"An unfortunate choice of words" – how VA denied Agent Orange claim by insisting Agent Orange is harmless

Just received from the Department of Justice: DOJ has summarized VA's response to our inquiry regarding the famous statement used by VBA Compensation and Pension to deny a C-123 veteran's claim. VA actually ordered the claim denied by insisting there is no evidence of Agent Orange and its toxic component TCDD causing human health injuries.

Now, DOJ says that was "an unfortunate choice of words." Unfortunate but still adequate, however, for VA to have denied the claim for five years!

One of the first C-123 Agent Orange exposure claims faced the determined opposition of VBA's Compensation and Pension Service, a determined opposition which continues even years later, despite all scientific evidence.

Opposition (guided by VA's go-to consultant Dr. Al Young) which has included even denying Agent Orange claims by insisting that Agent Orange is somehow harmless and that Agent Orange benefits specified by Congress in the 1991 Agent Orange Law for Agent Orange exposure with resulting Agent Orange illnesses...claims which are to be denied on the personal whim of VA staffers annoyed at veterans seeking care. (sorry for the run-on sentence.)

C&P's view was that C-123 veterans' Agent Orange exposures are to be blocked, despite meeting the requirements of the 1991 Agent Orange Act, and VA's own regulation VAM-21-1MR.

Portland's VA Regional Office forwarded a C-123 vet's claim to VBA's Agent Orange desk as required, with the field's recommendation for approval given the vast amount of supporting evidence and compliance with the law. Compensation and Pension responded with what has continued to be their blanket denial of all such claims. Here is what was just an early example of their extra-legal injection of personal attitudes into claim denials:

"I figured they would take care of me, but so far they haven’t."

“They promised me health care, and I figured they would take care of me, but so far they haven’t.”

That's the story from so many VA patients in Oklahoma and elsewhere. More stories than there should be, given the standards VA sets for itself and the typically complex medical situation of aging veterans.

We've written before about how much it hurts all veterans to read about VA failures in providing essential medical services. The title of the USAToday news feature sums up its damning indictment of the Oklahoma City Veterans Hospital. Not only are veterans abused with a claims system making them wait months and years before allowed VA medical care and benefits, but the care they've been promised falls short of their needs.

My own care at various VA facilities has been excellent for the most part, especially in dental service, urology, medical imaging and the emergency department services. 

However, I also had my second-worst experience at the VA when the Portland VA emergency department diagnosed avascular necrosis of my right hip. I was referred

to orthopaedics where a surgeon concluded I had simple bursitis, although I couldn't walk for the pain and had several falls. He made this conclusion despite his own hospital's emergency department and radiology physicians' written diagnosis of avascular necrosis, basing his conclusion on the fact that I had no history of taking prednisone, a powerful steroid.

Problem: the orthopaedist didn't bother reading the many pages in my medical record that detailed his own hospital's prescription for my massive doses of prednisone over a several year period. He wrote in my records "no history of prednisone use," and nothing came up in our conversation about it for me to realize his oversight...I discovered only on reading my records after a FOIA request. 

His failure to diagnose cost me many more months of increasingly miserable pain, more falls, and failed to treat a hip that could have been saved. Like the patients in USAToday's article, my problem was finally diagnosed by a private physician. Complaining about it to my VA doctor's supervisor and then, filing what's called an 1151 complaint, only brought VA's official conclusion that my VA care (for the hip and for the probably unrelated earlier problem which required the massive prednisone) had somehow equaled the standard for care in the Portland medical community. The complaint was dismissed. 

Avascular necrosis (large bone death caused by loss of blood supply to the bone) is progressive...and how! I eventually couldn't move the hip at all, and was bedridden until I sought care and was properly diagnosed at Oregon Health Sciences University. By then my hip was damaged past the point of recovery and I went through two painful replacements and less than optimal results.

Months later I felt ready to collapse and ended up once again at the VA emergency room –with an infection of the hip prosthesis I'd received at OHSU. I was shocked when the same VA physician came in to care for me, and for the first time in my life I refused care and asked to be transported to another hospital. 

My story, like every other individual's story, is only anecdotal. It takes many such stories to prove a fact, and we've seen those stories accumulate to the point of proving the case: VA care too often is substandard and veterans pay with pain, suffering and death. USAToday and other publications have certainly proven that VA care is too often below the standard of what aging veterans need and below the standard the Secretary expects of his Department.

Mr. President, Mr. Secretary and my own Colorado federal legislators, the entire country needs the VA to succeed. We need heros in the VA to pull it up to the standards in health care we deserve. With news like Oklahoma City, Phoenix and other problem facilities, we're losing the support of the American public. Without that support, the Department can only sink lower and lower into disrepute. Please lead the Veterans Health Administration into the ranks of America's finest!

Because I need it and my experiences warrant it, I'm a vocal supporter of the Department of Veterans Affairs and its leaders, but not VA's claims process. Stories like this in USAToday sadden VA's most enthusiastic supporters and threaten to make 2015 a repeat of 2014, which everyone called "the year of scandals."

Working with your Veterans Service Organization Representative

Many vets have the misunderstanding that the various veterans service organizations (VSO) which represent veterans before the VA are responsible to the "grand design" of a claim for service connection.

While some VSOs may indeed offer that assistance, not all do, as in the case of Oregon's Department of Veterans Affairs. Oregon staffs their counties with state-affiliated, VA-authorized service officers as well as teams in Portland and the state capital, Salem. These officers offer a broad range of advice and interface with community-based services, but in Oregon veterans are responsible for submitting their own claims and creating, from their own resources, a basic strategy.

Oregon's role, as explained to me late last month by their Portland staff, is to focus on strategizing the vet's appeal only once the claim is denied. The service officers are notified by the VA shortly after the award or denial decision is made, and they then swing into action to help a veteran determine the next steps.

For many, the best approach will be a "notice of disagreement" (NOD) or alternately, a request for a local review by a senior VA rating officer not previously involved in the claim, a decision review officer (DRO.) That is the first important level of strategy where the service officer is able to help, because specifics of the claim can make one approach better than another.

After that, that, a vet's principal concern will be the amount of time required simply waiting in line, because appeals or DRO reviews can take years to be heard. When the big day finally rolls around, the service officer will present the VA with the facts of the case, the errors made by the VA, and the justification for an award in the vet's favor.

This entire process, and the inherent threat of years of delay working a denied claim, places a significant value in the veteran's initial claim being as complete, accurate, comprehensive, persuasive and error-free as possible. The veteran must hope for a positive response from the VA rather than a denied claim, wasting years and continuing to be denied VA medical care and other benefits. This means a vet needs to select a VSO carefully, especially if you feel unqualified to manage your own claim prior to the VA denial.

How to best approach this yourself with some hope of success if your VSO isn't set up to mange the initial claim for you? The very first step is to notify the VA in some form of your intent to file. All benefits are based on the date you first inform them of your wish to make a claim...and you can do this with a simple letter listing every possible boo-boo you have, or you can begin the process on-line at their web site.

Then, Attorney Katrina Eagle offers her "Dirty Dozen," thirteen tips of things NOT do do, and that's a great place to start– begin the process by not stepping on any minefields. Next, gather all your papers and have them scanned into digital form, because eventually you'll want to submit a "Fully Developed Claim" which is done on-line. Why? Because the VA processes those fastest, and because in many instances the VA even can back-date benefits a full year to motivate us to us that electronic process.

Next, file a a Freedom of Information Act request with the VA and with your military service to insure you've got all official documents on-hand. This may take months to get completed, so file early in your claims process. Then scan all those documents also, especially your DD214, any Line of Duty determinations, and medical records.

The VA will arrange a physical for you to address your claimed illnesses or injuries, but a faster route is the Disability Benefits Questionnaire (DBQ) which your own physicians' can complete and submit. Your doctors can expand further in a letter, but you and they should be aware of phrases the VA is attuned to. For instance, "may" to the VA means "no" and "more likely to than not" means yes. A physician simply saying your broken back may be due to your airplane crash is dismissed by the VA. A physician saying your broken back "is more likely than not" due to your airplane crash is accepted by the VA (usually) as credible support for your claim. We've noticed that physicians' stating their qualifications, or medical references in their veterans letters are generally more useful to the vets.

Beyond this, one of the veterans' claims self-help books is probably of greater value to a veteran preparing a claim than anything which can be typed here. There are many Internet resources and many, many veterans' web sites offering excellent advice. The point is: Tell the truth, assert your interests firmly, if something hurts (range of motion, etc.) say so instead of toughing it out, and don't quit.

Oregon Public Radio Interview: C-123 Veterans & Agent Orange

The interview with a C-123 Veterans Association member follows after about 45 seconds of local broadcasting. We discussed the aircraft contamination, the amusing strategies developed by the VA to prevent lawful claims, and what this has done to Air Force veterans.

http://www.kboo.org/sites/default/files/episode_audio/kboo_episode.2.130712.0900.2854.mp3

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

Vietnam Veterans of America - doing their job?

Yes, they are indeed!

There has been some Internet chatter this weekend about the usefulness of the Vietnam Veterans of America - some folks feel VVA isn't doing enough for Guam, Blue Water Navy or other non-core VVA populations.

That's not my experience. Rather, VVA was the first to address our needs with their national resolution calling on DOD and VA to treat us right. VVA introduced us to effective allies in the Agent Orange community, without which much time would have been wasted. I have no complaints and each request for liaison or other support has been honored by their leadership.

My only concern is a local one here in Portland, Oregon. VVA lacks a service officer in the Portland VARO and instead utilizes dedicated volunteers elsewhere in the state. With my own claim, I felt I needed a local contact and went with another service organization (State of Oregon) only for that reason...I wish local VVA VSOs had been available as obviously the Vietnam Veterans of America has the expertise in Agent Orange issues.

Heck...some of the veterans' organizations in which I have life memberships, such as the Disabled American Veterans and the Paralyzed Veterans of America, never even answered multiple letters and phone calls asking for their leadership and assistance in our C-123 veterans' struggle. I get the feeling too much focus is on fundraising. Specific requests to PVA regarding help needed in Washington DC re: handicapped issues have been ignored. PVA even lost my appeals documents for my claim before the Air Force Board of Correction of Military Records when their staffer left the organization. This happened twice, then they told me they no longer represented members at the AFBCMA! Two years wasted. Yet, years ago, it was the PVA medical director, the late Dr. Bodenbender, who documented my Gulf War injuries for my initial VA claims.

From my experience, we have had all the assistance we could have hoped for from the Vietnam Veterans of America and the American Legion. We hope for a national resolution this summer from the Veterans of Foreign Wars. To all  veterans organizations dedicated to helping veterans stand up to the VA, our thanks. God bless!

Let's stop squabbling, okay?

Wes Carter, Chair, C-123 Veterans Association

Member, Vietnam Veterans of America, American Legion, Paralyzed Veterans of America, Disabled American Veterans, Veterans of Foreign Wars

DoD records agency torpedoes C-123 Claims!

JSRRC, Alexandra, Virginia

This week I had the opportunity to review my "C" file at the local regional office. Lesson learned...should have done so much earlier! It turns out that the Joint Services Records Research Center, the DoD agency responsible for informing the VA about any veteran's individual PTSD or Agent Orange claim, was totally off base and helped torpedo my VA claim.

In my case, which is likely the same as every other C-123 veteran who has approached the VA for service connection, the VA regional office did a fair job summarizing my claim and boiled down to a single question what was needed from JSRRC: "We are requesting a determination as to whether herbicide (sic) were found as alleged." An accurate answer would be vital, confirming my own description of the situation or leaving it unfounded.

JSRRC has boxes and boxes of supporting information collected in their normal course of activities. They gather unit histories, combat action reports, deployment orders...all that sort of stuff. But for some reason, last year when I was referred to JSRRC for information to support the C-123 exposure issue, they responded in the negative...nothing available, per their chief, Mr. Dominic Baldini.

So I oped to provide Mr. Baldini a large collection of what our C-123 veterans had collected since April 2011. I sent JSRRC flight logs, toxicological tests, contemporary news articles, "buddy letters", expert independent scientific opinions, findings by other federal agencies, photographs, emails and official correspondence. Enough any historian would agree to answer that question"was herbicide found as alleged." Sometimes historian want original source documents, and everything I sent is still readily available today from the various agencies if Mr. Baldini felt he couldn't accept what I sent as official enough for their purposes.

Faced with their mission objective of helping the VA help veterans substantiate claims, the JSRRC completely failed me and all other C-123 veterans. Instead of responding to the VA's inquiry about me with a summation of testing done on Patches and the rest of the fleet, supported by all the official documentation which thus far totals over 300 pages, the JSRRC simply torpedoed  us!

In respond to the VA question, the JSRRC uselessly and in error wrote:

"Unfortunately, the JSRRC in unable to verify or document that an (sic) air crewmembers were (sic) exposed to Agent Orange resulting from Agent Orange residue or dioxin contaminated aircraft or aircraft parts. Please refer to your (VA) website and the VA's determination for this information."

Four problems here which would ruin any C-123 veteran's hopes for a fair deal from the VA:
1. JSRRC did not address the question posed by the VA but instead said it couldn't "verify or confirm" aircrew Agent Orange exposure
2. JSRRC referred the VA back to the VA for supporting information (with the referral back to the VA's C-123 press release from VA Public Health) - ridiculous in the extreme to tell the VA  seeking source documents to read their own (erroneous) web page!
3. JSRRC was incorrect in their answer anyway, as ample information was available at JSRRC to establish aircrew Agent Orange exposure - in particular, the expert scientific opinion from Dr. Tom Sinks, Deputy Director, CDC Agency for Toxic Substances and Disease Registry, who stated:

"Given the available information, I believe that aircrew operating in this, and similar, environments were exposed to TCDD"

Dr. Sinks, speaking on behalf of his agency which is responsible for making such decisions, coudn't have been any clearer. His letter certainly was one item of verifying documentation JSRRC had to offer. His answer should have been adequate.
4. Finally, once JSRRC responded the VA did nothing to challenge  either the failure to address the original VA question, or to challenge the JSRRC response which clearly was in error - the VA had the same documentation from ATSDR and other sources

Another VA Claim Sunk - for inadequate proof!

Observation: We all need to personally visit our Veterans Affairs Regional Office (VARO) to review our records. Discuss with the staffer who will sit with you while going through the records any errors, omissions, whatever. You can request copies which they may be courteous enough to offer, but if not, simply FOIA the entire collection. Remember this "C" file at the VARO is separate from your medical records and you need to make sure both are complete and accurate. In my visit I uncovered three very important issues to address which will help make my case successful...well worth the trip downtown to keep them from letting your application be torpedoed!

This is terrifying. JSRRC and the VA can't be counted on to meet their own mission of accurately gathering and evaluating evidence of our Agent Orange exposure, and then when challenged by veterans simply ignore us!

Bad VA Decision - Now a "Notice of Disagreement"

(update 20 Dec 2014: still haven't heard from VA after two and a half years waiting)

Last week's expected (yet disappointing) VA denial of the first of our veterans' Agent Orange claims gives momentum to our campaign. Rather than the issue sitting on some VA wonk's desk, it gets to the stage where a clarifying argument can be offered, and failing that, can progress to the Board of Veterans Appeals.

Here is the mechanism of this particular claim going forward (from the Vietnam Veterans of America web site). In this particular case, representation will be sought from the American Legion, given their national support and the local VSO's strengths.

How To Respond To The VA's Decision:

You do not help yourself if you simply dump a pile of loose records on the VA. Organize the records and explain their significance in a letter you and your representative prepare together. Once the VA regional office makes a decision with respect to your claim, you (and your service representative) will receive a notice of that decision which explains the reasons for the VA’s determination. Read the notice carefully and discuss it with your representative. Your appeal should address the specific reasons why the VA denied the claim or awarded a rating that is too low or an effective date that is too late.

The first step in appealing a claim is to send the VA regional office a "Notice of Disagreement " (NOD). There is no official NOD form. Generally, the NOD can be a written statement on VA Form 21-4138 (Statement in Support of Claim) or a letter that states that you disagree with the decision. Be sure to include in your NOD the date of the decision that you disagree with, which issues you disagree with and that you intend to appeal those issues. You have one year from the date of the VA’s notice of its decision to file your NOD with the VA regional office. If you miss this deadline, you can only reopen your claim based on new and material evidence or establishing that the VA denial was the product of clear and unmistakable error (which is very difficult to prove).

After the VA receives your NOD, you should receive a letter that acknowledges your NOD. You will be asked whether you wish to have your appeal sent to the Board of Veterans’ Appeals (BVA) in Washington, D.C., or whether you wish to have your claim reviewed on a de novo basis. The latter refers to the VA’s Decision Review Officer (DRO) program. This is an informal appellate process within the regional office. The DRO has the authority to reverse or modify a VA rating board decision. We recommend that you seek DRO review before you request a BVA appeal. The DRO process is frequently successful and is generally faster than going straight to the BVA. If you do not receive a better decision from the DRO, you can still appeal to the BVA.

Once the DRO has made a decision or has received your request for BVA consideration, the VA will issue a “Statement of the Case” (SOC). This document will explain the VA’s decision(s) in detail. You have 60 days from the date of the SOC to file your substantive appeal to the BVA on VA Form 9. (VA forms can be downloaded from the VA’s “Compensation” website. You can even apply for benefits online under “Vonapp” (Veterans Online Application)). Your appeal will then be certified and forwarded to the BVA.

Giving Up My Agent Orange Claim - But with a Strategy

I have given up my Agent Orange disability claims today...but with a strategy.

Today I had my C&P exam in Portland and thought it went well, with the nurse-practicioner having read through my file last night and ready with questions for me today. Good exam. My application has been in for a year now, and I was told on March 8 in our Washington DC meeting with Mr. James Sampsel of the Veterans Benefit Administration that it will "probably" be denied, regardless of all the Air Force, CDC, GSA, university or other documents that clearly support in my claim and the claims of my crew mates.

So, on to a more public forum. Once denied on a Notice of Disagreement, I'll progress to the Board of Veterans Appeals where I will be able to have proper legal representation. My DAV VSO here in Portland has been great but there is nothing outside the Beltway which will get VA to change their pre-determined opinion, So on to the BVA and whatever follows. Hope I'm not shooting myself in the foot!



Unrelated: The nurse-pratitioner doing my C&P exam today was surprised that, 20 years after my injury, I still have yet to see a VA neurosurgeon or orthopedic surgeon for my injured neck or back. Hey...this is the VA. Virtually every single partitioner I have seen has been skillful, kind and caring, but get real...waiting three years to see a dentist isn't my idea of good dental care. Waiting six months to see an orthopedist for an unstable hip and new knees isn't anybody's idea of good medical care. No VA employee would accept this standard of care for themselves or their families. Oh, well...just venting a bit. I absolutely love my primary care, dental (when I can see them), audiology, optometry and the pharmacy services. My prostate cancer treatment has been top-notch.

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!
-------------

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]