Korea's Vietnam Veterans' Agent Orange Exposure Study Released 9/5/2014

International Journal of Epidemiology, 09/05/2014  Clinical Article:

Yi SW, et al. – Agent Orange (AO) was a mixture of phenoxy herbicides, containing several dioxin impurities including 2,3,7,8–tetrachlorodibenzo–p–dioxin (TCDD). In this study, the authors aim was to identify the assoc . iations between the AO exposure and mortality in Korean Vietnam veterans. This study suggests that AO/TCDD exposure may account for mortality from various diseases even several decades after exposure

Note: in 2013 Dr Mark Garzotto, a physician researcher at the Portland VA Hospital and Oregon Health Sciences University, published research in the journal Cancer showing that Agent Orange-exposed veterans (assuming Agent Orange to be the source) had twice the rate of highly aggressive prostate cancers. Dr. Garzotto was my treating physician at the Portland VA hospital and he associated my own cancer wtth C-123 exposures

Comments from a VA Agent Orange consultant:The difficulty for the Koreans is that 350,000 men served over a seven year period in II Corps and their philosophy was to work closely with the Vietnamese (probably more successful than either other nation in Vietnamization). The use of defoliants and crop denial efforts were strongly rejected by the Koreans in their tactical area of responsibility in II Corps. 
Thus, there was only limited use of tactical herbicides, some sprayed by the Korean Chemical Corps, but most of the little amount sprayed was by our Chemical Corps or in some cases RANCH HAND. The analytical studies for TCDD were essential the same for Korean veterans who had served in Vietnam, as for Korean veterans who served the homeland. The present study uses the criteria of our IOM and their acceptance of  the same associated diseases.  Such Mortality studies do not establish cause and effect, hence, their statement "suggests" that AO/TCDD exposure may account for mortality from various associated diseases.

VA Claims Agent Orange “Harmless" – Challenged by Other Federal Agencies

– Claim Denied! "No conclusive evidence that TCDD exposure causes any adverse health effects."
(Director VA Compensation Services, personally ordering C-123 vet's claim denial)
– "TCDD is the most toxic of the dioxins, and is classified as a human carcinogen by the Environmental Protection Agency."
(VA Public Health Bulletin )

C-123 "Provider" flown by us 1972-1982

The VA statements are in obvious contrast with each other, yet the VA permits veterans’ claims to be denied by pretending Agent Orange is harmless as per the first statement...a statement which is unscientific, and which flies in the face of VA’s own Agent Orange research.

In September 2012 VA’s Compensation and Pension Service denied C-123 veterans’ Agent Orange exposure claims. Reaching for whatever could be typed on the denial, no matter whether it be legal or scientific, VA leadership opted to deny the claims by pretending TCDD (dioxin, the toxin in Agent Orange) is harmless.

It seems ridiculous...and it is! However, it satisfies the VA’s desire to prevent C-123 veterans’ claims. They might as well have typed that TCDD is beneficial, good for hair restoration, good for food preservation, and  controls earthquakes or whatever else might come to mind. The claims had to be rejected...so VA pretended that TCDD is harmless. 

Science and Medicine, of course, have found otherwise. In particular, the US Government has found otherwise, and even the VA in various Internet pages agrees that TCDD is a human carcinogen, and dangerous to health. But somehow not in the case of C-123 exposures, reads C&P’s tome.

In this, a policy-driven claim denial, VA’s excuse stands challenged by the rest of the United States Government. The agencies with both the statutory responsibility to determine the toxicity of environmental hazards and the scientific expertise to do so, all challenge the VA.

The two agencies in the van of the challenge are the CDC/Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute of Health/National Toxicology Program.

The director of the ATSDR is Rear Admiral (MD) R. Ikeda, who confirmed earlier findings by ATSDR’s director and deputy director which determined C-123 aircraft were contaminated with TCDD and the veterans were exposed. In fact, ATSDR determined these veterans had a 180-times increase in cancer risk because of their service aboard the transports.

The director of the NIH/National Toxicology Program (NIP) is Dr. Linda Birnbaum. On behalf of the NIP, Dr. Birnbaum concluded C-123 veterans were exposed. She stated, “Exposure is assumed based on wipe-tests demonstrating high dioxin concentrations in the C-123K’s. While contact with the aircraft results in exposure to dioxins, the magnitude of these exposures is uncertain.”

Thus, challenging the VA are the ATSDR and the NTP. As regards the NTP, it is important to note that it is a consortium of many government agencies speaking with one voice on toxicological issues. Represented are virtually every concerned US government agency, including DOD, NIH, CDC,  FDA, EPA,  OSHA, National Institute of Occupational Safety & Health, National Institute of Environmental Health Sciences and the Consumer Product Safety Commission.

In her determination that C-123 veterans were exposed, Dr. Birnbaum of the National Toxicology Program represented the many agencies forming the NTP, and her conclusion that C-123 veterans were exposed to TCDD stands in stark contrast to the policy-driven VA refusal to treat C-123 veterans’ Agent Orange illnesses, with VA hiding behind a pretense that TCDD is somehow harmless.

Only VA has stated TCDD is harmless, and VA has made that unfounded statement only in the case of C-123 veterans. VA’s own researchers, including Dr. Mark Garzotto at the Portland VA Medical Center, an oncology urologist treating a C-123 veteran, concluded that Agent Orange-exposed vets suffer twice the rate of highly aggressive prostate cancers. His research was published in May 2013 by the American Cancer Society, and the VA ignored him...without notice at all, his official written opinion that the C-123 veteran was exposed to Agent Orange and that it likely caused the vet’s prostate cancer was simply ignored as the VA denied the vet’s claim. Dr. Garzotto had to be ignored in order to better deny the claim.

TCDD is not harmless as C&P claims. Rather, TCDD is a potent human carcinogen, recognized as such worldwide, and recognized as such by every federal government agency, including the VA. Except...the VA pretends otherwise for the purpose of frustrating C-123 veterans’ claims.
(note: December 2015 – the Department of Justice released VA's admission that their "TCDD is harmless" statement was in error.)

If you haven't already had an Agent Orange exam, your C-123 Veterans Association urges to to obtain one immediately, even at your own expense. Yesterday an important article was published about aggressive prostate cancer being linked to Agent Orange exposure:

"This is a very, very strong predictor of lethal cancer," said urologist Dr. Mark Garzotto, who worked on the study at the Portland Veterans Affairs Medical Center in Oregon."If you're a person who's otherwise healthy and you've been exposed to Agent Orange, that has important implications for whether you should be screened or not screened," he said. (click here for full text of published article)

Dr. Garzotto happens to be my own VA urologist and already provided an opinion that I was exposed

during my years aboard the C-123, but the Portland VA regional office then rejected his expert opinion classifying it as "unacceptable lay evidence." From my perspective, he's a great physician, teaches at a fine medical school, works for the VA and obviously knows a lot about prostate cancer and dioxin...but VA makes its own rules and then choses which ones to use against us. VA regional offices seek any opportunity, however remote, to deny claims regarding Agent Orange. Any supporting evidence of C-123 veterans' exposure to Agent Orange is automatically unacceptable to the VA, per VA Compensation Services.

Last week we were informed by VA's Deputy Director of Post Deployment Health that Agent Orange exams are no longer allowed for our exposed C-123 veterans because of new internal VA rules requiring the exam be restricted to just Vietnam veterans or veterans in contact with LIQUID Agent Orange. Because our exposure was to the dried dioxin residue on the airplane which left it "heavily contaminated" we are prohibited from seeking an Agent Orange exam.

We believe Dr. Garzotto's research makes clear that all C-123 veterans need to be examined if they haven't already been seen for Agent Orange exposure. Do this promptly even though we are now excluded from the VA system.

The current Agent Orange Registry page on the VA site is outdated where that it says all veterans who believe they've been exposed may ask for the AO exam. "All veterans" does not include C-123 veterans as of last week. Outdated, or there may be some sort of confidential VA Post Deployment Health internal memo used to exclude us, but this new exclusion from the Agent Orange Registry has been confirmed with their Deputy Director and veterans already denied exams. The version for  C-123 veterans is:

"Other potential Agent Orange exposures

• Veterans who may have been exposed to herbicides during a military operation or as a result of testing, transporting, or spraying herbicides for military purposes. Learn about herbicide tests and storage outside Vietnam. Agent Orange or Dioxin dried on surfaces does not present a significant threat to human health. Veterans are eligible if they were in the presence of liquid Agent Orange such as when Agent Orange was sprayed, tested or transported"

VA Health Benefits Administration, as we were told by Compensation Services when we met with them on 28 Feb 2013, already ruled that C-123 veterans could not have been exposed and that no evidence to the contrary, such as from VA doctors, scientists, medical schools, or even the finding by the Director of the CDC/Agency for Toxic Substances and Disease Registry that we WERE exposed, is acceptable to VA. So the VA has determined that we cannot seek medical care there, but Dr. Garzotto's research makes it clear that we must seek it somewhere - do so now! We can't wait for the VA any longer.

New Study Links Agent Orange with Aggressive Prostate Cancer

(Posted: An article by my own VA urologic oncologist here at the Portland VA Medical Center. Note that the VA has earlier dismissed Dr. Garzotto's opinion confirming C-123 Agent Orange exposure as "unacceptable lay evidence", regardless of any qualifications he obviously presents. Any evidence at all which contradicts PostDeployment Health is unacceptable.)

About 3 million Americans served in the armed forces in Vietnam and nearby areas during the 1960s and early 1970s, the time of the Vietnam War. During that time, the military used large amounts of mixtures known as defoliants, which are chemicals that cause the leaves to fall off plants. One of these defoliants was Agent Orange, and some troops were exposed to it. Many years later, questions remain about the lasting health effects of those exposures, including increases in cancer risk, according to the American Cancer Society.

Past studies have linked agent orange exposure to serious health issues including tumors birth defects and cancers such as breast cancer, multiple melanoma and prostate cancer however, some studies found a small excess risk of prostate cancer related to dioxin exposure until now.

A new study reveals U.S. Veterans who were exposed to Agent Orange is linked to a two-fold risk for developing the most deadliest forms of prostate cancer.

Photo credit:  

GettyImages/TIME & LIFE Images 

A new study led by Dr. Mark Garzotto, MD, associate professor of surgery/urology at Oregon Health and Science University, Chief Urologic Oncology, Portland VA Medical Center and colleagues have found that agent orange is not linked to a small excess risk of prostate cancer but is linked to a two-fold significant risk of developing the most deadliest forms of prostate cancer.

In this cohort study researchers looked for a link between Agent Orange exposure and life-threatening, or high-grade, prostate cancer, Nathan Ansbaugh, MPH, designed and conducted analyses on a group of 2,720 US Veterans who were referred by multiple providers for initial prostate biopsy. Biopsy results and clinical information were compiled for analysis by principal investigator Dr. Garzotto.

Risk factors included family history of prostate cancer, digital rectal examination, prostate-specific antigen (PSA) density, body mass index, and service branch history. Agent Orange exposure was collected through entry in electronic health records. Those with missing data were considered unexposed.

Participants were mostly Caucasian, average age 64.7, 39.4% were overweight and 42.9% obese.

Prostate biopsy showed 896 participants had prostate cancer and that the cancer was high-grade in 459 of those cases. Medical records showed 203 participants had been exposed to Agent Orange.

Exposure was significantly tied to prostate cancer (P=0.017), and especially so for high-grade prostate cancer (P=0.01) -- a 52% and 74% increased risk, respectively. Agent Orange exposure was associated with a 2.1-fold increase (95% CI 1.22-3.62, P<0.01) in the risk of detecting prostate cancer with a Gleason score ≥8.

Independent predictors included positive family history, older age, Marine Corps service, and increased PSA density.

According to the researchers the findings from this study shows knowing whether they have been exposed to Agent Orange is a readily identifiable way to improve prostate cancer screening for Veterans. Lethal cases would be spotted earlier, which with prompt treatment could potentially prolong survival and improve quality of life for patients.

Dr. Garzotto stated “It also should raise awareness about potential harms of chemical contaminants in biologic agents used in warfare and the risks associated with waste handling and other chemical processes that generate dioxin or dioxin-related compounds.”

The authors note that their findings should influence prostate cancer screening screening practices for veterans, particularly those who have been exposed to Agent Orange.

This study is expected to be published in the journal Cancer today.

More information on Agent Orange and cancer can be found online at the American Cancer Society website.

Citation "Agent orange as a risk factor for high-grade prostate cancer" Cancer 2013

 Explore further: Agent Orange exposure linked to life-threatening prostate cancer

My own doctor's Prostate Cancer-Agent Orange Study!

I am fortunate to be treated by Dr. Mark Garzotto, who is on staff at both the Portland VA Hospital and the Oregon Health Sciences University. Yesterday, in the afterglow of yet another biopsy, he shared with me his recent article on prostate cancer and Agent Orange. Dr. Garzotto yesterday confirmed he makes no distinction between Vietnam War veterans and those otherwise exposed to Agent Orange!
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June 8, 2011 -- Veterans of the Vietnam War may require more tailored prostate-cancer screening strategies because of Agent Orange exposure, researchers stated here at the 2011 Annual Meeting of the American Society of Clinical Oncology (ASCO).

Agent Orange, a defoliate contaminated with the known carcinogen dioxin, is a serious concern for Vietnam War veterans, and exposure may be associated with a 74% increase in risk of high-grade prostate cancer (HGPCa). The investigators found there was a unique effect on the risk of HGPCa when they looked at Agent Orange exposure, with no significant increase in risk of low-grade prostate cancer.

“Asking our patients if they had Agent Orange exposure may be the most important question you can ask,” explained investigator Mark Garzotto, MD, Oregon Health & Science University, Portland, Oregon, speaking here on June 5. “We typically ask about race and family history, but the thing that was interesting was that if they had Agent Orange exposure, then they had high-grade prostate [cancer].”

“Race and family history are not necessarily tied to grade, and we found that Agent Orange is a marker for lethal prostate cancer,” Dr. Garzotto added.

These veterans are now reaching the age at which prostate cancer is most prevalent. Recent studies suggested that Agent Orange exposure was associated with nearly a 50% increase in the risk of prostate cancer. It was unknown, however, whether Agent Orange exposure increased risks for more a more aggressive phenotype of prostate cancer.

Dr. Garzotto and colleagues examined 2,720 veterans who underwent prostate biopsy, and found that 896 (32.9%) had prostate cancer and 459 (16.9%) had HGPCa. After adjusting for significant confounders, including prostate-specific antigen density, digital rectal examination and age, men with HGPCa were more likely to have had Agent Orange exposure as compared with those with low-grade prostate cancer or no prostate cancer.

This study is one of the largest ever to examine this issue; the results, if validated, could aid in the development of effective prostate-cancer screening strategies for Vietnam-era war veterans.

“It has been a little bit controversial,” Dr. Garzotto commented in an interview with Doctor’s Guide. “Many of the studies, if not all of them, were done with relatively small numbers of patients or done with men at [an] age when they were not likely to develop it.”

[Presentation title: Agent Orange as a Risk Factor for High-Grade Prostate Cancer Detected on Initial Prostate Biopsy. Abstract 4667]