Veterans Appeals Delayed Years – Whistleblower Suggests Leadership Issues

News | October 2014

By Sandra Basu, US Medicine, The Voice of Federal Medicine

WASHINGTON — A VA whistleblower told lawmakers last month that veterans’ cases waited hundreds of days for a final decision at the Board of Veterans’ Appeals, even though some of them required nothing but a signature to be completed.

“Most of the cases involved decisions on appeals of waiting veterans that already had been prepared by board attorneys,” VA Board of Veterans’ Appeals (VBA) Senior Counsel Kelli Kordich told lawmakers in written testimony last month.

Lawmakers were flabbergasted by the delays, with Rep. Phil Roe (R-TN) incredulous that someone might be waiting more than 600 days for his or her disability claims case to be resolved in the appeals process.

“I have to go home and look at one my colleagues who served in Vietnam … did that for our country and they are waiting for somebody to take … their pen and sign a chart?” Roe asked.

Kordich agreed that cases shouldn’t take “200 days or 606 days,” to complete, suggesting there was a leadership problem at the BVA.

Kordich made her accusations at a hearing held last month by the House Veterans’ Affairs subcommittee, where Laura Eskenazi, VBA Executive in Charge/Vice Chairman of the Board of Veterans’ Appeals, also testified.

Secretary's Promise to Veterans of All Conflicts

We will not let our Veterans languish without hope for service-connected disabilities resulting from their service. (then-Secretary Shinseki, August 2010)

C-123 veterans have not only been "languishing," but have been actively opposed in our seeking medical care for proven exposures. ("We cannot permit C-123 claims." "We have to draw the line somewhere." - VA Public Health Post Deployment Health)

VA has even redefined exposure to its own purposes to prevent exposure claims, and disregarded obligations repeated three times in the Federal Register to treat all veterans exposed to military herbicides with presumptive service connection.

How VA "Helps" Veterans' Appointment Lists – By Denying or Delaying Other Veterans' Claims

How VA Games Their Claims System:

 "We have to draw the line somewhere." (VA VHA official quoted by AP)

VA's Veterans Benefits Administration and Veterans Health Administration skillfully developed their own solution to a mutual problem long ago.With hospital appointment lines long, budgets constrained, staff overburdened, and a too-visible claims delay backlog...lightbulbs went off over the heads of staffers from these separate but related functions of the VA.

(note below: advantages favor VA, disadvantages favor veterans)

A. The VA Delayed Claims Solution: Deny claims (as often as possible for whatever reason comes to mind (legal or not) but not right away...wait out as long as possible until the time stamp on the claim starts getting visibility for being too long delayed,) then deny the claim.

• Advantage: many vets give up at this point or die off. 

• Advantage: VA continues to deny all medical care and benefits for a year or more, with great savings and shorter appointment lists

• Disadvantage: some vets will appeal to the Board of Veterans Appeals (VBA)

B. The VA VBA Appeals Delay Solution: Delay for several years, with perhaps three-four years since claim submitted. Then remand to start all over again, deny to force appeal to CAVC or in a few cases, approve.

• Advantage: more years with medical care denied, vets give up, survivors don't know how to proceed, vets die off (VA term:vet deaths = "advantageous wastage"

• Advantage: process looks fair, although designed to prevent rather than approve claims

• Advantage: even if claim is approved for total righteousness, BVA decisions set no precedent so an identical claim five minutes later can be decided totally differently

• Advantage: Few vets have resources to hire representation; most VSOs are less skillful than attorneys

• Disadvantage: denying precedent wastes VA resources as identical cases eat up time, when precedent could instead be cited for denying more claims coming into BVA

C. The VA Court of Appeals for Veterans Claims Delay Solution (CAVC): Additional several years to be heard, often remanded back to rating office for minor details, 

• Advangage: many more vets give up or die off; even their survivors start dying off

• Advantage: VA continues to deny all medical care and benefits for several more years, with fantastic savings and shorter appointment lists and forcing vets onto Medicare, Medicaid.

• Advantage: CAVC decisions are not precedent-setting except by three-judge decisions

• Advantage: few vets have resources to get this far; few have resources to retain counsel

• Advantage: surviving vets after these years generally focus more on health than legal conflicts, either giving up, becoming less competent, or conflicted with other commanding health issues

• Disadvantage: none. Few vets have resources for representation, plus mandatory fees help discourage representation but for the odd pro bono

• Disadvantage: precedent rules requiring three-judges means identical cases often have to keep being heard, wasting Court time but assisting VA in preventing all care to the affected veterans (remember...prevention of care is the priority. Prevent, Prevent until they die. Refusing medical care helps the vets die off faster, saving both money and appointment list scrutiny.)

Veterans Solution: The immediate help for veterans would be a claims process providing immediate overall review to identify "more likely than not" appropriate disability claims and permit those veterans access to VA medical care on a tentative basis. With or without compensation, but at least medical care to survive.

Those claims continue into a "fast track" system of evaluation to be resolved and terminate VA care if appropriate 30 days after denial, with a scheme to either buy into a private plan or an alternate, lower priority VA program. Approved claims join the ranks of approved claims in the normal manner.

VA Solution: Obviously, none of the above. Find more ways to delay. Redefine various obligations for care to further exclude veterans from eligibility. Tell Congress things are working well except for the odd, delusional veterans who whine on about things when they should keep their damn mouths shut!

VA Withholds Vital Documents During C-123 Agent Orange Institute of Medicine Investigation - Refuses FOIA Requests

Last week C-123 Veterans Association received notice that the VA will not release documents

requested by the veterans, needed for the Institute of Medicine study now underway in a special C-123 Agent Orange committee.

The IOM's first public meeting, at which both VA and C-123 veterans presented, was last Thursday, May 15. The next meeting, at which the C-123 veterans are the principal speaker, is June 16.

Little wonder why VA denies access to materials of such interest to the veterans and the IOM, or at least seeks to withhold it until the committee's report to Secretary Shinseki is submitted...incomplete.

As separate FOIA request submitted long ago by the C-123 veterans was ignored and forced legal action through the US District Court of Washington, D.C. VA applied several stalls but now has agreed to try...not to actually do...releasing some...not all...of the ordered documents with the final release set by VA as two weeks after the IOM concludes.

Clever, clever timing to prevent anything disturbing to VHA. These people know how to game their own system. While they'd never wish us ill, or fail to help us on the street or shake hands in church, they show us that veterans are not in their value set. Last week, I was shocked at the vitriol spewed by leaders of other veterans organizations when we met...so many veterans in leadership positions see VA executives in a profoundly negative light (and used very, very nasty words to convey that thought.) For most, they've lost all hope of cooperation.

Veterans find it amazing that requests for public information...even information about veterans' own health records... are denied by VA's Veterans Health Administration Chief FOIA officer on the artificial basis of "no significant public interest" in the subject, nor any ability of veterans to share the requested information with the public.

Perhaps, a moment spent with Google would illustrate the intense interest our fellow citizens have in why VA prohibits access to vital medical care, and does this by gaming their own system, reinventing fundamental scientific terms, refusing input from other federal agencies, cherry-picking among its consultants for views already agreeable to the Department in denying Agent Orange's harm, and other VA missteps.

"We have to draw the line somewhere, " AP quoted VHA. Veterans access to documents in secret VA file cabinets (or what the heck they store stuff in) will help the nation understand why the heck such a line has been drawn over our bodies, and why VA has shown heroic determination in preventing C-123 veterans' claims.

If there is going to be one lesson this spring and summer, it will be that the people in the Department of Veterans Affairs, with exceptions, are not like us. And do not like us.

C-123 Exposure Study by Institute of Medicine – More Details Emerge

The National Academy of Sciences Institute of Medicine has been handed a contract by the
Department of Veterans Affairs to evaluate the C-123 Agent Orange contamination and exposure concerns raised by veterans. The study has its first committee meeting May 15, and the final on June 16, with a report due back to the Secretary of Veterans Affairs by the end of September. Veterans hope that, with such a narrow study focus, the report might be finished earlier.
A full description of the VA assignment, the IOM plans for its meetings, and committee members is available at the IOM website or here.

Vietnam Veterans of America Annual Report Report for 2013

---

Committee Report

BY HERB WORTHINGTON, Vietnam Veterans of America Committee Chair

2013 was a record year for educating the public and veterans about Agent Orange, the other rainbow agents, burn pits, and depleted uranium use by the government both domestically and overseas.

More than twenty-one town hall meetings have been held, with attendance ranging from one hundred to almost five hundred people. At each meeting Agent Orange folders are distributed that contain information on how to run a town hall meeting, copies of individual stories (The Faces of Agent Orange), a copy of the Agent Orange Self-Help Guide, a report from our Communications Department, a report on the impact of Agent Orange on U.S. veterans after forty years, the Agent Orange/Dioxin Committee position paper on birth defects, a report on male mediated studies, a list of all ships recognized as exposed to Agent Orange, an information paper from the Department of Defense on herbicide tests and storage outside of Vietnam, and a report on proposed legislation for veterans' families for research and treatment.

The committee continues to work with the National Birth Defect Registry and has adopted two resolutions. The first deals with the C-123 Pilots and Aircrew Association and the second with the Blue Water Navy Association. We continue to advocate for Vietnam veterans who were exposed to Agent Orange in locations other than Vietnam—Thailand, Laos, Okinawa, the Philippines, Johnston Island, Korea, Cambodia, Guam, and many military installations within the United States. We have reached outside of the VVA and AVVA membership and have held town hall meetings in conjunction with other organizations. All have been very successful, and we have noticed an increase in local membership once a town hall meeting is completed.

Scheduling town hall meetings for 2014 has begun. May and much of June already are booked. States that have scheduled meetings so far this year: Florida, New Jersey, Oregon, Washington, Tennessee, North Carolina, Michigan, Nevada, Alabama, and Maine.

We are endorsing Sen. Richard Blumenthal's (D-Conn.) legislation, S.1602, which calls for all veterans exposed to toxic substances to be diagnosed and treated, along with their progeny. We will host a meeting on the Hill on April 10 with as many members of Congress as possible to introduce and urge passage of S.1602. Attending this briefing will be VVA Board members, state council presidents, AVVA members, and children of veterans who have been exposed to Agent Orange.

US Army Fails to Respond to IG Inquiries: Months Pass Without Action

US Army Inspector General

Problems in Fort Belvoir!

In the Fall of 2012, C-123 veterans submitted concerns via proper channels to the US Army Inspector General regarding the Army's Joint Services Records Research Center, Fort Belvoir, VA. The concerns were the failure of proper interaction between JSRRC and the VA liaison office. VA inquiries to JSRRC were being returned with inadequate documentation which doomed C-123 veterans' Agent Orange exposure claims.

Initially, discovering the absence of JSRRC documentation and the subsequent VA denial of claims based on that JSRRC response, the C-123 veterans delivered in person hundreds of pages of official documentation.

Months have passed. And so have too many veterans, passed waiting for help from the Army!

JSRRC, Fort Belvoir, VA

JSRRC's archivists work only with official documentation. Unit histories, ship logs, after action reports, anything official. In our case, flight orders, C-123 dioxin test results, official correspondence, all such things were provided the Chief of JSRRC in person as well as via repeated emails. We were told they then had enough in hand to respond properly to VA inquiries.

We even provided input from the USAF Historical Records Research Agency regarding Patches and other other Agent Orange spray aircraft. Flight orders, Form 5s, AF test reports, correspondence.

Things seem to have broken down. First, we'd expected JSRRC to update their responses to earlier VA inquiries which had been improperly substantiated. That didn't happen. JSRRC explained they would provide such updates only to military or VA sources.

As of March 2014, VA still has JSRRC material denying any evidence of my own Agent Orange exposure dated 2012, before JSRRC's records were updated. That is because VA's liaison officer to the JSRRC, Mr. Sampsel, very deliberately does not ask for an update – that is to insure that only the initial, negative JSRRC documents are in VA files to insure that the exposure claims and appeals remain denied.

VA Mr. Sampsel informing Portland VA no info or acknowledgement of C-123 exposures; he has been provided that for his own VA files but defers to JSRRC, and then directs JSRRC which info to use or ignore on response

JSRRC info has been updated to adequately substantiate C-123 veterans' exposure to military herbicides. That even includes federal agency (CDC, NIH, EPA, US Public Health Service) interpretations of that AF test data and establishes the contamination and the veterans' harmful exposures. Mr. Sampsel, apparently, has directed JSRRC not to accept that information with his instructions that only MILITARY source documents will be acceptable, and discarding as well all the universities and other scientists who've analyzed the military documents to explain the veterans' exposure.

Further, Mr. Sampsel suggests PVARO continue in his own pretense that C-123 exposures were "secondary" or "remote." Not the case. Our exposures were direct skin-on-toxin as well as via inhalation. His clever but deceptive word switcheroo notwithstanding, exposure was direct and primary.

All this was detailed to the IG without response. For some reason, they asked for the details again, and were given it in great detail along with supporting documentation. Complaints went to our congressional representatives, who were told the VA has faithfully asked JSRRC for C-123 information, and told by the JSRRC that they have at least three "acceptable" military source documents to use, but nothing has changed.

Why? VA needs to prevent or at least delay veterans from entering their system, at least, Agent Orange exposed veterans not specified by law as eligible for VA care. The law also provides that veterans outside the Vietnam Boots on the Ground population will be treated if they prove exposure...and using a negative JSRRC response is an important element in VA's ability to refuse care. By keeping accurate JSRRC information from being fed to the VA, VA can deny claims.

JSRRC negative response, dooming VA exposure claim. Amazingly, VA is even referred back to its own incorrect web pages to help deny the veteran's exposure claims. Despite requests to JSRRC and to VA and to Congressional representatives, JSRRC has not updated this 2012 response even though JSRRC acknowledges it now has updated archival materials confirming the veterans' exposures aboard the C-123 fleet, blocked by VA maneuvers to prevent accurate and complete information from interfering with claim denials

Veteran with exposure claim

Obviously this problem might straighten itself out based on the solid evidence once the veteran's claim reaches the BVA, but even there VA wins...they've been able to delay providing care for the three to five years a BVA appeal requires.

From their VA perspective, hopefully the veteran is dead by that time and VA is faced with only the goal of obstructing the survivor's claims and prevent paying burial costs...that's another battle but VA delays, delays, medical care at the most important time.

Another victory using delay tactics, stalling a sick veteran's claim for years: get the vet discouraged enough with the claims that they seek treatment through Medicare or private insurance. Thank them for their service, then show 'em the door. Veterans sick with prostate cancer get their treatment outside the VA system and VA saves costly medical care by thrusting it onto private insurers...or the vet postpones treatment altogether.

VICTORY! Another valid claim denied

Remember: The vet files for VA disability when the vet is already ill. By design, VA has the claimant wait two years or so to have VA issue their automatic denial. The vet then waits two to three years, sometimes five, for Board of Appeals final justice.

Four to seven years, when the veteran has been already diagnosed with illnesses such as ALS, soft tissue sarcoma, heart disease...those years are critical to the patient seeking life-saving medical care, but also critical to the VA seeking to avoid providing that expensive life-saving medical care. The partnership between JSRRC and VA insures millions of dollars in avoided medical care for Agent Orange exposed veterans...and it is a highly successful partnership. To VA, this is a take-it-home and brag about it to the family victory to be proud of. And they are so very proud.

Repeat: The vet is already ill and VA established a delay system preventing any care at all letting for around four to seven years...that saves big, big bucks!

The catch-up financial compensation is nothing compared to costly medical care for a terminally ill multisymptom vet. VA avoids the most expensive part of a veteran's lifetime of medical requirements.

JSRRC still has its two-year old negative response to the Portland VARO inquiry,and no update with correct information.  There has been a very deliberate decision by VA to avoid any request to JSRRC for an update, because that would support the veteran's claim rather than insure it being denied.

Compounding the problem, the Army's IG has avoided any action on an official IG complaint to them for over six months in the face of people being denied VA medical care for want of Army assistance.

Agent Orange May Double Invasive Skin Cancer Risk

(note: last year, Portland VAMC cancer researcher Dr. Mark Garzotto published in Cancer his dramatic findings which also used the word, "double." In that case, published in the journal Cancer, Agent Orange exposure doubled risks for highly aggressive prostate cancer. This is a remarkable piece of research.)

Agent Orange Exposure Appears to Double Risk of Invasive Skin Cancer

April 2014 | Department of Defense (DoD) | Department of Veterans Affairs (VA) | News | Oncology

0 comments

By Annette M. Boyle

Mark Clemens, MD

HOUSTON — Even four decades later, veterans exposed to Agent Orange during the Vietnam War have twice the risk of developing unusually invasive nonmelanotic skin cancers compared with the general population, according to a recent study.

“We noticed a lot of veterans coming into our clinic had very aggressive squamous and basal cell carcinomas, and it seemed like there was a connection to Agent Orange exposure, but a literature search failed to find any studies that showed an association in humans,” said Mark Clemens, MD, assistant professor of plastic surgery, University of Texas M.D. Anderson Cancer Center. Previous studies have demonstrated a positive correlation between 2-, 3-, 7-, 8-tetrachlorodibenzodioxin (TCDD), the highly toxic contaminant in Agent Orange and nonmelanotic invasive skin in animals.

As of 2009, more than 485,000 veterans with Agent Orange exposure had registered with the VA. DoD and the VA recognize and provide benefits for many TCDD exposure-associated diseases, including peripheral neuropathy, amyloidosis, B-cell leukemia, birth defects, chronic lymphocytic leukemia, type 2 diabetes mellitus, Hodgkin and non-Hodgkin lymphoma, ischemic heart disease, multiple myeloma, Parkinson’s disease, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft-tissue sarcomas and chloracne.

Currently, however, skin cancer is not presumptively associated with Agent Orange exposure. The latest Institute of Medicine update to the Veterans and Agent Orange report concluded that there is “inadequate and insufficient information to determine whether there is an association between exposure to Agent Orange and basal cell or squamous cell cancer.”¹

That didn’t dissuade the M.D. Anderson researchers from further investigation.

“In our clinic, we talked about an association on a daily basis. We wanted to systematically take the first step toward conclusively making that case,” Clemens said. “We did a pilot study with 100 consecutive patients and found a surprisingly high rate of 51% of veterans had nonmelanotic skin cancer, which is about twice what you would see in an age-matched cohort in the general population,” Clemens told U.S. Medicine.

The researchers evaluated the medical records of patients who enrolled in the Agent Orange registry at the Washington, DC, VAMC from August 2009 to January 2010. The patients ranged in age from 56 to 80 years old, with a mean age of 65.7 years. Only patients with Fitzpatrick skin types I-IV (fair to medium complexions) were included in the study. The results of the study appeared in the February issue of Plastic and Reconstructive Surgery.²

“We compared whether they sprayed fields every day, lived and worked in the area or traversed a field once as part of work and then looked at the incidence by group,” Clemens said. Among the 30% of patients who actively sprayed Agent Orange, the risk of skin cancer was even higher — 73%. Of those who lived or worked in areas sprayed with the chemical, 46% had nonmelanotic invasive skin cancer (NMISC). For veterans who reported only traveling through areas exposed to Agent Orange, the rate dropped to 21%.

About 43% of patients had chloracne, known to be caused by dioxin exposure. The presence of chloracne increased the rate of NMISC substantially, to 80%. Cutaneous melanoma occurred in 9% of the patients, similar to the 8.8% rate seen in individuals over the age of 65 in the general population. More than one-fourth of the patients (26%) had other malignancies.

Men with lighter skin and light eye color also had increased risk. Of the 14 men with Fitzpatrick skin type I, the lightest, 10 (71%) had NMISC. Just under 60% of those with Fitzpatrick skin type II and 45% of those with type III had NMISC, while none of those with skin type IV did. Of the 38 veterans with blue eyes, 66% (25) had NMISC, as did 60% (9) of those with green or hazel eyes. The incidence rate was much lower in veterans with brown eyes, at 36%.

“The takeaway from the study is that there may be an association between Agent Orange and development of nonmelanotic skin cancer, but it needs to be studied on a larger scale with thousands of patients. What we’ve observed is very, very suspicious and supports what’s been reported anecdotally,” Clemens noted.

Clemens said he and his colleagues are hoping to enroll patients in a larger, prospective study. The researchers pointed out that their study had some significant limitations, such as reliance on recalled TCDD exposure and the absence of a control group of nonexposed Vietnam-era veterans.

Dick Matte Hospitalized at Brigham & Womans Hospital, Boston

Disturbing news about MSgt Dick Matte received today from LtCol Dave Zamorski, through Steve Caraker:

I received a call from Matte–he was calling from Brigham Women's Hospital, with the news he had his right leg just below the knee amputated. Apparently he was admitted to Mercy Hospital with open lesions on his right foot, treated with antibiotics and after a short stay released and told to see his provider. The provider just endorsed the same treatment although the lesions were still not healing. On 6 Jan he went to Brigham for his normal routine follow up visit, when he showed the physician his foot he was immediately admitted. Two operations were performed to save the leg by taking out the dead tissue but the infection had run its course which call for the amputation. He is under close watch,on antibiotics to ensure the infection has not spread. Hopefully all will go well, the stay should be for one to two weeks.

Prayers for Dick's continued recovery...his earlier heart transplant and denied Agent Orange claims add to the concerns for his health.

01/24/2013 Update: Dick was released to a rehab facility nearer his home in Agawam. He's in great humor and certainly hangin' in there!

C-123 Agent Orange Book Now Available for ALL Macintosh Computers!

Yesterday's release of Apple's newest operating system for the Macintosh, Mavericks OS 10.9,  included the much-desired ability for iMac and MacBook computers to read iBooks publications. Until yesterday's newest software, those terrifically interactive, multi-media iBooks could only be read on Apples iPads. Now, these publications are available throughout the Apple user base.

Got a Mac or an iPad? Got you covered! Download our free C-123 Agent Orange book now!

Exciting–packed with high drama! Stunning in scope and revelations!
Read now! Don't wait for the movie!

VA Bars C-123 Veterans Agent Orange Claims - By Redefining Science

PART TWO: The Grand Deception

You see the VA's trick, don't you? They took the standard interpretation of "exposure" and redefined it. They added the requirement that exposure to the toxin dioxin in Agent Orange be linked to specific reactions in the bodies of the C-123 veterans. "Exposure = contamination field + biological availability." But it turns out  this is a completely false, illogical, and unscientific definition challenged by other agencies such as the CDC...agencies with the statutory authority and scientific expertise to make such determinations. 

That is a blatant rebuilding of the medical nexus barrier used by VA against Vietnam veterans to prevent their decades of exposure claims. Congress, reacting to the amazing bad faith exhibited by VA towards veterans (actually, in not responding!) passed the 1991 Agent Orange Act. This obliged the Secretary of Veterans Affairs to utilize the National Academy of Sciences and its prestigious Institute of Medicine to evaluate Agent Orange exposures and resultant illnesses.

Medical nexus was completely eliminated as a requirement for a veteran's claim. The law obliged the VA to treat all veterans with "boots on the ground" during Vietnam as a "presumptive eligibility" cohort. If you were in-country, you were covered. Covered, eventually for nearly 20 illnesses and diseases which the IOM and VA agreed to associate with Agent Orange exposure. Diabetes, prostate cancer and other illnesses could be treated for any veteran with proof of boots on the ground.

But the laws went further. Congress made it clear that exposure to Agent Orange and other "military herbicides" was hazardous in and of itself, and Title 38 explicitly requires VA to treat all veterans with proof of military herbicide exposure if those veterans are diagnosed with one of the Agent Orange presumptive illnesses. Of course, should a veteran claim a disease not on the IOM list, proof of medical nexus could be required in such situations...and only in those situations.

Just to be quite clear about it, VA was formally asked by Congress and the public just how such veterans would be treated. On 8 May 2001 the Federal Register, on page 23166, repeated the VA's answer that all veterans with Agent Orange exposure would be treated the same as boots on the ground Vietnam War veterans, as far as Agent Orange illnesses were concerned.

Fast forward to the C-123 veterans discovering their aircraft contamination after the FOIA-forced released Air Force documents showing the warplanes "heavily contaminated on all test surfaces" and "a danger to public health," as read the Air Force toxicologists' reports. The veterans sought VA care–and this is what the Department of Veterans Affairs Post Deployment Health section was ordered to prevent!

C-123 veterans had little difficulty establishing their exposure to Agent Orange, given the decades of military testing documents and correspondence about "the Agent Orange airplanes" and the fact that the remaining warplanes were destroyed as toxic waste. C-123 veterans had little difficulty establishing their Agent Orange illnesses with physicians' diagnosis in-hand as they turned to the VA. Relying on law and the Federal Register verbiage, veterans knew that proof of exposure plus proof of Agent Orange illnesses should result in a VA recognition of service-connection and thus access to VA medical care.

C-123 veterans, however, were unaware at the time of the resolution inside VA offices that Agent Orange claims be prevented from any veterans other than the Vietnam War vets already covered. Prevented by any means possible, And the bright idea of redefining "exposure" in a way to prevent claims was born. We can just imagine the meeting where VA staff congratulated themselves on the strategy – to pretend that exposure doesn't mean exposure.

But what does it mean? According to the CDC/Agency for Toxic Substances and Disease Registry, the EPA, the National Institutes of Health and other federal agencies as well as civilian authorities, "exposure" means the contact between the skin and a contaminant. Or, ingesting or inhaling the contaminant. Thus, one is exposed by simple skin contact in the case of C-123 veterans having a decade of such service aboard toxic Agent Orange spray aircraft. But VA set out to redefine the word to mean only what VA wanted it to mean so that the law's requirements could be ignored.

Clever VA staffers utilized the Society of Toxicology conference to introduce their sly scheme to prevent C-123 veterans' claims. Because poster displays are invited and not subjected to the same rigorous scientific challenges as medical and scientific articles in professional journals,  it was decided to simply submit a poster display at the SOT gathering and then flood the Internet with references to it as through it was some sort of scientifically established proof. And without challenge from the SOT or other scientists and physicians, it pretty much was allowed to condemn C-123 veterans' claims.

No veteran exposed to an herbicide can specifically prove the illness suffered is tied to the herbicide. There can only be the "likelihood" or "demonstrated possibility" of such an association. The VA hid behind this for decades in their mission of denying benefits, but medical nexus was lifted from the veterans' burden of proof through the Agent Orange Law and Title 38.

Enter the bright folks from Post-Deployment Health. Dedicated, professional, mission-oriented scientists and physicians, charged with preventing veterans' Agent Orange claims and both eater and tireless in meeting meeting their responsibilities. Their approach? Redefine, at least within the VA, the word exposure. Pretend that VA has the scientific authority to change the meaning of a word in order to then use it to prevent successful claims.

With the vehicle being their SOT poster display, which wasn't juried or subjected to critical review by other physicians and scientists, the folks from Post-Deployment Health inserted medical nexus into the VA requirement for recognition of exposure. They said no exposure existed except in cases where the veteran proved subsequent bioavailability, or the impact somehow of the toxin on the veteran's health.

Clever! And it took a great while for the veterans so catch on. Our visit with Veterans Benefits Administration's Compensation and Pension Services had one result being the recommendation to speak with the Deputy Director of the Post-Deployment Health section of the Veterans Health Administration. VHA kindly explained the requirement now in place at the VA that exposure isn't recognized unless also supported with proven bioavailability...thus the reintroduction of medical nexus as a claims barrier despite the law. VHA further explained that by that definition no veterans of the Vietnam War were exposed, except perhaps some of the Operation Ranch Hand flyers. And certainly not, any of the C-123 veterans!

The C-123 Veterans Association sought out opinions from experts in other federal agencies and in civilian institutions. All disagreed with the VA's redefinition of exposure, and all reaffirmed that exposure is the simple contact between skin and toxin. Authorities from CDC/ATSDR, NIH and others all agreed that the VA had improperly redefined the word to its own policy objectives.

Requests for review of the VA's poster display by the Society of Toxicology were ignored, even when routed through previous SOT leadership.