10 things every Veteran should know about Agent Orange

Learn the basics of VA's Agent Orange benefits and care

1. Agent Orange was a herbicide and defoliant used in Vietnam

Agent Orange was a blend of tactical herbicides the U.S. military sprayed from 1962 to 1971 during the Vietnam War to remove the leaves of trees and other dense tropical foliage that provided enemy cover. The U.S. Department of Defense developed tactical herbicides specifically to be used in “combat operations.” They were not commercial grade herbicides purchased from chemical companies and sent to Vietnam.

More than 19 million gallons of various “rainbow” herbicide combinations were sprayed, but Agent Orange was the combination the U.S. military used most often. The name “Agent Orange” came from the orange identifying stripe used on the 55-gallon drums in which it was stored.

Heavily sprayed areas included forests near the demarcation zone, forests at the junction of the borders of Cambodia, Laos, and South Vietnam, and mangroves on the southernmost peninsula of Vietnam and along shipping channels southeast of Saigon.

2. Any Veteran who served anywhere in Vietnam during the war is presumed to have been exposed to Agent Orange.

For the purposes of VA compensation benefits, Veterans who served anywhere in Vietnam between January 9, 1962 and May 7, 1975 are presumed to have been exposed to herbicides, as specified in the Agent Orange Act of 1991.

These Veterans do not need to show that they were exposed to Agent Orange or other herbicides in order to get disability compensation for diseases related to Agent Orange exposure.

Service in Vietnam means service on land in Vietnam or on the inland waterways (“brown water” Veterans) of Vietnam.

3. VA has linked several diseases and health conditions to Agent Orange exposure.

VA has recognized certain cancers and other health problems as presumptive diseases associated with exposure to Agent Orange or other herbicides during military service. Veterans and their survivors may be eligible for compensation benefits.

• AL Amyloidosis
  A rare disease caused when an abnormal protein, amyloid, enters and collects tissues or organs
• Chronic B-cell Leukemias
  A type of cancer which affects a specific type of white blood cell
• Chloracne (or similar acneform disease)
  A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.
• Diabetes Mellitus Type 2
  A disease characterized by high blood sugar levels resulting from the body’s inability to produce or respond properly to the hormone insulin
• Hodgkin’s Disease
  A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia
• Ischemic Heart Disease
  A disease characterized by a reduced supply of blood to the heart, that can lead to chest pain (angina)
• Multiple Myeloma
  A cancer of plasma cells, a type of white blood cell in bone marrow
• Non-Hodgkin’s Lymphoma
  A group of cancers that affect the lymph glands and other lymphatic tissue
• Parkinson’s Disease
  A progressive disorder of the nervous system that affects muscle movement
• Peripheral Neuropathy, Early-Onset
  A nervous system condition that causes numbness, tingling, and muscle weakness. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of herbicide exposure.
• Porphyria Cutanea Tarda
  A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.
• Prostate Cancer
  Cancer of the prostate; one of the most common cancers among older men
• Respiratory Cancers (includes lung cancer)
  Cancers of the lung, larynx, trachea, and bronchus
• Soft Tissue Sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
  A specific group of malignant of cancers in body tissues such as muscle, fat, blood and lymph vessels, and connective tissu

4. Veterans who want to be considered for disability compensation must file a claim.

Veterans who want to be considered for disability compensation for health problems related to Agent Orange exposure must file a claim.

During the claims process, VA will check military records to confirm exposure to Agent Orange or qualifying military service. If necessary, VA will set up a separate exam for compensation.

5. VA offers health care benefits for Veterans who may have been exposed to Agent Orange and other herbicides during military service.

Veterans who served in Vietnam between January 9, 1962, and May 7, 1975, are eligible to enroll in VA health care. Visit VA’s Health Benefits Explorer to check your eligibility and learn how to apply.

6. Participating in an Agent Orange Registry health exam helps you, other Veterans and VA.

VA’s Agent Orange Registry health exam alerts Veterans to possible long-term health problems that may be related to Agent Orange exposure during their military service. The registry data helps VA understand and respond to these health problems more effectively.

The exam is free to eligible Veterans and enrollment in VA health care is not necessary. Although the findings of your exam may be used to inform your subsequent care, they may not be used when applying for compensation as a separate exam is required. Contact your local VA Environmental Health Coordinator about getting an Agent Orange Registry health exam.

7. VA recognizes and offers support for the children of Veterans affected by Agent Orange who have birth defects.

VA has recognized that certain birth defects among Veterans’ children are associated with Veterans’ qualifying service in Vietnam or Korea.

• Spina bifida (except spina bifida occulta), a defect in the developing fetus that results in incomplete closing of the spine, is associated with Veterans’ exposure to Agent Orange or other herbicides during qualifying service in Vietnam or Korea.
• Birth defects in children of women Veterans are associated with their military service in Vietnam but are not related to herbicide exposure.

The affected child must have been conceived after the Veteran entered Vietnam or the Korean demilitarized zone during the qualifying service period.

Learn more about benefits for Veterans’ children with birth defects. http://www.publichealth.va.gov/exposures/agentorange/benefits/children-birth-defects.asp

8. Vietnam Veterans are not the only Veterans who may have been exposed to Agent Orange.

Agent Orange and other herbicides used in Vietnam were used, tested or stored elsewhere, including some military bases in the United States. Other locations/scenarios in which Veterans were exposed to Agent Orange may include:

• Korean Demilitarized Zone
  Exposure along the demilitarized zone in Korea between April 1, 1968 and August 31, 1971
• Thailand Military Bases
  Possible exposure on or near the perimeters of military bases between February 28, 1961 and May 7, 1975
• Herbicide Tests and Storage Outside Vietnam
  Possible exposure due to herbicide tests and storage at military bases in the United States and locations in other countries
• Agent Orange Residue on Airplanes Used in Vietnam War (PRESUMPTIVE EXPOSURE EFF.ECTIVE 06/19/2015)

Possible exposure of crew members to herbicide residue in C-123 planes flown after the Vietnam War (PRESUMPTIVE EXPOSURE EFF.ECTIVE 06/19/2015))

9. VA continues to conduct research on the long-term health effects of Agent Orange in order to better care for all Veterans.

VA and other Federal government Departments and agencies have conducted, and continue to conduct, extensive research evaluating the health effects of Agent Orange exposure on U.S. Veterans.

An example is the Army Chemical Corps Vietnam-Era Veterans Health Study designed to examine if high blood pressure (hypertension) and chronic obstructive pulmonary disease (COPD) are related to herbicide exposure during the Vietnam War. Researchers have completed data collection and aim to publish initial findings in a scientific journal in 2015.

Learn more about Agent Orange related studies and their outcomes here: http://www.publichealth.va.gov/exposures/agentorange/research-studies.asp

10. VA contracts with an independent, non-governmental organization to review the scientific and medical information on the health effects of Agent Orange.

VA contracts with the Institute of Medicine (IOM) of the National Academy of Sciences every two years to scientifically review evidence on the long-term health effects of Agent Orange and other herbicides on Vietnam Veterans. The IOM uses a team of nationally renowned subject matter experts from around the country to gather all the scientific literature on a topic, identify peer-reviewed reports, and then examine the studies to determine the most rigorous and applicable studies. The IOM looks for the highest quality studies. The IOM then issues its reports, including its conclusions and recommendations to VA, Congress, and the public.

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About the author:
Dr. Ralph Erickson is an Army Veteran of the Gulf War (1990-91) and Operation Iraqi Freedom (2003). He retired with 32 + years active-duty service, during which he held a number of leadership positions to include:  Commander of The Walter Reed Army Institute of Research; Command Surgeon, US Central Command; and Director, DoD Global Emerging Infections and Response System (DOD-GEIS). He is a board certified physician in Preventive Medicine and Public Health. He received his medical degree from the Uniformed Services University of the Health Sciences  (USUHS), Masters of Public Health from Harvard University, and Doctorate of Public Health from Johns Hopkins University. Dr. Erickson was instrumental in resolving the C-123 issues.

VA's Empty Promises to Senate & Veterans: "Case-by-Case C-123 Claim Evaluation"

Challenged by veterans, veterans service organizations and the media, VA has assured all who would listen that C-123 veterans aren't (from the VA perspective) eligible for presumptive service connection. Veterans argued that VA simply has a 100% VA blanket denial policy for C-123 exposure claims.

To which VA assured the veterans, veterans service organizations and the veterans' legislators that VA carefully considers each C-123 claim on "case by case basis." VA's actual intent, and result,  was to deny all C-123 veterans' claims but deny any accusation of a blanket denial policy.

(Cambridge University English Language Dictionary)

A "case by case" disability claim, decided on its merits, free from external pressures sounded perfectly reasonable. Reading into the phrase, one expects that VA will consider each claim's particular situation and proofs, making a just and fair decision on the facts. Especially considering VA's statutory duty to approach the claim on a pro-veteran basis!

Wrong. Never going to happen! Not on their watch.

Wrong because VA's decision against the C-123 veterans' claims was already made in early 2011 at 810 Vermont Avenue NW, Washington DC. The decision against the veterans was virtually automatic..."no more Agent Orange claims." We acknowledge that many, probably most folks in VA want to do right by veterans like us, but the VA itself certainly did not! VBA did this without specific denial language but instead their words of advice to the regional offices carried the message in several different formats:

• From VA's JSRRC Coordinator:
– "Until such time as the IOM review is completed, VA will continue to evaluate post‐Vietnam C‐123 claims on a case‐by‐case basis."
– "Therefore, exposure to tactical herbicides for crewmembers that served aboard post-Vietnam C-123 aircraft cannot be conceded."
– "No legal basis for providing this disability benefit."
– "Alice, there is no VA acknowledgement of AO 'remote' or 'secondary' exposure for post-Vietnam aircrews of C-123 aircraft used for Operation Ranch Hand."
– "The problem here is that there is some evidence from "scientific sources" supporting the claimed post-Vietnam Agent Orange exposure. However, the overwhelming preponderance of evidence is against any such exposure, including a VHA website stating that such exposure could not have occurred."
– "The real problem here is that Senator Burr and others have claimed that VA is denying these claims in a "blanket" and not following our stated "case-by-case" policy."
– "If you get a positive response from JSRRC on the direct claim, you can move forward with granting the claim (assuming all other requirements are met). (email regarding Navy veteran's claim, but Sampsel refused to "go forward' with C-123 claims also having positive JSRRC response.)
– "I can try to work on some guidance for the field on this issue that will walk a line between preponderance of the evidence and case-by-case evaluations."

• From then-Secretary Shinseki:
– "The potential for exposure to TCDD and subsequent development of any adverse health effects from flying in potentially contaminated C-123 aircraft years after the Vietnam War is essentially nonexistent. As a result, there is no scientific basis for VA to establish the  presumption of Agent Orange exposure among this group of Veterans." Shinseki letter to Congressman Young, Oct 2011.

• From Senior Advisor for Benefits, Veterans Benefits Administration: 

- " Unfortunately, there is evidence from credible sources, including ATSDR, noting the presence of Agent Orange in the C123 aircraft, so it would be difficult to sever service connection, not to mention politically unpopular." Mr. Flohr found it "unfortunate" that other government experts confirmed C-123 veterans' exposure and Unfortunately allowed the veteran's claim to be approved.
– "This does, however, present a problem for us as, although there is no precedent set by the RO decision, it is public knowledge and others may file claims citing it." Flohr thought it a problem other veterans might also apply, rather than seeing the Bailey decision as helpful to other veterans.
• From Director Compensation & Pension Service:
– "Per discussions with Jim Sampsel, the evidence the DRO relied on was lay statement and NOT sufficient to grant SC." (re: Manchester NH VA reconsideration & award of LtCol Paul Bailey claim) Suggestion was that VA rule itself in error to withdraw the only C-123 award ever made. Murphy states Sampsel categorized expert input from CDC/ATSDR, DOD, NIH, US Public Health Service, Columbia University, Oregon Health Sciences University, and the veteran's physician as "lay statement."
– "In light of all the evidence in the claims folder and referenced above, exposure to Agent Orange cannot be presumed or accepted for this Veteran or any other crewmembers of post-Vietnam C-123 aircraft. The Veteran did not serve in Vietnam and has not served in any other area that would allow for presumption of Agent Orange exposure or direct occupational exposure to be accepted. Medical studies showed that it was unlikely the human body was able to absorb any dioxins from residual Agent Orange on aircraft surfaces, or that any exposure would lead to adverse health effects. Therefore, the Veteran's claims associated with Agent Orange exposure should be denied service- connection." Compensation & Pension ordered Portland to deny a C-123 claim the VARO wanted to approve.
.– "In summary there is no conclusive evidence that TCDD exposure causes any adverse health effects." Claim denied, although TCDD is considered, even by VA, as a human carcinogen.
• From VHA Post Deployment Health Section:
– "The potential for exposure to TCDD and subsequent development of any adverse health effects from flying in potentially contaminated C-123 aircraft years after the Vietnam War is essentially nonexistent. As a result, there is no scientific basis for VA to establish the presumption of Agent Orange exposure among this group of Veterans."
• From Deputy Chief Consultant VHA Post Deployment Health Section:
– "We have to draw the line somewhere." Statement to the Associated Press.
– "Please see attached. I hope it is useful." Attachment to USAF C-123 investigation team was set of articles by Dow and Monsanto-sponsored scientists, plus Dr. Al Young, VA & USAF Agent Orange consultant who opposed Agent Orange exposure claims. Violated rules keeping agencies apart.
• From Under Secretary for Veterans Benefits Administration:
– "Exposure to tactical herbicides for crewmembers that served aboard post-Vietnam C-123 aircraft cannot be conceded." Letter to Oregon's Governor, June 2013. VBA had had in its possession the JSRRC confirmation of C-123 veterans' exposures since March 2013 but did not reveal that information.

KEY POINT:
Not one of these VA officials ever follows their public "case-by-case" assurances, verbal or in print, of proper C-123 claims processing with the well-known fact (inside VA) that Veterans Benefits Administration and Veterans Health Administration together ordered that no C-123 claims be approved. 

This was done by incorrectly instructing VBA's regional offices that "no basis exists for service connection for post-Vietnam C-123 veterans' exposure claims." That's why not a single C-123 claim has ever been approved. VA simply told their regional offices "exposure cannot be conceeded." 

This is VA-speak for deny.

At VA, "case-by-case" equals denied claims...100% of the time.

The January 9 2015 report of the Institute of Medicine to the Secretary confirmed the C-123 veterans' exposures, and proved that VA had been wrong on the science, medicine and law all along. NEVER did VA obey requirements in the Veterans Claims Assistance Act to be pro-veteran, non-adversarial and insure that "benefit of the doubt" rests with the veterans.

VA was wrong. 

Veterans paid the price.

C-123 Agent Orange Claims Progress 2011 to 2015?

Its not like having our soft tissue sarcomas, heart disease, diabetes, prostate cancer, ALS and other illnesses treated now or months from now will make any difference in the end. 

We might live a little longer. We might be in less pain, but really, what difference would it make? To VA...nothing at all.

A few months here, a few months there...what's the problem with VA refusing care even if the Institute of Medicine said we were exposed to Agent Orange and harmed thereby?

Its not like we have any special right to have our illnesses cared for. Indeed, our lesson from VA is that for their reasons not shared with us, we shall do without.

We're tough. We were taught for years by the military to tough it out, work through the pain. Now, we'll just have to learn to do without medical care...a lesson taught us since our first C-123 Agent Orange claims was denied by Compensation and Pension.

After all, the Director of VA Compensation and Pension has explained in ordering all C-123 claims denied* (on what they termed a "case by case" basis) that there is no evidence of TCDD causing any adverse health effects
and therefore, Agent Orange claims are without merit. 

And Post Deployment Health leaders helped us understand that, just like Vietnam veterans, we were never exposed anyway. 


This was later termed "an unfortunate choice of words," meaning the claim was ordered denied but other excuses should have been created for refusing the medical care sought by the veteran. 

The "unfortunate choice of words" was left to be appealed, a process underway since 2011 and which may or may not be resolved at some point prior to the veteran's death. It was important to Post Deployment that "a line had to be drawn somewhere."

There is firm VA protection for a veteran' right to appeal, but precious little assurance of a fair and accurate decision in the first place.

*2012 Agent Orange exposure claim denial by Compensation and Pension. Mischaracterized actual scientific opinion by Dr. Thomas Sinks of CDC/ATSDR that veterans were exposed. Please compare Dr. Sinks' letter to VA with the summary prepared of it by VA.  Dr. Sinks later made clear to VA that C-123 veterans should have been wearing full HAZMAT in the contaminated airplanes. VA Office of General Counsel explained that such errors can be appealed, even if the correction process takes years. Years during which VA refuses care and benefits.

VA CARES...Agent Orange poster mentions Vietnam veterans AND others exposed to Agent Orange

It is very telling in VA's poster that it mentions not only Vietnam veterans, but all others exposed to Agent Orange.

Last week. Dr. Ralph Erickson in VA's Pre-9/11 Post Deployment Health authored a blog page in which he specified C-123 veterans as among the potentially exposed population.

C-123 & Blue Water Navy: Similar IOM Experiences

C-123 veterans, families and friends are looking forward to the release of the Institute of Medicine C-123 report on January 9 at 11:00 AM in Washington, D.C. The report heavily influences whether or not the Department of Veterans Affairs will permit C-123 veterans to be admitted to VA hospitals for treatment of Agent Orange illnesses associated with their decade flying these former Agent Orange spray aircraft.

The only parallel to this situation is that of the "Blue Water Navy" where deep-water vessels' crews claimed Agent Orange exposure and IOM conducted a study after VA disqualified this group of veterans from "presumptive service connection" for which they'd previously qualified.

Looking over the Blue Water Navy and IOM, we see three events similar to how C-123 veterans have experienced. First, the VA issues a "charge" to the Institute of Medicine. This is a contract with objectives spelled out. The language of the charge is very carefully considered by the VA's Post Deployment Health Section as they seek to guide IOM to specific conclusions and not permit a more comprehensive or wide-ranging response. Second is the announcement by IOM of their findings, and third, the basic analysis of the VA, formed as closely as possible to VA's desired policy objectives.

Below are these three fundamental parts of the process, experienced by the Blue Water Navy veterans and likely to be the same process ahead for C-123 veterans. Veterans hope IOM's report will support our claims for service connection due to proven exposures.  Opposing them, as they have for years via other maneuvers, VA leaders hope the report will dismiss veterans' claims for Agent Orange exposures or at least provide some leeway, call into question, or offer some loophole permitting VA to continue refusing medical care to these veterans seeking care for Agent Orange-caused ailments.

The 9th of January will be an important day, and one we hope not as painful as was the IOM Blue Water Navy report for those worthy veterans! 

From another vet group's editorial addressing IOM's earlier review of Gulf War concerns:

"A final note -- while the IOM may claim it was just doing its job as mandated by the VA, that's not good enough, not for an institution that is part of the National Academies, which calls itself "Advisers to the Nation on Science, Engineering and Health." IOM could just as easily have read their Civil War-era Congressional mandate and told the VA that its request was not in accordance with IOM's mission nor with questions the nation needed answered. 

IOM could and should have informed VA science and the nation's needs would not be confined to the VA's policy-directed "charge," so cleverly phrased by VA to guide IOM to a pre-determined VA objective.

In fact, why didn't they stand up for good science? IOM says it advises "the  nation." 

The nation is not the VA -- the nation is veterans. The nation is not the CDC -- it's families and individuals coping with an autism epidemic. And the nation is certainly not the federal government -- the nation is the people who elected that government to protect and defend them; it's you and me. 

Sadly, IOM is not meeting objectives set forth in the law signed by Abraham Lincoln in 1863. Rather, IOM now meets objectives set by VA policy makers with only a sprinkling of scientific flavoring."

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ONE: The VA Charge to the IOM

Blue Water Navy Vietnam Veterans & Agent Orange Exposure

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Type:	Consensus Study
Topics:	Veterans Health, Environmental Health, Select Populations and Health Disparities
Board:	Board on the Health of Select Populations

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Activity Description

The IOM will conduct a study and prepare a report on whether the Vietnam Veterans in the Blue Water Navy experienced a comparable range of exposures to herbicides and their contaminants (focus on dioxin) as the Brown Water Navy Vietnam Veterans and those on the ground in Vietnam (i.e., specifically with regard to Agent Orange exposure).  The IOM's report is expected to include:

1.    An historical background on:  the Vietnam War; Combat troops (ground troops); Brown Water Navy (includes inland waters); Blue Water Navy; VAO legislation

2.    A discussion of exposures (Blue Water Navy in comparison with ground troops in Vietnam): specifically compare exposures on ground with those on ships (discuss all possible routes of exposure); and examining the range of exposure mechanisms for herbicide exposures (i.e., concentrating toxics in drinking water; air exposure possibly from drift from spraying; food; soil; skin.

3.    A determination, if possible, of the comparative risks for long-term health outcomes comparing Vietnam veteran ground troops, Blue Water Navy veterans, and other "Era" veterans serving during the Vietnam War at other locations (given the possible dioxin exposure).

4.    A review of studies of Blue Water Navy veterans for health outcomes (assuming there are studies specific to that cohort of veterans).

For more information

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TWO: IOM report and press release

Blue Water Navy: 

Veterans’ Risk of Agent Orange‑Related Health Problems Unclear

Released: 5/20/2011

From 1962 to 1971, the U.S. military sprayed herbicides, including Agent Orange, over Vietnam. Exposure to these chemicals is associated with several cancers and a variety of other health problems. The Agent Orange Act of 1991 established that veterans with any of the diseases linked to Agent Orange were presumed exposed during their service, and therefore could claim disability. The law saved veterans from the often impossible task of proving they were exposed to Agent Orange during their service. However, the Department of Veterans Affairs (VA) only compensates veterans who served on the ground or on inland waterways in Vietnam. The “Blue Water Navy”—those who served on deep water vessels—are not automatically eligible for disability benefits.

In response to a growing concern from Blue Water Navy Vietnam veterans that they may have been exposed to Agent Orange during the war, the VA asked the IOM to examine whether the exposure to Agent Orange of Blue Water Navy veterans was similar to the exposure of other Vietnam veterans. Although the IOM found several plausible ways by which Blue Water Navy veterans could have been exposed to herbicides, there was not enough information for the IOM to determine whether Blue Water Navy personnel were or were not exposed to Agent Orange.

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THREE: VA announcement of report w/VA perspective:

Institute of Medicine Report on Agent Orange Exposure

VA asked the National Academy of Sciences' Institute of Medicine (IOM) to review the medical and scientific evidence regarding Blue Water Veterans’ possible exposure to Agent Orange and other herbicides.

IOM’s report Blue Water Navy Vietnam Veterans and Agent Orange Exposure was released in May 2011. The report concluded that "there was not enough information for the IOM to determine whether Blue Water Navy personnel were or were not exposed to Agent Orange."

- See more at: http://www.publichealth.va.gov/exposures/agentorange/locations/blue-water-veterans.asp#sthash.mSYMHdKx.dpuf