Another VA Fact Sheet Needs VA IG Review – The C-123 Fact Sheet

VA's Senate Briefer

In May 2013, the Secretary of Veterans Affairs responded to inquiries from Senator Richard Burr, Ranking Member of the Senate Veterans Affairs Committee, regarding VA management of C-123 veterans' Agent Orange exposure claims.

The Senate was fed two pages of deception. Here's how.

C-123 post-Vietnam exposure claims were ordered denied regardless of substantial proofs by Veterans Health Administration's Post Deployment Health Section and were the basis of Senator Burr's concerns. The Secretary's response was drafted for him by a Veterans Benefits Administration manager, Mr. James Sampsel, and has been found to present over twenty significant errors. Some can fairly be termed clearly deceptive.

Although the factual errors were pointed out to the VA soon after the Secretary's fact sheet was received by Senator Burr, no corrections were ever permitted. VA's consultant (who is a former Dow and Monsanto consultant well) even raised objections to the scientific merit of tests performed on Patches at the USAF Museum, but other experts disagree CDC, NIESH, the Committee of Concerned Scientists and Physicians, the original experts Dr. Ron Porter and LtCol (PhD) Wade Weisman, and the USAF-contracted testing facility Midwest Testing Institute... find the procedures and results appropriate and Drs. Porter and Weisman stand behind them, per their 2011 correspondence.

Objection now to these tests from a single consultant who has expressed for decades his belief as to the innocence of Agent Orange, and who also expressed his disdain for the veteran aircrews, and who was retained by VA at a cost of $600,000 to obstruct the veterans' claims, seems hardly appropriate. It is, rather, starkly anti-veteran. The Fact Sheet is policy, not science nor law. It reflects staff members' personal agenda, selective use of references rather than a broad assessment of materials, and is clearly not a neutral, objective, accurate assessment of a serious issue.

Readers must note that unlike the recent deception VA's own Inspector General found in a VA Fact Sheet given Congressional staff, this is far more troubling as it is over the Secretary's signature and directly to the Senate Veterans Affairs leadership.

Department of Veterans Affairs (VA) 

Fact Sheet for the Honorable Richard M. Burr Regarding Processing of 

Disability Claims Based on Agent Orange (AO) Exposure Aboard C-123 Aircraft 

Outside the Republic of Vietnam 

Several hundred C-123 aircraft were used during the Vietnam War for a variety of
purposes, including troop and supply movements in Vietnam, flare dropping and
gunship security on Thailand airbases, and aerial spraying of insecticides to control
malaria-causing mosquitoes in both Vietnam and Thailand. Only a small number of
these C-123s (approximately 30) were rotated through Vietnam and used for the aerial
spraying of tactical herbicides, such as AO. This occurred from 1962 to 1971 during
Operation Ranch Hand, which was designed to destroy enemy food crops and reveal
enemy jungle positions. Following the 1971 termination of tactical herbicide use in
Vietnam, the involved aircraft may have been assigned other missions in Vietnam or
sent back to the United States.

Eventually, all C-123s in Southeast Asia were sent back to the United States, where they were used by Air National Guard or Reserve units for the remainder of their useful life. VA does not currently have a method of determining if a Veteran claiming stateside AO exposure was flying on one of the Operation Ranch Hand C-123s on one of the many other post-Vietnam C-123s flown stateside during the 1970s and 1980s.

The general claim of AO exposure among stateside C-123 crewmembers is based on a
wipe test sample of residual 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) (the
carcinogenic element in AO herbicide) found in only one C-123, which is exhibited at the
Wright-Patterson U.S. Air Force Museum in Dayton, Ohio. That aircraft, named
"Patches" because of the numerous enemy bullet holes that were patched during its
Vietnam service, was assigned to Operation Ranch Hand initially and stayed with the
operation longer than other C-123s. Most of the Operation Ranch Hand C-123s arrived
in Vietnam after 1968, when the application of tactical herbicides was on the decline
and herbicides other than AO, such as Agent White and Blue, were in use. These other
tactical herbicides did not contain TCDD.

Despite these facts, there seems to be a widespread and unfounded assumption that all
other C-123 aircrafts would contain TCDD samples equivalent to "Patches," if tested.
VA has no way of verifying this assumption, but government documents provided by
Dr. Alvin Young, a retired U.S. Air Force Colonel and leading expert on tactical
herbicides, do shed light on the issue. Analysis of surface wipe samples taken from
four mothballed Operation Ranch Hand C-123 aircraft between 1996 and 2009 showed
no evidence of TCDD in two of the aircraft and only trace amounts of TCDD in the other
two. Air samples from all four planes showed no TCDD. It is not clear how VA could
obtain additional aircraft samples and determine if residual TCDD was present in other
C-123s because they are no longer in use, and in some cases, have been destroyed.

Additionally, wipe sampling is a universally accepted method used to detect at what
level a chemical is present on a surface, but cannot be directly extrapolated to represent
human health risk, as chemical intake must also be taken into account. Further, the use
of a solvent removes more of the chemical from the surface than would be available through casual contact with the surface. This illustrates the difficulty VA faces when evaluating whether a particular Veteran claiming stateside AO exposure was actually aboard a C-123 used for Operation Ranch Hand and, if so, whether there was any residual TCDD present in that aircraft, and if it was able to enter the body.

VA assumes that some Veterans flew stateside aboard post-Vietnam Operation Ranch
Hand C-123s that did contain residual solidified TCDD similar to that found in "Patches,"
and so the issue of exposure and long-term health effects among those Veterans must
be considered. To that end, the Veterans Health Administration's (VHA) Office of Public
Health has already conducted a specific scientific investigation into the theory of
exposure to TCDD via incidental aircraft contact. The results are posted on VA's Web
site.

The general conclusion is that:
(1) any residual TCDD in the Operation Ranch Hand aircraft had solidified and is unable to enter the human body in any significant amount, and  (2) there is no scientific evidence that a Veteran's presence in an aircraft containing solidified TCDD can lead to adverse long-term health effects.

Regarding this VHA Office of Public Health scientific investigation:
1. Some scientists have argued against the VHA conclusions and provided opinions stating that the concentration of TCDD in "Patches" was excessive, and, therefore, crew members in any post-Vietnam Operation Ranch Hand C-123 would have been exposed to a high dose. However, several other scientists who are involved with ongoing toxicology research have independently and without solicitation contacted VA to refute the aforementioned opinions. They note that the percentage of TCDD in a wipe sample obtained with a solvent does not translate into a high dose that would be absorbed by the human body. They further note that studies show the skin to be a strong barrier against absorption and that extremely high temperature would be required to vaporize TCDD and make it available for absorption through the lungs.

2. Regarding VHA's conclusion on adverse long-term health effects, numerous public sources have identified the 20-year longitudinal Air Force Health Study, initiated in 1982, as a source of scientific information. It followed and studied 1,261 Vietnam Veterans who were actual pilots and crew members of Operation Ranch Hand C-123s. As such, they were exposed to tactical herbicides on a daily basis and testing showed the presence of TCDD in their bodies. However, current health data (obtained as late as 2012) fail to show a general increased risk of adverse long-term health effects as compared to other populations. Given that the evidence from actual participants in Operation Ranch Hand does not show a health risk from direct exposure to TCDD, it is difficult to ascertain a basis upon which to find a health risk among crew members of post-Vietnam Operation Ranch Hand C-123s.

Veterans Benefits Administration Veterans Health Administration
May 2013

Conclusion: There' much more for the VA IG to consider here! Denial by VA of essential medical care and other earned benefits, as VA staffers seek to implement their personal agendas, cannot be left unchallenged by VA's internal watchdog. Neither can VBA staffers' sabotage of the Secretary of Veterans Affairs in this year of monumental scandals be left concealed.

BVA Cites Non-Existent VHA "Scientific Studies" to Deny Exposure Claims

The first BVA citation below is for a Navy veteran and not C-123, but the inclusion of such language is
terrifically wrong! VBA did not "review all available scientific evidence" but instead VHA Post Deployment Health selected references it felt best blocked exposure claims to fulfil VHA policy. This can be seen from their cited references, paid-for opinions, Dow/Monsanto opinions but avoidance of unpaid and independent expert input from ATSDR, NIH, USPHS, Columbia, OHSU, etc.

Further, this defies statements from VA leaders, including Secretary Shinseki and Under Secretary Hickey, that each claim will be considered on a case-by-case basis, as instead VA automates the denials not only at BVA but directs RO denials as well.

"Citation Nr: 1426689: the Department of Veterans Affairs did address residual Agent Orange exposure concerns by post-Vietnam crews that later flew C-123 aircraft that had previously sprayed Agent Orange. VA's Office of Public Health is noted to have reviewed all available scientific information (?) regarding the exposure potential to residual amounts of herbicides on the C-123 aircraft surfaces. It was concluded that the potential exposure for the post-Vietnam crews that flew or maintained the aircraft was extremely low and therefore it was concluded that the risk of long-term health effects was minimal. See http://www.publichealth.va.gov/exposures/agentorange."

And from an April 2014 BVA decision, also reflecting VBA's damage. Actually, these studies and findings have repeatedly been brought to VA's attention.

 "Citation Nr: 1413377: there are no studies that VA is aware of showing harmful health effects for any such secondary or remote herbicide contact that may have occurred."

From others:

 " An undated Compensation Service Memorandum indicates  that there was no presumption of secondary exposure based upon being near or working on aircraft that had flown over Vietnam or handling equipment once used in Vietnam, noting that the aerial spraying of tactical herbicides in Vietnam did not occur everywhere and that it was inaccurate to think that herbicides covered every aircraft and piece of equipment with Vietnam.  Additionally, the undated Memorandum notes that the high altitude jet aircraft stationed in Thailand generally flew far above the low and slow flying UC-123 aircraft that sprayed tactical herbicides over Vietnam during Operation Ranch Hand.  The Memorandum also reflects a comment that there were no studies showing harmful health effects for any such secondary or remote herbicide contact that may have occurred. "

"Citation Nr: 1337387: note, the Department of Veterans Affairs did address residual Agent Orange exposure concerns by post-Vietnam crews that later flew C-123 aircraft that had previously sprayed Agent Orange.  VA's Office of Public Health is noted to have thoroughly reviewed all available scientific information regarding the exposure potential to residual amounts of herbicides on the C-123 aircraft surfaces.  It was concluded that the potential exposure for the post-Vietnam crews that flew or maintained the aircraft was extremely low and therefore it was concluded that the risk of long-term health effects was minimal.  (See www.publichealth.va.gov/exposures/agentorange.)  Otherwise, other than his unsubstantiated allegations, there simply is no evidence that the Veteran was exposed to Agent Orange or other herbicides based on his contact with any military vehicle that may have once been used in Vietnam."

VBA/VHA have institutionalized the C-123 non-exposure position, citing non-existent "scientific" studies on its web pages which were policy statements on VA web pages, contradicted by VA's Federal Register publications and statements by VA leadership. These unscientific positions then become cited by BVA in refusing care to exposed veterans.

It seems to BVA that VHA web pages citing non-existent "scientific studies" by Post Deployment Health trump VA Federal Register publications addressing non-Vietnam herbicide exposures.

Can't this be corrected or is it too late?

VA's Agent Orange Consultant: Also Had 2006 DOD Contract to Identify Exposure Sites

Here's one we didn't know about. We knew the consultant Dr. Al Young had a distinguished Air Force career, helping develop Agent Orange as a military herbicide weapon. We knew that he had a role opposing early veteran demands for recognition of their Agent Orange illnesses in different assignments with the AF, VA and White House, we didn't know the rest of the story until more recent years.

Once we started learning about Patches and the other C-123s' record of spraying Agent Orange during Vietnam, we filed Freedom of Information Act requests with the USAF, and uncovered a large part...but only part of Dr. Young's involvement guiding VA (where his office was "Agent Orange Projects Office" at 810 Vermont...VA HQ!) and USAF in addressing veterans' exposure claims. It goes back through the decades. The same song, playing over and over. Remember Groundhog Day?

In 2006, the Department of Defense also contracted with him to produce a list of Agent Orange exposure sites. Although testing had identified Agent Orange residue in the C-123s stored at Davis-Monthan, the aircraft weren't mentioned.

In 2009 the AF sought advice and was reminded of Dr. Young's services by the Office of Secretary of the Army. Young's advice is mentioned in various documents from those years, but the significant ones are three "Decision Memorandum" he wrote to officials, including Major Carol McCrady, Mr. Jim Malmgren and Mr. Buddy Boor. In each, he recommended the immediate destruction, without further testing, of the former Agent Orange spray C-123 aircraft. Dr. Young also reminded AF officials that exposed veterans could seek care for their Agent Orange disabilities, and discussed the need to keep the destruction process "below the radar."

Dr. Young next appears on our radar when one of his correspondents shared an exchange in which the exposed C-123 veterans were denigrated by this retired Air Force officer in 2011 emails.

Then, he again enters the scene in 2012 as the VA consultant awarded an unsolicited $300,000/year contract to prepare articles on post-Vietnam Agent Orange situation. You guessed it...his first articles were to target C-123 veterans claiming post-Vietnam AO exposures aboard these former Ranch Hand warplanes.

In 2013, the Office of Deputy Under Secretary of Defense again found him invaluable in the investigation to insure no Agent Orange was found on Okinawa, site of many barrels of Dow chemical burial. I don't know that situation well enough to comment.

But what really rubs salt into our Agent Orange wounds is the VA's acceptance of his reports for use against us at the June 16 Institute of Medicine committee hearing. Is it a coincidence that his contract runs through the end of the IOM C-123 process, September 27, 2014?

I was there. We shared a hour-long panel discussion, and I felt his genuine passion, defending a point of view he's kept unchanged for decades. But this was a scientific gathering of experts to provide input to the Institute of Medicine of the National Academies of Science. I was representing the veterans, and we were the only ones in the room entitled to express ourselves passionately!

I didn't make a big deal about his use of web site photos from recent restoration of a privately-owned C-123 to represent the same airplane being "restored and refurbished" in 1973. I didn't mention his foul slurs about us. I didn't even object to his failure to completely answer Professor Lu's question about why the C-123s were destroyed and his decision to avoid mention of own role recommending exactly that.

And if I made mistakes he graciously didn't make too big a deal of them, either. It seemed a civil discourse, but I remain critical most especially of his failure to mention to the committee his VA contract for $600,000. He was under contract to the VA running before, during and after his presentation to the IOM, yet neither he nor the VA properly informed the committee. By the way, the VA didn't pay me anything to carry my side of the argument, but the IOM paid my airfare to get to Washington, DC.

We've been asked if we see this as sinister? No, but certainly not pro-veteran, not pro-benefit of the doubt, hardly non-adversarial, and most definitely, unscientific. The consultant's papers, which were not peer-reviewed, were heavily slanted against Agent Orange being harmful, against any Agent Orange being present, and, if there was Agent Orange present, it somehow was the kind which couldn't expose anyone.

The VA did not simply place a stack of documents before the IOM representing all available information. Instead, they contracted out for $600,000 to prevent our claims. They accepted input from Dow and Monsanto who sponsored scientists to write to the Under Secretary to argue against us. They chose which documents to release to the VA...and withheld others.

The folks from VHA Office of Public Health were adversarial and, after submitting the charge to the IOM, then strongly argued against it instead of keeping their distance...letting the IOM search out the truth. Perhaps this added to the reasons behind the six major veterans' service organizations joint letter to the Secretary of Veterans Affairs, objecting to the historical role of this consultant regarding veterans and Agent Orange.

Whistleblower Mental Health Allegations CONFIRMED by VA Officials

Investigation Proves Whistleblower Claims – VA Neglected some Suicidal Veterans

note: This Blogmaster is aware of one veteran who previously attempted suicide and sought help from VA mental health facilities and was instead invited to an afternoon veterans' picnic, with no professional follow-up. Claims of depression brought prescriptions for Prozac from a primary care provider.

The Department of Veterans Affairs has substantiated some of the allegations made last year by a former epidemiologist who claimed that the agency neglected assisting suicidal veterans and was slow to release important research data.

The former employee, Dr. Steven S. Coughlin, was a principal investigator at the VA’s Office of Public Health until resigning in December 2012. Coughlin testified in March 2013 before an investigative and oversight panel of the House Committee on Veterans’ Affairs. (See “Whistleblower Accuses Government Of Neglecting Suicidal Veterans And Suppressing Science”.)

The VA’s Office of Research and Oversight investigated Coughlin’s claims and completed a report on its findings last summer. It did not brief Congressional staff of the House Committee on Veterans’ Affairs on its report until January, according to Chairman Rep. Jeff Miller (R-Fla.).

After interviewing several VA staff and reviewing 3,000 pages of relevant documentation, the investigators substantiated three of 10 allegations made by Coughlin:

·       VA lost medical data obtained from the children and spouses of Gulf War veterans that might have demonstrated an association between illnesses, including those related to wartime exposure, in service members and their offspring;

·       Coughlin’s superiors responded to his concerns in a way that could have been perceived as threatening or retaliatory;

·       VA neglected to contact participants in a study of Gulf War veterans who shared suicidal thoughts or feelings.

Regarding Coughlin’s other claims, the investigators often said the disagreements between Coughlin and his superiors resulted from conflicting priorities.

While Coughlin, for example, said his supervisors were deliberately withholding important data regarding exposure of Iraq and Afghanistan veterans to toxins and inhalation hazards, those interviewed about the claim said the data needed to be cleaned and that analysis should focus on the main subjects of the study, which are traumatic brain injury and post-traumatic stress disorder. The report urges VA to complete the analyses “as expeditiously as possible.”

Related Story: Burn Pits Still Used In Afghanistan, Endanger Troop Health

Coughlin, who is now a professor of preventive medicine at the University of Tennessee in Memphis, claimed that the decision to report his concerns took a toll on him professionally and personally. “I quit my job and left because it wasn’t just one ethical problem, it was a whole constellation,” he said. “I finally had enough.”

He remains concerned that veterans participating in different VA studies who expressed suicidal feelings have not or may still not get a follow-up call from a mental health provider. Before he left VA, he was eventually permitted to involve clinicians in a 20-year study of 30,000 Gulf War veterans. A team of social workers and psychologists placed follow-up phone calls to nearly 100 veterans who had reported suicidal behavior. The report found that a smaller group of veterans participating in a separate study required follow-up; six veterans were subsequently contacted.

Coughlin’s supervisors told investigators that they had not rushed to develop a plan for contacting suicidal veterans because they felt doing so “represented a desirable innovation, rather than an immediate need.” They also worried that calling veterans would violate privacy and confidentiality guarantees and “thereby undermine Veterans’ trust in future [Office of Public Health] surveys.”

Since the investigation concluded, VA has taken several steps to address Coughlin’s substantiated claims.

Dr. Tom Puglisi, executive director of the Office of Research Oversight at the Veterans Health Administration (VHA), said in a statement that the “evolving standard is that participants demonstrating suicidal ideation in research studies should be contacted promptly for clinical follow-up, and VHA expects that future [Office of Public Health] surveys will adhere to this standard.”

The report recommends increased Institutional Review Board oversight for research conducted by the agency. Office of Public Health supervisors have participated in human resources training in conflict resolution. That office has also established timelines for analyzing and publishing data from major studies on Gulf War, Iraq and Afghanistan veterans, including results that might indicate a neurological explanation for Gulf War Illness.

Related Story: Critics Concerned Over VA’s ‘Sweeping’ Changes To Gulf War Illness Research Panel

In a statement, the agency acknowledged the results of the investigation and said the its “highest priority” is the mental health of veterans.

“The Department of Veterans Affairs recognizes and respects the service, dedication and many challenges of Veterans of the 1990-1991 Gulf War, and is committed to improving the health and well-being of these Veterans,” Puglisi said. “Research is a vital component in improving that treatment.”