Art Chadwell had been back from Vietnam for 18 months when he and his wife-to-be Kathryn first met. Even then, in 1967, she noticed he had problems with peeling skin, hard lumps and a lot of joint pain. He trembled all the time, she recalled.
"He knew something was going on," Kathryn said. "But he didn't know what it was."
Chadwell, who moved from Tacoma, Washington, to Dover in 1956, was a loadmaster on a variety of airplanes, including the C-123. The prop-driven cargo plane was a major player in the Vietnam War's Operation Ranch Hand, an 11-year program of chemical defoliation aimed at denying the enemy cover and food. One of the chemical defoliants sprayed across the jungle came to be known as Agent Orange, named for the orange stripe painted on the 55-gallon containers.
As a loadmaster, Chadwell had a lot of contact with the military-grade herbicide, which contained the highly toxic compound dioxin, an unintentional byproduct of the manufacturing process that causes skin lesions in the short term and is classified by the World Health Organization as a "known human carcinogen."
"He was heavily exposed to the Agent Orange in the aircraft and on the ground," Kathryn said in her soft Tennessee drawl. "But they told him it was safe. He told me that the men even took rags and used the Agent Orange to clean their tools, with their bare hands. That's how heavily exposed he was to it."
Over the years – the couple spent most of their 28 years together in Bridgeville – Chadwell's condition sometimes improved, though he suffered frequent skin infections, some of which had to be cut away. Losing weight and becoming jaundiced, he visited a Department of Veterans Affairs doctor in April 1996. The news was heart-stopping: Chadwell had developed pancreatic cancer. Six months later, he was dead. Arthur C. Chadwell was 51.
For much of the next two decades, Kathryn tried and failed to get the government to acknowledge that Agent Orange had caused his cancer, despite the efforts of the Vietnam Veterans of America and, beginning in 2012, a Bethesda, Maryland, national law firm that specializes in compensation cases before VA.
Then, in April, she opened a letter from the VA containing a copy of a decision by the Board of Veterans' Appeals, or BVA. She could hardly believe what she read: "The Board finds that service connection for the cause of this Veteran's death due to herbicide exposure in service is warranted."
"After 181/2 years, I was so stunned that I had to read it, like, six times before I believed it," Kathryn said during a recent interview. "I just knew there was something in the verbiage that I was missing."
For Kathryn, who'd never worked outside their home and suffered financial hardship following Art's death, the decision should mean the ability to live out her life more comfortably, said Joe Moore, an attorney with Bergmann & Moore, the firm that took up her case. The decision is also important news for others who have been similarly afflicted, or who lost a spouse to the disease, he said.
"This case isn't precedential," Moore said. "This case doesn't, unfortunately, add this cancer to the presumptive list. But if veterans and their families hear about the fact that pancreatic cancer can be service-connected due to Agent Orange exposure, they won't give up."
The Chadwell decision, he said, will show them the way.
"This is a road map right here," Moore said. "It's telling someone else exactly what they have to do to win service connection for pancreatic cancer."
VA presumes exposure to herbicides for all who served in Vietnam from 1962 to 1975. The agency recognizes only 14 diseases – Parkinson's disease is one – as being associated with Agent Orange exposure and eligible for compensation benefits.
Pancreatic cancer is not on the list. The Institute of Medicine has found there is "inadequate or insufficient evidence" of an association between the defoliant and pancreatic cancer.
Still, exposed veterans with diseases not on the list have the right to argue their case and may be eligible for compensation "if they show on a factual basis that they were exposed," VA says. Prevailing in this case, the BVA said, required medical evidence or, in some circumstances, competent lay evidence of in-service occurrence or aggravation of a disease or injury leading to death; and a "competent medical evidence" connecting the two.
The key to the Chadwell decision, Moore said, was the oncologist who provided the expert medical opinion for the case. Maxwell M. Krem, a board-certified VA physician, pointed out that no epidemiologic studies of Agent Orange and pancreatic cancer have been conducted. Instead, he based his opinion on published studies that "strongly suggest" the herbicide increases pancreatic cancer risk.
"It is at least as likely as not, and possibly more likely than not, that Agent Orange actively promotes the [development] of pancreatic cancer," Krem wrote, adding that Chadwell's heavy smoking, which began in the service, "definitely contributed" to the cancer and his death. He also noted that another VA doctor's 2009 opinion that led to the initial VA rejection of the claim, less than half a page long, did not discuss the literature reviewed, did not provide a rationale and failed to note Chadwell's history of smoking. The BVA agreed, calling it "less probative" than Krem's report.
Chadwell had no family history of pancreatic cancer.
A big, strong man who drove semis for a living, Chadwell's condition seemed to improve about five years after he met Kathryn, she said. Despite his physical problems, she said, he never lost his sense of humor. "Always jokin'," she said. "Kept us laughing."
He was also "very patriotic," she said. But in the early 1980s, with the joint pain becoming more acute, particularly in his ankles and knees, she said Art came to suspect his issues might be related to heavy exposure to Agent Orange. In 1982, he signed up with the VA's Agent Orange Registry, established in 1978 to index medical exams of veterans who were exposed to the defoliant.
"They told him at the time that they couldn't really find anything wrong with him," she said.
Pancreatic cancer is rarely diagnosed early and spreads rapidly; more than 83 percent of those diagnosed with the disease in 2015 will die, the American Cancer Society said. After he was diagnosed in April 1996, Chadwell underwent a series of procedures. In late August, doctors performed a bypass operation and looked to see if the tumor could be removed.
It was too late. "It had already spread to the liver and the lymph nodes," Kathryn said. "He never came home from the surgery."
She had no idea, she said, that she'd spend the next 16 years trying to resolve the true cause of his death. Moore said he was astounded by her perseverance.
"Amazing," he said. "She's an amazing woman. And doing that after losing her husband ... she's been through so much for something that her country pretty obviously owed her."