Force Base in Guam, review of the claims file reflects that the RO has not applied the procedure for verification of exposure to herbicides as directed by M21-1MR, Part IV, Subpart ii, Chapter 2, Section C, para 10(n). Evidentiary development procedures provided in the Adjudication Procedure Manual are binding. See Patton v. West, 12 Vet. App. 272, 282 (1999) (holding that the Board failed to comply with the duty-to-assist requirement when it failed to remand the case for compliance with the evidentiary development called for by M21-1). As such, the Board finds that the RO must develop the claim in a manner consistent with the above provisions. Accordingly, the case is REMANDED."
Congratulations to this veterans and the BVA for a good call on VBA mismanagement! The claim denial was an obvious mistake, revealing VA's determination to block claims whenever possible. To "draw the line" with C-123 vets, VA simply blocked the JSRRC from providing relevant information to keep DOD from confirming our claims. VA also attacked us by classifying our aircraft contamination as unable to have exposed us to the Agent Orange. For insurance, VA promised, then reversed, a decision to refer our issue to the Institute of Medicine.

VA then stalled, letting us fade from the scene through deaths and distractions. Finally, faced with mounting scientific challenges, VA submitted the C-123 problem to the Institute of Medicine which began its investigation in February, and an expected report to the Secretary of Veterans Affairs in September.

But this, too, was just another attack on us. VA carefully worded its assignment to the committee to prevent any possible response which could clarify our right to proper claim evaluation.

The law simply requires that veterans without Vietnam service submit proof of exposure. But the VA asked the IOM to determine the degree of harm, if any, that our duty on the airplanes caused us. Whatever answer the IOM provides is irrelevant: VA is going to continue blocking C-123 exposure claims by insisting we weren't exposed under their definition of that word.

Some good news came Friday. VA was blocking the DOD Joint Services Records Research Center from correcting earlier mistakes about C-123 claims, and from forwarding proofs of our exposure from other federal agencies. Friday, this changed.

Friday, this changed and VA will now accept JSRRC data about veterans along with information about us from the US Public Health Service, CDC, EPA and other authorities. This can help...we'll see over the next few months.

Veterans' Toughest Battle

05 June 2014

US Attorney Caught Flat-Footed: Denies VA has documents VA already released to IOM

On June 3 Assistant US Attorney Kidwell for the District of Columbia was a little off her
game when presenting to the US District Court in Civil Action 14-519 her assurances that the Department of Veterans Affairs had posted all of its C-123 documents on their web pages, and informing the Court that no other documents exist. Not her fault, however.

For years, veterans and their advocates had sought via Freedom of Information all the VA's records dealing with C-123 exposures and veterans's claims, to include preparation of their position against the veterans, contracts with outside firms to generate materials against the veterans, solicitation of input from Dow and Monsanto, correspondence, and the rest of their pile of information.

There's just a ton of it, especially dealing with the scheme to redefine exposure, preparation of their 2012 SOT poster and more.

But the VA has repeatedly refused the FOIA, claiming nothing exists. Then they said they'd have to charge $4,800. Then they again said nothing exists. After years of patient waiting, the C-123 Veterans Association, represented by the firm of Davis Wright Tremaine, filed suit and forced both the AF and VA to respond. Both agencies told the court they'd "try" to have significant amounts of available documents released by the end of May in time for the Institute of Medicine meetings. Never happened...big surprise.

On June 3, Ms. Kidwell filed her response to the Court insisting the VA documents we'd been asked to wait for actually do not exist. Nada.

But perhaps Ms. Kidwell was unaware of the list of 87 documents VA months earlier submitted to the IOM (but continued to withhold from the veterans.) Perhaps VA forgot to tell her. Perhaps VA preferred not to tell her...or us.

Perhaps VA feels somehow special, regarding its obligation to follow the FOIA just as it feels special or exempt in opting not to follow the 1991 Agent Orange Act & Title 38.

VA certainly has special people, but most of them are in scrubs and delivering the health care we're so grateful for. VA's other ranks don't seem to reflect the same standards of honor, honesty, service, compassion, and other values we would prefer to associate with everyone in government service. Sadly, there is little in recent months and years to show the quality in the staff at 810 Vermont reflects the high standards set by the Departments' front-line practitioners.

Dow and Monsanto Issue New Defenses of Agent Orange

In papers recently released by the Department of Veterans Affairs (although earlier withheld against Freedom of Information Act requests by stating no such documentation exists,) an article was identified as authored by scientists sponsored by Dow and Monsanto, the wartime manufacturers of Agent Orange. Veterans might recall that Dow and Monsanto are quite defensive when questions arise about their role spreading the toxin worldwide, and their money continues to be spread about to defend themselves.

Authors Ginevan and Ross were retained to focus on the Stellman finding which confirms the C-123 veterans' exposure, and the subsequent Committee of Concerned Scientists and Physicians letter reaching the same conclusion. The chemical firms' writers attack the science used by the independent and unpaid experts...unsuccessfully!

The only news here is that Dow and Monsanto are still spending money whenever and wherever
they can challenge any veterans' hopes of receiving VA medical care for Agent Orange illnesses.