C-123 Veterans 5th Submission to JSRRC

As we promised JSRRC during our conversation this morning, the C-123 veterans' collection of official  USAF, GSA, EPA, NIH, CDC/ATSDR and other government agency documentation establishing our aircraft contamination and exposure to veterans therein was submitted, along with 17MB of specific data...much more data exists to prove the point, but in an effort to respond to Mr. Baldini's request only a representative document was included to address each of the JSRRC questions.

---our letter to JSRRC-----

Dear Mr. Baldini,

Thank you again for your wake-up call this morning…nice to know we are on your list. Our little group of veterans is grateful for the opportunity to detail our issues before the JSRRC.

The fundamentals of our issue are simple. The C-123 aircraft we flew included many ships which previously sprayed Agent Orange in Vietnam. These airplanes remained contaminated through their destruction as toxic waste in 2010. The airplanes’ contamination resulted in exposure to dioxin (TCDD) of the aircrews, maintenance and aerial port personnel assigned to them.

In an earlier conversation with you, we discussed the fact that a wing’s flying squadrons had assigned to them their own crews, and attached to them for flying duties were other wing personnel such as flight surgeons, flying crew chiefs, aeromedical evacuation crews – these personnel would show formal assignment to their units with attachment to the flying squadron for flying duties. If this needs clarification please contact any Air Force unit. We need JSRRC not to contest a situation where, perhaps, a flight surgeon assigned to the 439^th Tactical Hospital, will also claim to be attached to the 731^st TAS for flying duties and thus part of the population we address. Let the veteran’s own official documentation, such as flight orders, address that peculiarity.

As to an individual veteran’s claims, we can leave it to the individual to establish duties with the aircraft using flight orders, Form 5s, or other documentation. Our concern here is to make clear that the aircraft were contaminated and the veterans exposed, in order that JSRRC might more completely advise the VA when queried.

The first element of the issue is the history of the C-123 aircraft which were used for Ranch Hand. In general, this is established by the 2011 report from Ms. Betty Kennedy[1], AFRC/HO who explained “The C-123 aircraft in the 731^st TAS fleet had been used to dispense chemical defoliants over Southeast Asia during the Vietnam War.” Further details of specific aircraft are provided by the AMARC list of C-123 aircraft tested and eventually destroyed and other commonly available lists of C-123 aircraft that flew in Vietnam.[2]

The second element is to establish the contamination by military herbicides of C-123 aircraft flown in Vietnam and also flown by post-Vietnam squadrons. Only one aircraft had extensive documentation of such testing, Tail #362, and detailed in two toxicological exams performed by the USAF Armstrong Labs in 1979[3] and 1994[4].

Both tests confirmed “military herbicides” with the 1994 test characterizing the airplane as “heavily contaminated on all test surfaces” utilizing standard test techniques. It confirmed contamination by dioxin, but dioxin was not tested for in the 1979 test. The aircraft was subsequently decontaminated to permit restoration.

This aircraft is identified in the HA AFRC/HO report as assigned to the 731^st TAS during the period 1972-1982. Six to eleven other former spray aircraft were also assigned.

Other C-123 aircraft assigned to the 731^st were not tested for contamination until many years later, after long years of storage at Davis-Monthan AFB AZ, and all still reported between trace and low levels of dioxin contamination.[5] All were quarantined in HAZMAT storage in 1997.[6] Testing was accomplished many times between the 1982 date most entered AMARC storage and their 2010 destruction, with either trace or low levels of contamination remaining on about half of the aircraft. 42% of the C-123 aircraft remaining in USAF inventory in 1982, upon their retirement, were Ranch Hand aircraft.

The remaining issue is actual exposure to “military herbicides.” No mention is made in law nor C.F.R.s regarding the amount of exposure, the duration of exposure, the type of exposure, nor any other qualification…only the word “exposure.” In every other instance, the US Government has treated contamination issues to have also been exposure issues, but in this instance the VA has merely allowed that some contamination might have remained on the airplanes but that no exposure could have occurred. Again, there is no qualification in the law regarding how much contamination. VA seems fixated on the "years after their service" before the planes were tested, and "sophisticated testing" - yet only standard tests were performed, nothing special required.

When VA promulgated its herbicide presumption in 2001, the issue of herbicide exposure outside Vietnam was also addressed.  66 Fed. Reg. 23166 (May 8, 2001).  VA explained if a veteran did not serve in Vietnam but was exposed to an herbicide agent defined in 38 C.F.R. §3.307(a)(6) during active military service and has a disease on the list of presumptive service connection (which includes diabetes mellitus type II and ischemic heart disease), VA will presume that the disease is due to the exposure of herbicides.  See 66 Fed. Reg. 23166; 38 C.F.R. §3.309(e).[7]

When asked, an executive of the EPA reminded me of the simple definition, both scientific and generic, of “exposure” which is “the contact between a chemical or biological agent and the outer boundary of an organism.” Thus, we prove our claim to exposure…our skin came into contact with what even the VA suggests is “dry dioxin” and thus led to contamination. Experts other than the VA, experts who do not have a mindset to automatically deny veterans’ claims, dispute the VA’s literature review which led to the VA opting to refuse service connection and decry it as “unscientific.”

Mr. Baldini, the veterans of the C-123 Veterans Association have done as asked of us this morning: we have identified official government documents detailing our C-123 aircraft fleet’s Vietnam service. We have identified official government documents detailing the contamination of the C-123 fleet, based on the only aircraft extensively tested over a long period of time and which remains existent at the USAF Museum, while nearly all others were destroyed as toxic waste. And finally, we have identified numerous government documents from a variety of federal agencies that confirm specifically that C-123 veterans were exposed to military herbicides aboard the contaminated C-123 fleet. Not detailed here are numerous independent scientific opinions submitted to JSRRC earlier from reputable institutions such as Columbia University and University of Texas Medical School reaching the same conclusion.

I trust we have fulfilled your assignment given me this morning. The many gigabytes of official USAF, EPA, CDC, NIH and GSA information in the DVDs submitted to you last month and in print since 2011 go into this with even far greater detail, with numerous additional supporting official documents all reaching the same conclusion. Many of these experts are members of the National Academy of Sciences, Institute of Medicine, well-qualified to address this issue even though not perhaps part of your examining of the issue. Still, you can see there is a general agreement in science and medicine regarding our claims.

If JSRRC for some reason, despite these official documents and the others submitted to you over the years, remains unconvinced that the VA should be informed that our veterans were exposed aboard the contaminated C-123 aircraft, I can only suggest you contact the following federal or state officials, each of whom has already provided their agency’s conclusion in confirmation of our exposure claims:

a.     Dr. Linda Birnbaum, Director, National Toxicology Program and Director, National Institute of Environmental Health Sciences “According to the narrative [the 1979 & 1994 USAF tests], exposure is assumed based on wipe-tests demonstrating high dioxin concentrations in the C-123K’s.”[8]

b.     Dr. Tom Sinks, Deputy Director, CDC/Agency for Toxic Substances and Disease Registry “I believe aircrews operating in this, and similar, environments were exposed to TCDD.”[9]

c.     Dr. Fred Berman, Director Toxicology Program. Oregon Health Sciences University (State of Oregon), “It is my professional opinion that Major Wesley Carter (and likely, other aircrew veterans who flew these aircraft in the same time period) was exposed to harmful levels of dioxin the course of his aircrew duties.”[10]

I cannot imagine if there was this volume of evidence that somehow existed to argue against our claim, how we could possibly persuade. That’s not the situation however. Instead, we submit gigabytes of confirming evidence. Official government historical record and agency opinions and qualified independent expert opinion…and lots of it.

How much additional confirming proof could JSRRC possibly require? How much additional evidence should any veteran be required to research himself to provide to JSRRC and the Department of Veterans Affairs to receive medical care for the hazards of military service long-ago concluded? The airplane was contaminated. We were exposed. We call upon JSRRC to say so.

The VA can make its call on whether we meet their requirements, but they should not do so based on an inaccurate or misinformed JSRRC response.

I trust that JSRRC will consider that the twenty years of official USAF descriptions by staff officers, general officers, heads of agency, GSA, the Air Staff and Judge Advocates General attorneys of these C-123s as “the Agent Orange airplanes” did not change until 2011 with the first C-123 veteran’s Agent Orange exposure claim.

Respectfully,

/s/  Wesley T. Carter, Major, USAF Retired

Air Force Report - A Glimmer of Hope?

Sometimes, writers say what must be said in oblique phrases when more direct wording cannot be used. Reading carefully, perhaps we can find a glimmer of hopeful news in the USAFSAM April 27, 2012 report, which was briefed to Senator Burr's staff and C-123 veterans on Wednesday, 11 July.

The Air Force said in the Executive Summary that USAFSAM was unable to make accurate quantitative estimates of individual exposures. They also concluded the two groups dealt with (occupational and general population) were "unlikely to have exceeded acceptable regulatory standards for dioxin exposure."

We can work with this. Very importantly, both the report and the briefers from the AF Surgeon's office stress that USAFSAM was unable to quantify individual exposure...but they allow us hope from two perspectives:

• individuals can actually use elements of this report to establish one's probable individual dioxin exposure
• individuals can further use the report to stablish both cumulative and simultaneous exposure to dioxin by all three routes (ingestion, inhalation and dermal), and then reference several supporting reports (Weisman/Porter, Conway, ATSDR) to establish contamination, then reference ATSDR, Stellman, Berman, and Dr. John Doull. Doull's "Acceptable Levels of Dioxin Contamination in an Office Building Following a Transformer Fire, Doull makes the point that exposures can be cumulative, and can be simultaneous (dermal at the same time as inhalation and ingestion). If exposures are simultaneous such as while aboard the C-123, Doull states "the associated risks will increase by a factor of 2 with the assumption of a linear dose-response relation at low doses." This means the Air Force report and its opinion that crews "were unlikely to have exceeded acceptable regulatory standards for dioxin exposure" can be argued with the fact that we've actually had TWICE the dosage the AF estimates.

As this writer sees it, we presently cannot seek presumptive connection as a group of aircrew, maintenance or aerial port veterans. But...we can and should proceed with individual claims for Agent Orange benefits. The important thing is to reach the threshold of "as likely to as not", and to stress that the benefit of the doubt is supposed to rest in the veteran's favor.

This might be the formula by which we can proceed with our claims. And remember, you will do much better if represented by one of the dedicated professionals from the American Legion, VFW, Vietnam Veterans of America, etc. Veterans need not be members of any group - these service organizations represent any and all veterans who approach them for assistance and do so expertly, without charge!

• establish proof of diagnosis for a typical Agent Orange illness(s)
• establish the contamination of the aircraft (Weisman/Porter, Porter, etc all do that)
• provide nexus letters from your physician stating the illness is "as likely to as not" to be associated with your dioxin exposure(s)
• provide numerous scientific and medical opinions as to the likelihood of your individual exposure to the dioxin-contaminated C-123 (remember: both contamination and exposure must be proved to at least a 50% possibility)
• try to obtain expert Independent Scientific Opinions from toxicologists or epidemiologists in your own state; approach medical schools and universities in your area
• try to obtain support from state-level professional societies, such as the Society of Toxicologists, state medical board, etc.
• And Most Importantly - get a claim in as soon as possible! Any benefits will likely date from the date your application is received by the VA. 

Have faith. We have friends working on our behalf!

USAF School of Aerospace Medicine Releases C-123 Agent Orange Letter

The Commander, USAF School of Aerospace Medicine has finally released the long-awaited examination of the C-123 Agent Orange contamination issue and it is totally lackluster! A buck-passer. Actually, a stab in the back of all C-123 veterans! (update: on 18 Jun 2015 VA agreed with the Institute of Medicine that this USAF report was scientifically and mathematically flawed)

The USAFSAM spent several months looking over earlier toxicologist's testing of the C-123 fleet, particularly Patches (Tail #362) which had the most documented contamination by dioxin left over from Operation Ranch Hand in Vietnam. Released by the unit's commander, a physician, no note is made of the individual researchers who worked on the study, unlike most other such reports. 
For our veterans, this is a tremendous disappointment. The errors abound and are certain to be brought up in other forums, particularly the Senate and the VA itself.
Here's our take on the report. First, it is not new science or research, but rather an examination of earlier tests and reports because all the subject aircraft have been destroyed - because they were toxic! The report is written by a physician, not a scientist. If there were professional toxicologists or other scientists, their names were left off the report. Our points are:

1. The report fails to state that the ten years exposure inside the aircraft for the crews would be more harmful than levels of TCDD as detected twelve and 27 years after the airplanes retired - one should assume, though here they did not, that contamination was more intense in the years before authoritative testing was done

2. The report does give some wiggle room, if they'd use it, for the VA and the IOM to provide benefit of the doubt for crews. In the Blue Water Navy situation the VA went with the IOM simply because of the IOM statement that sailor's exposure couldn't be ruled out - here, the contamination is confirmed but a misleading conclusion invented out of the true facts to offer a pretense that exposure, miraculously, wasn't likely to be damaging in the long-term. This will be interesting news to the world's toxicologists!

3. Great weight is given the results of the 2009 tests conducted at Davis-Monthan, yet the author of that report told veterans that no conclusions should be drawn regarding dioxin exposure from his data. Further, even those tests confirm TCDD presence - 27 years after the aircraft were stored in the Arizona desert. Again, one reasonable conclusion would be that those 27 years in storage, preceded by ten years of our flying, allowed TCDD to degrade and allowed the TCDD to be released via wind and rain (which freely enters this old aircraft - famously, the crews wore raincoats flying it especially in the cargo area!) No report specifies the degree of contamination which existed in 1972 when stateside crews started flying these aircraft - no attempt was made to provide a retrospective analysis of the earlier levels of our exposure

4. The 1994 and 1996 Air Force tests, done by the military's own toxicologists, are mentioned but dismissed. Here, an excuse to discard these early results was the cautious statement by the researchers that further testing would be necessary to fully characterize the contamination - logical enough but not an excuse to dismiss the results! These original 1994 researchers did, very clearly, establish to their professional satisfaction the fact that the cabin and flight deck were "heavily contaminated" on 100% of their test surfaces, and this damning characterization was noted in today's release - then dismissed without justification

5. No mention is given of the testimony of Dr. Ron Porter, AF toxicologist from the AF Armstrong Labs who also co-authored the 1994 and 1996 tests, where he swore under oath the C-123 fleet was "a danger to public health" such that they couldn't be used or sold

6. No mention is made of the fact that Patches at the Air Force Museum took three separate decontamination procedures before it was reasonably safe to place inside the facility - but crews flew this specific aircraft for a decade, over twelve years before this testing - and others in the fleet were even more contaminated!

7. No weight is given to the fact that contamination of the C-123 would have to be more intense as post-Vietnam crews began flying them in 1972, and more intense before the veterans' own repeated efforts to decontaminate the airplane - many AF documents detail the early scrapping and washing of Patches and the other aircraft, removing gooey black substances, scrubbing with Dawn detergent as directed by AFMC Warner-Robbins - the airplanes would necessarily then have been more contaminated in 1972 before any testing which was first done in 1979 (and that was not a test for dioxin, only military herbicides which were confirmed to be present)

8. No mention is made of the ATSDR letter nor are the points of Dr. Sink's letter dealt with. He says the AF and VA have both contacted him and wishes the C-123 veterans "good luck", and stands behind his letter

9. And the big point: The report says not enough data could be located to draw a conclusion about aircrew exposure, but still it draws the conclusion that the aircrews were not exposed to enough for long-term health problems. This is a set of statements 180 degrees apart from one another
10. Various laws dealing with exposure to agents used in Vietnam generally group them as "military herbicides" - every single test done on these aged airplanes has confirmed the contamination of them by "military herbicides" - a fact not even touched upon in today's reports

C-123 veterans believe the AF is justifiably concerned about earlier sales of the C-123s to Disney Films and to South Korea and Thailand through the AF Security Assistance Center at Wright-Patterson. A bit embarrassing to tell another government we sold them dioxin-contaminated airplanes. This report has chewed over what old data could be uncovered, dismissed the military's own test conclusions, and constructed a denial of the aircraft even being contaminated!

Why didn't they simply say enough doubt exists to extend the benefit of the doubt, or clearly state there is a possibility, through remote to some degree, of aircrew exposure?

C-123 veterans agree with the report's conclusions that it would be virtually impossible for patients, paratroops, cargo attendants, and other passengers to have had any exposure. Veterans, however, feel strongly that the aircrews, maintainers and aerial port personnel absolutely were exposed.

Colonel Christian Benjamin, USAF MC CFS

Tell us, Colonel Benjamin. If these aircraft were being delivered to AFMC today, would you find them airworthy and safe for flight? Would any of these veterans' illnesses today been less likely to manifest themselves if they hadn't been exposed to such long-term duties aboard this "danger to public health?"

Frankly, this report smells of VA editing all over the place. Unwarranted assumptions are injected to construct an artifice that denies aircrew exposure, and obvious facts are ignored.  Maybe USAFSAM and AFMC leadership should have added their signatures to Colonel Benjamin's. Should USAFSAM welcome VA into to the Wright-Patterson blue-suit "Band of Brothers?"

March 8 Meeting with VA Officials & Sen. Burr's staff:

---more from notes about Thursday's meeting---

But first, unending thanks to Dr. Jeanne Stellman who joined us for the meeting in Washington DC. A powerful voice from a gracious lady and esteemed supporter of veterans' issues, bringing 30 years expertise to the discussion!

Senator Burr of North Carolina, ranking member Senate
Veterans Committee

We had our meeting with VA's Health Benefits Administration in the Hart Senate Office Building, hosted by Sen. Burr's staff, with the following results:
1. the C-123 aircrew/maintainers dioxin exposure issue will be referred to the Institute of Medicine for a special report, hopefully ready by the end of 2012 (note...this promise was broken and unfulfilled for three more years.) VA will prepare a Statement of Work (SOW) without outside input, but IOM will conduct public meetings soliciting comment
2. VA reassured C-123 veterans our herbicide exposure poses no risk to health
3. VA stated no medical care will be allowed even on a presumptive eligibility basis for AO-presumtive illnesses (unless the veteran is otherwise eligible)
4. benefits claims now in for C-123 aircrews and maintainers will most likely be denied
5. VA assured veterans that the Agency for Toxic Substances and Disease Registry letter of 26 Jan 2012 has no particular relevance to benefits eligibility of veterans as it was provided outside the realm of the VA itself; apparently, "its the VA's ball" - other government agencies' rulings have no impact on VA refusal to provide veterans' medical care
6. VA defends their apparent "not enough dioxin to harm" newly created threshold, never before established by any US government agency
7. VA didn't realize only about 1500 aircrew and maintenance personnel are involved in this issue, expecting the numbers to be higher
8. VA defended their earlier challenges to and dismissal of the 1979 Conway survey of Patches and the 1994 Weisman/Porter survey of Patches, saying use of standard swipe protocol resulted in inaccurate findings and thus no veterans were affected by either inhalation, ingestion or dermal routes of exposure

9. other than the suggested IOM referral, not a single suggestion was made by the VA, whose duty it is to assist veterans in presenting their claims, to help us present our claims; we were struck by the fact not a single note was taken by them of points we felt important to bring to the discussion

10. one VA official likened our exposure during 1972-1982 to her traveling as a 1976 passenger in Army trucks which may have been used earlier in Vietnam

11. VA agreed it will be appropriate for IOM to form a retrospective view of Patches prior to the 1979 Conway report, as dioxin contamination levels are likely to be higher in the earlier years

74AES Flight Nurses: "not enough
dioxin" to hurt them or their
children--VA

12. VA likened the requirement for employees at Davis-Monthan AFB to wear HAZMAT protection around the quarantined C-123K fleet to the "hysteria" of recent civilian water contamination 

13. the expected USAF School of Aerospace Medicine report wasn't presented, and apparently isn't quite ready for either discussion or presentation - aircrews certainly hope that USAFSAM will take a hard stand confirming our exposure, and that at the very least since they cannot direct VA to provide care, USAF should declare that the aircraft were unsafe to fly during the years we had them, and would certainly be awarded an unsafe to fly designation today

In an outside, casual conversation, making our suggestion that our benefits applications are being stalled to prevent appeals progressing to the more public forum offered by BVA and other courts was not challenged... the VA official simply smiled. The oldest claim we can identify among our veterans is one year old, other than those denied years earlier by BVA due to veterans' inability to identify specific tail numbers of AO-spray aircraft and inability to prove lingering contamination. Note: both such proofs released by the USAF via FOIA in May 2011, but not available to the veterans before their claims were denied in 2007. It is to be expected that claims henceforth will continue to be denied, but with newer reasons created to cite as justification as the old ones are now invalid.

Our thanks to leadership of the American Legion, which hosted us on Wednesday in preparation for the VA meeting. American Legion is solidly behind us and, we hope, will be presenting a resolution to their Spring conference. Also, thanks to Dr. Jeanne Stellman of Columbia University's Mailman School of Public Health, and Dr. Fred Berman of Oregon Health Sciences University who presented expert support during Thursday's conference. Both experts generously contributed their time and expertise to supporting our presentation.

Your guy in DC!

Oregon Health Sciences University - NEW C-123 exposure confirmation

Today the Secretary of Veterans Affairs was sent an Independent Scientific Opinion from Oregon Health Sciences University. In this expert opinion, Dr. Fred Berman concludes that C-123 aircrews flew aboard aircraft were indeed contaminated as per the 1994 Air Force tests (Porter/Weisman), and that exposure occurred within these "heavily contaminated" airplanes!

Dr. Berman agrees that the VA's announcement dismissing our Agent Orange exposure claim was incorrect, and that aircrews "were more likely to than not" subjected to AO-presumptive illnesses caused by the dioxin exposure.

The VA has claimed there wasn't even any exposure! This is in denial of multiple Air Force tests, reviewed and accepted by other federal agencies and universities, all which say there WAS both exposure and crew contamination.

What's it take? Gold tablets from Heaven?

US AGENCY FOR TOXIC SUBSTANCES & DISEASE REGISTRATION Examines C-123 Agent Orange Issue

received today, addressed to me from the Department of Health and Human Services Public Health Service. Certainly a polite letter but its value will only be felt if VA and DOD officials will, in turn, consider it. There is no doubt as to the accuracy of our AO claim, just the struggle to get those whose job it is to automatically deny such claims to yield in their position...just a little.

Dear Major Carter,


Thank you for your recent correspondence. Your letter refers to airmen and flight nurses who flew C-123K/UC-123K Provider aircraft from 1972 through 1982. You state that their service led to exposures to Agent Orange (AO). You state that they operated aircraft that had not been properly decontaminated after serving in Vietnam and spraying AO during operation Ranch Hand. Your correspondence includes substantial information to support your claim.


You ask that the Agency for Toxic Substances and Disease Registry (ATSDR) provide emergency assistance by recommending that the Department of Defense (DOD) designate these contaminated aircraft as Agent Orange Exposure Sites. I understand that the Department of Defense does evaluate information of this type and determine if an AO exposure occurred. Should DOD conform past AO exposures, the US Department of Veterans Administration (VA) applies this designation in determining a service connected illness. ATSDR has forwarded your information to the VA and requested that it be forwarded to the appropriate office in DOD.


Your letter concluded in stating that VA will automatically deny any Agent Orange exposure claim by a veteran without service in Vietnam. The VA's website provides the presumptive service connection for AO has been extended to veterans deployed in the Korean Demilitarized Zone between April 1 1968 and August 31 1971. In addition, veterans involved in duty on or near the perimeters of military bases in Thailand may qualify for benefits. These veterans must show on a factual basis that they were exposed to herbicides between February 28 1961 and May 7 1975. 


The effort made by you and your colleagues to collect this information is remarkable. I greatly appreciate the service you and your colleagues have given our country. I believe the information you have provided should be carefully considered by the Department of Defense.


Sincerely,


/signed/
Chris Porter, Ph.D.
Director, National Center for Environmental Health, and
Agency for Toxic Substances and Disease Registry