Virginian-Pilot Publishes C-123 Agent Orange vs.VA & Dr. Al Young Report, Part One

This six page newspaper report is the 19th in their series of extraordinary coverage of Agent Orange from the beginning of Vietnam War.

The reporters offer new details on the unique and troubling role of Dr. Alvin Young in guiding the Department of Veterans Affairs for decades in the determined obstruction of veterans' exposure claims.

Dr. Young is named as the "go-to" guy for a predictable negative opinion whenever the VA seeks buttress goods denial of Agent Orange claims. The report offers a tight focus on the role of Dr. Young (and suggests another title of "Dr. Orange") when he and Major Wes Carter appeared before a committee of the Institute of Medicine Investigating veterans' exposure claims.

Veterans won this argument, with the IOM concluding that their exposure aboard their aircraft was harmful. In June 2015 the VA finally yielded, granting presumptive service connection for these veterans for the recognized list of Agent Orange ailments.

The second part of this report publishers on Monday October 31, 2060.

DOD Inspector General Complaint filed by C-123 Veterans Association

Today the C-123 Veterans Association filed an official complaint via the Department of Defense Inspector General Hotline, asserting failure of DOD officials to designate Agent Orange-contaminated C-123 aircraft as "Agent Orange Exposure Sites," on a list maintained by the Department of Defense.

Because the presence (or absence) of sites on the Agent Orange Exposure Site List guides VA in approving or denying veterans' exposure claims, failure by DOD to place these toxic Agent Orange spray aircraft has endangered the health of veterans. VA cites the absence of these Vietnam War Agent Orange-spray aircraft as proof against veterans' claims.

This is unscientific and illogical. The contamination of the aircraft was established

by the Air Force itself over decades of testing. More current analysis of those tests led the CDC/Agency for Toxic Substances and Disease Registry, the NIH/National Institute of Environmental Health Sciences and the US Public Health Service to inform the VA that the aircraft were contaminated with deadly dioxin, and the veterans exposed.

Most telling was the analysis by Dr. Tom Sinks, Deputy Director of the CDC/Agency for Toxic Substances and Disease Registry who concluded that the veterans were indeed exposed, and have a 200-fold greater cancer risk.

C-123 veterans have sought VA care for their Agent Orange illnesses for years, without success. VA even has denied C-123 veterans' exposure benefits, insisting that the toxin in Agent Orange is harmless. This is a wrong which veterans call on DOD to remedy.

VA Veterans Health Administration: Gaming The Wait Lists Via Claims Process

VA Health Benefits Administration

The VA has two key agencies gaming the system against veterans' health.

These are the Veterans Benefits Administration (VBA) which decides disability claims, and Veterans Health Administration (VHA) providing the veterans health care and research. They're working together to keep their waiting lists, and costs, within management's goals.

We report on the prevention of claims by linguistic slight-of-hand: VA prevents exposure claims by redefining exposure to keep veterans from being considered exposed. A simple solution. VA invented for its own use a special definition of exposure, unique in medicine and science:
"Exposure = contamination field + bioavailability."

That redefinition works great. Using it, VA denies every exposure claim crossing their desk for Agent Orange, burn pits, radiation, dirty water, biohazards, toxins, immunizations...everything except situations where VA is compelled by law to provide care. No law=no exposure, regardless of proofs of exposure.

Legislation such as the 1991 Agent Orange Act protects veterans of the Vietnam War with "boots on the ground." That law, and various court decisions and announcements in the Federal Register also require VA to provide care to veterans exposed to Agent Orange outside Vietnam.

So, VA pretends it has the scientific and legal authority, and boldly redefines exposure to pretend no exposures take place. In the case of C-123 veterans, who flew the Agent Orange spray airplanes for a decade after Vietnam, the aircraft tested positive for Agent Orange residue many, many times up until their destruction as toxic waste in 2010. Too toxic for landfill, and the Air Force concerned about a threatened EPA HAZMAT fine of $3.4 billion for illegal storage, all C-123s were shredded and smelted as toxic waste, upon recommendation of the consultant to the Office of Secretary of Defense.

That same consultant then was retained by VA to construct arguments against the veterans' claims, and developed arguments that the veterans' dermal contact, inhalation and ingestion of the military herbicide residue did not constitute exposure, utilizing the VA's unique redefinition. His VA work continues decades of defending Agent Orange and its harmful effects.

This redefinition, and the decision against awarding C-123 veterans exposure benefits, is challenged by many universities as well as other federal agencies. The CDC/Agency for Toxic Substances and Disease Registry, the US Public Health Service, and the NIH/National Toxicology Program have all informed VA that tests prove the aircraft contamination and the veterans' exposure.

All input contrary to the VA's objective of preventing C-123 veterans' service connection is disregarded, explained away or simply ignored as with the input to VA from the Director, NIH/National Institute of Environmental Health Sciences who wrote, "Based on contact with the aircraft, exposure is assumed...the magnitude of these exposures is uncertain."

The VHA informs the Veterans Benefits Administration that none of the C-123 veterans were ever exposed, and therefore have no basis for exposure claims. In fact, VHA officials also insist that under their new exposure definition none of the ground soldiers during the Vietnam War were ever exposed, and perhaps only a few of the Air Force crews which sprayed from their C-123s. This directive flies in the face of Secretary Shinseki's repeated assurance to the Senate that all C-123 veterans' claims are considered on a "case by case basis," an obvious misstatement when VA has predetermined all the vets to be disqualified...thanks to that nifty redefinition of exposure from VA's Post Deployment Health Section.

"Unscientific" and "reflects a lack of understanding" are the judgements of leaders in the science of toxicology. But the claims remain denied, with vets told to get in line for appeals taking three to five years.

There, justice may await, but often only for the veterans' survivors. Complaints to the VA's National Center for Ethics in Healthcare resulted in recommendation that veterans turn to the VA IG because of the criminal and ethical implications of preventing medical care to eligible veterans. There, the issue has been ignored for years with inaction.

Dr. Linda Birnbaum, Director Nat'l Institute of Environmental Health Sciences Recognized by C-123 Veterans

Members of the C-123 Veterans Association had the opportunity this weekend to recognize Dr. Linda Birnbaum and her staff for the dedication shown over the years by NIEHS and the National Toxicology Program, as they helped meet the needs of military families. Indeed...our profound thanks!

Unfortunately, having met this dynamic leader, I can't imagine there being a space left on her office walls for our plaque, but it certainly felt wonderful to express our appreciation and respect to this lady!

Push Back: Resisting the VA Redefinition of Exposure

Veterans exposed to military herbicides (and we're talking Agent Orange in particular) are, by law, to be treated by the VA and considered "presumptively service connected" for the range of Agent Orange-presumptive illnesses. Key word, as we've seen for two years, is EXPOSED.

Exposed. No other qualifier.

But that word was hijacked by the VA a couple years ago.

By redefining exposure to their own perspective, clever folks at Post Deployment Health were able to explain away the scientifically-proven "as likely to as not" exposures of C-123 veterans. Although universities, scientists and other federal agencies continues issuing opinions and formal findings, VA keeps going back to their unique definition of exposure to prevent any C-123 veterans from qualifying for Agent Orange benefits.

Around 2012, VA was faced with the law's requirement that veterans claiming exposure...and proving it...were to be treated and provided benefits. To avoid this, VA invented their unique definition of exposure as: "Exposure = contamination field + bioavailability." 

Here, they didn't put the cart before the horse, but instead virtually put the horse into the cart. They put bioavailability into exposure, saying no exposure happened unless the veterans proved bioavailability also.

This was a very crafty, but ethically questionable, way to skirt the law's clear intent, which VA had recommitted to in several Federal Register postings. Veterans exposed to Agent Orange are to be treated...unless Post Deployment Health could find a way around the law. The physicians and scientists at Post Deployment Health, blocked C-123 veterans' exposure claims by redefining away the fact of the veterans' exposures.

VA's goal was to prevent these veterans gaining access to VA medical care for treatment of cancers, heart disease, ALS and other Agent Orange ailments. Theirs is a blanket policy of denials, despite the Secretary's assurances to the Senate that no such blanket policy exists.

Veterans couldn't very well prove bioavailability of dioxin exposures 40 years after the fact, so VA insisted they'd never been exposed and thus denied the veterans' disability claims.

VA is wrong, and not by accident but rather design. Keep reading.

Exposure is a specific, initial toxicological event. Other than a contaminant being physically present in some manner, exposure is the initial event in what the National Academy of Sciences named the activation of the toxicity pathway. No longer discrete events, the NAS considered them as a whole, as a pathway from toxin to eventual morbidity and mortality.

Repeat: Exposure is the first toxicological event in that pathway. Subsequently, the toxin enters tissues and that is followed by biological interaction. The NAS graphic presents it well, and in our case, helps prove that we've been exposed. Exposure first, then bioavailability down the line.

Not by the VA definition. Fortunately, the NAS graphic and the experts behind its creation show that the VA definition is wrong. Unscientific, as many have said. Ludicrous, as one scientist put it.

Exposure is the initial event in the cycle. Exposure is as simple as skin contact, or inhalation or ingestion of coffee, dust, toxins or other substances. Later, further along in the toxicity pathway, there is biologic interaction...or, as VA phrased it, "bioavailability." Other scientists use the term bioaccumulation, but in all cases exposure is a separate toxicological event, and bioavailability is not a part of exposure but its own event.

Dr. Linda Birnbaum, Director, NIEHS

VA is not only wrong, but completely alone. Their redefinition of exposure, by decree from that small office and not by scientific or legislative process, is wrong and perhaps illegal in that it was done to the great harm of a group of veterans, depriving them of rights without due process.

"We all die" was the response from Post Deployment Health when the veterans asked if the process could be addressed before their illnesses overtook them. We all die, indeed, but C-123 crews drew little comfort from Dr. Peterson's dismissal of our hopes to delay that a bit longer...perhaps as long as others who didn't fly these airplanes.

VA enforces its own rules and regulations, but is subject to outside judicial review. Reinventing exposure to prevent C-123 veterans claims will be eventually resolved, but the VA gains by denying thousands of such veterans all benefits for years...there is no recovery of the costs a veteran handles on his or her own over the years of waiting for VA to unlock their hospital doors. Rehab, pharmacy, prosthetics, dental, vision, survivor benefits, travel, specialty clinics...all denied for years. Either paid for by the veteran or, more likely, done without.

VA Claim Prevention System

Normally (until recent and very effective steps by Veterans Benefits to improve) after getting hurt and then discharged, a veteran has had to provide his/her own medical care for two to three years waiting for a normal disability claim to work through the system. Many find this a complete financial disaster, unless some other medical coverage is available. Savings, homes, marriages suffer while VA dithers for years whether to allow a disabled veteran to be treated.

In the case of the C-123 veterans, events have truly overrun the veterans. First, the Air Force had us fly
these airplanes for a decade, insisting to us there was no contamination from their earlier Agent Orange missions. After the planes retired to storage, when the Air Force by 1994 had definite confirmation of the C-123 toxicity, they ordered all contamination information kept from us, when the Air Force Office of Environmental Health directed "all information be kept in official channels only." The USAF Surgeon General agreed C-123 veterans were not to be notified of our previous exposures "to prevent undue distress."

A low-level of quasi-secrecy ("official channels only")  was maintained up through destruction of the toxic C-123s at Davis-Monthan AFB, Arizona. The consultant from the Office of Secretary of Defense helped craft press releases minimizing the C-123 Agent Orange legacy and touting, instead, the USAF "environmentally responsible" recycling of the metal.

Not mentioned in the press release, which was never released (!) was the fact that the smelting of the contaminated airplanes was necessary to avoid a threatened EPA fine of $3.4 billion for illegal HAZMAT storage over the decades.

Not mentioned was the fact that the regular manager for surplus military sales, the Defense Material Remarketing Service, considered the C-123 fleet hazardous material and insisted on special handling or they wouldn't cooperate without public bidding for HAZMAT processing...which the Air Force wanted very much to avoid. Too much notice would mean that veterans might learn of the problem, another concern expressed by the Office of Secretary of Defense that was to be prevented.

The point should be clear: The C-123 airplanes were to be eliminated without informing already-

exposed C-123 veterans. The OSD consultant's recommendations went to three Hill AFB authorities, including Major Carol McCready, and concerns about preventing veteran awareness were repeated as approvals were sought from higher headquarters..."don't let the C-123 veterans know of this or they'll apply to the VA for exposure benefits" seemed the approach used by the USAF.

I've written about this before in various posts and articles. Why keep repeating the message?

Because VA keeps ordering their regional offices to deny C-123 veterans' exposure claims. VA keeps telling our veterans to seek help elsewhere for Agent Orange illnesses.

VA keeps telling Diane Olmsted, widow of LtCol Aaron Olmsted and mother of an adult, disabled and
institutionalized son, that his VA claim remains denied because Olmsted wasn't exposed during the thousands of hours he flew the C-123...at least, not by the special VA definition of exposure crafted by Post Deployment Health to prevent acknowledging exposure!

VA Definition of “EXPOSED” – Another Scientist Challenges VA

VA: “Exposure = contamination field + bioavailability.” 

The term exposure was redefined (from the VA perspective, not by regulatory authorities or industrial standards nor any other peer-reviewed action) to include bioavailability,VA's objective being evasion of requirements in the law for providing exposure care to C-123 veterans. The flyers’ exposures were redefined away with VA’s novel redefinition of exposure. No bioavailability = no exposure =denied claim.

The VA redefinition of exposure was apparently first utilized at the VA’s poster display for Society of Toxicology 2012, where the line appeared as part of the historical perspective of Agent Orange, the focus of the poster. It was an official VA poster, with none of the usual disclaimers about not necessarily reflecting agency typical…indeed, usually recommended, on such scientific displays. After SOT 2012, VA continues to deny veterans’ claims insisting the veterans failed to prove bioavailability.

In fact, the bioavailability requirement was grasped by VA’s Post Deployment Health and included by them in the VA’s poster, Agent Orange: 50 Years of History which staff of Post Deployment Health presented themselves. The VA need for a creative redefinition of exposure became apparent when the Federal Register of 31 August 2010 carried a VA statement that the Department would provide “presumptive service connection” to non-Vietnam War veterans able to prove their exposure to Agent Orange. 

Post Deployment Health was faced with either treating the exposed veterans, which policy opposed, plus yet another significant impact on the Department’s health care budget...or VA could create some ways preventing C-123 exposure from being acknowledged.

Thus was born the VA redefinition of a fundamental toxicological term. The VA redefinition is unique, not used elsewhere in science, medicine or government. VA has no statutory or regulatory authority to define such terms. The agencies which do have such authority include the CDC/Agency for Toxic Substances and Disease Registry, and the National Institutes of Health/National Toxicology Program. Both agencies have taken exception to the VA’s redefinition.

In particular, objections were voiced by Dr. Linda Birnbaum, Director of the National Toxicology Program. She wrote,” In all my years as a toxicologist, I have never heard bioavailability as part of the exposure field. Exposure is skin contact (or inhalation or ingestion) with a chemical of any type.”

courtesy of Professor. R.S. Pollenz, Univ. South Florida

Bioavailability itself MUST follow exposure , but not all exposures have the subsequent event of bioavailability. Further, bioavailability is a complex concept based on the chemical nature of the agent.  There is also the major concept of biotransformation since nearly all compounds are metabolized once they enter the body.  TCDD and PCBs however, are somewhat resistant to the biotransformation, since humans do not have enzymes that are able to remove the CL molecules (this is one reason why CL is used as a halogenating agent in creating T45T and other chemicals that kill stuff).  

Readers may be able to find similar schematics on line and in some of the toxicology text books.  Note that the connections may not be linear and are different for each chemical, but this gives the various terms to keep in mind and the complexity of the process.  If there has been an adoption of any term PRIOR to exposure, or definition of exposure to include another subsequent toxicological event as a required component, this is not correct because one MUST be exposed before anything can happen.  

Perhaps, VA has been focusing on the bioaccumulation from a standpoint of whether the amount that someone may carry is BIOAVAILBLE to do anything.  This has always been a hot area regarding the risk assessment of these halogenated compounds.