CDC Report Proves C-123 Agent Orange Exposures (Post-Vietnam)

In June 2014 at the Institute of Medicine C-123 Exposure Hearings, the CDC presented its findings about C-123 veterans' Agent Orange exposures, and they pulled no punches! We were exposed, and our duty aboard the C-123s subjected us to a greatly increased risk of cancer and were also 182 times greater than military limits for dioxin exposure.

These government experts determined that our post-Vietnam aircrew and maintenance workers suffered significant, and harmful, Agent Orange exposures which were probably even higher when we flew the planes, than when the Air Force tested them years after the C-123s were mothballed.

VA has had this information from the CDC since 2012, but just refused to evaluate it. Reviewing the details, VA's Compensation and Pension Service simply dismissed the facts presented as irrelevant to our claims.

For nearly four years now, VA has dismissed everything which possibly argued that we'd been exposed, and even ignores its own regulations to block our claims.

How much proof does it take to reach the "as likely to as not" threshold of the law? Apparently, much, much more than VA should be asking! They ignore the CDC, NIH, EPA, dozens of scientists and physicians (the "Concerned Scientists and Physicians",) National Institute of Environmental Health Sciences, National Toicology Program, US Public Health Service and even the DOD Joint Services Records Research Center.

The JSRRC report is considered "source DOD verification" of veterans' exposures – except with VA's treatment of C-123 claims. Our claims continue to be ordered denied by the VBA's Compensation and Pension Service, regardless of stacks of proof.

Below: Findings: CDC details proofs of C-123 veterans' Agent Orange exposures (from page 4, by Dr. T. Sinks)

CLICK HERE to read entire CDC C-123 Report

VA Announces C-123 Institute of Medicine Exposure Study

VA has posted a revision of the C-123 exposures page, which now includes a brief statement of the recent referral of the issue to the Institute of Medicine. Results expected late 2014.

The affected veterans appreciate the concern of the public and the Department of Veterans Affairs in submitting the issue to the Institute of Medicine. We feel, however, the issue is well-addressed in both legal and scientific proofs available to the VA today.

The inevitable delay in fairly considering C-123 veterans' claims which this IOM project involves means eligible veterans will continue to be denied VA medical care. This delay, perhaps as much as two more years, takes from us two years we don't have left to wait for such a decision to gain access to vital medical care.

It has been two years since VA broke their promise of the C-123 IOM project we'd agreed to, and now two more years are proposed mostly as a means of saving money by refusing medical care. That's wrong.

We're eligible now. But regardless, VA denies all claims now, on orders from Compensation and Pension.

Is it not a reasonable interim position that well-qualified C-123 claims be permitted approval? VA could ask for proof of service, proof of diagnosis of an Agent Orange-presumptive illness, and proof of duty aboard a known former Agent Orange spray aircraft such as # 362 (Patches) or one of the other Ranch Hand warplanes.

In our situation of exposure outside Vietnam, VA21-1MR requires VAROs to inquire of C&P as well as JSRRC. Rather than any evaluation at this point, C&P then responds to every referral by ordering denials, and VA has controlled how JSRRC can respond and upon what evidence JSRRC summaries can be based. Post Deployment Health and Compensation and Pension are able to explain better.

We believe that eventually somebody in authority will walk into General Hickey or General Shinseki's office and tell them what's actually being done to the C-123 veterans. The law reads exposure, the rules read exposure, the proofs from science and other federal agencies confirm both exposure and medical impact, but it seems orders still blast out of Washington to "deny, deny, deny. Invent whatever reason, but deny." Once leaders realize, as does the Senate Veterans Affairs Committee, that VA procedures are improper, things can change.

Until then, we'll continue to see each and every one of our perfectly valid exposure claims denied on the preferences of a few staffers.

What Laws Need to be Changed for C-123 Agent Orange Exposure Claims?

The question comes up occasionally...do any laws need to be changed for C-123 veterans to have
VA recognize their Agent Orange exposures and provide treatment for Agent Orange-type illnesses.

Easy...none. There is no new legislation needed because these veterans are fully eligible for VA care today. The law is based on the 1991 Agent Orange Act, Title 38, and the 31 Aug 2010 Federal Register statement by the VA.

Actually, VA would need legislation, or at least notice in the Federal Register, for a legal basis for denying claims as they do today.

We are advocating for VA to obey the law, not change it. Double check us with the NVLSP, Katrina Eagle, or other veterans law experts.

Yale Law did a comprehensive review which was completed 18 January 2014, concluding that C-123 veterans are legally qualified today for Agent Orange benefits. VA's failure to permit these claims is unacceptable implementation of policy.

As VA itself made clear (in the Federal Register 31 Aug 2010, p. 53205:)

Finally, we wish to make clear that the  presumptions of service connection provided by this rule will apply to any veteran who was exposed during service to the herbicides used in Vietnam, even if exposure occurred outside of Vietnam.

C-123s Returned from Vietnam Identified as Postwar Source of Agent Orange Contamination

Air Force Aircraft Returned from Vietnam Identified as Postwar Source of 

Agent Orange Contamination

New evidence published in Environmental Research shows personnel exposed to meaningful levels of Dioxin, contrary to current position held by Air Force and VA

·       BY JOSH HICKS

·       

·       February 26 at 6:00 am

The C-123 transport planes that sprayed Agent Orange during the Vietnam War may have sickened service members who worked with the aircraft after the conflict, according to a new study.

The report, published last week in the scientific journal “Environmental Research,” supports claims that exposure to the toxic defoliant after the war is greater than previously believed.

TCDD-contaminated C-123 Aircraft, Tucson AZ

Columbia University health-policy professor Jeanne Mager Stellman, who authored the study, said the findings conflict with U.S. Air Force and Department of Veterans Affairs conclusions and policies.

“Aircraft occupants would have been exposed to airborne dioxin-contaminated dust as well as come into direct skin contact, and our models show that the level of exposure is likely to have exceeded several available exposure guidelines,” Stellman said.

The VA has said that any postwar contamination on C-123s was not high enough to be linked to disease. But some lawmakers think the agency may be wrong.

Sen. Richard Burr (N.C.), the top Republican on the Senate Veterans Affairs Committee, and Sen. Jeff Merkley (D-Ore.) have asked the VA’s inspector general to review whether the department is inappropriately denying disability benefits to veterans who claim they were sickened by postwar Agent Orange contamination.

 “This is further evidence VA is out of step with the prevailing science — the facts speak for themselves,” Burr said of the report in a statement on Monday.

The VA said it will continue to review new scientific information on the issue as it becomes available and that it has asked the Institute of Medicine to study possible health complications among post-Vietnam C-123 crews.

“VA does not presume by regulation that these veterans were exposed to Agent Orange,” the agency said in a statement. “VA does presume exposure to Agent Orange for veterans who served in Vietnam because of the lack of exposure information that is available. We encourage anyone who believes they were exposed to Agent Orange to file a disability compensation claim or visit a VA health care facility.”

C-123s sprayed Agent Orange in Vietnam from 1962 to 1971 as part of Operation Ranch Hand, and about 1,500 Air National Guard and Reserve crew members flew the planes on cargo missions until 1982.

The study used U.S. Army algorithms and data from surface-wipe samples from aircraft used in Operation Ranch Hand to estimate “dioxin body burden,” comparing the results with available guidelines and standards.

“These models suggest that the potential for dioxin exposure to personnel working in the aircraft post-Vietnam is greater than previously believed and that inhalation, ingestion, and skin absorbtion were likely to have occurred during during post-Vietnam use of the aircraft by aircrew and maintenance staff,” a summary of the report said.

Merkley said in a statement on Monday that he hopes the study “prompts the VA to finally reverse their position and make sure all veterans suffering from Agent Orange exposure get the treatment and compensation they need and deserve.”

The VA in July reversed its denial of benefits for Paul Bailey, a retired Air Force lieutenant [colonel] and postwar C-123 crew member who is sick with cancer. Advocates of the decision have described the move as the first of its kind for veterans seeking compensation for post-Vietnam exposure to the defoliant.

"Agent Orange Linked to Increased Risk of Skin Cancer" – University of Texas Medical School

Agent Orange linked to increased risk of skin cancer

 

See also

• Disease & Illness 
• Agent Orange 
• Exposure

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January 29, 2014

Vietnam War veterans exposed to Agent Orange at higher risk for non-melanotic invasive skin cancer

A new report adds to past evidence that risk of non-melanotic invasive skin cancer (NMISC) is increased even four decades after Agent Orange exposure, with at least some exposed veterans having unusually aggressive non-melanoma skin cancers.

Agent Orange is the code name for an herbicide and jungle defoliant developed by the United States military during the Vietnam War. It has been linked to a wide range of cancers and other diseases, caused by the highly toxic dioxin contaminant TCDD.

As of 2009, there were 485,760 Vietnam veterans with documented Agent Orange exposure registered with the U.S. Department of Veterans Affairs, and many of these veterans reported significant health problems,

According to Dr. Mark W. Clemens, M.D, Assistant Professor of Plastic Surgery at The University of Texas MD Anderson Cancer Center,” TCDD is among the most carcinogenic compounds ever to undergo widespread use in the environment”

Dr. Clemens and colleagues set out to determine if prior exposure to TCDD was associated with an increased incidence of nonmelanotic invasive skin cancer.

The researchers reviewed the medical records of 100 consecutive male patients with Fitzpatrick skin types I through IV who enrolled in the Agent Orange registry at the Veterans Affairs Hospital of Washington, D.C., between August of 2009 and January of 2010.

The patients average age was 65.7 years (range, 56 to 80 years). TCDD exposure included living or working in contaminated areas (56 percent), actively spraying it (30 percent), or traveling in contaminated areas (14 percent).

Among the patients 51% had nonmelanotic invasive skin cancer, about twice as high as the rate expected in men of similar age group. The risk of skin cancer increased to 73% for veterans who actively sprayed Agent Orange. Exposed men with the lightest skin types and those with lighter eyes were also at higher risk.

Forty-three percent of the veterans had chloracne, and 26 percent had other malignancies, such as prostate (14 percent), colon (3 percent), or bladder cancer (2 percent).

Exposure by means of active spraying (73 percent versus 67 percent; p = 0.003) and presence of chloracne (81 percent versus 28 percent; p < 0.001) were associated with increased nonmelanotic invasive skin cancer incidence rates.

Exposure to Agent Orange and TCDD has been linked to a wide range of health problems, including many different cancers. However, its association with the basal cell carcinoma and squamous cell carcinoma—the two most common types of skin cancer—has been unclear.

Cases of "aggressive and diffuse" non-melanoma skin cancers in TCDD-exposed veterans were first reported in plastic surgery journals in the mid-1980s. Dr. Clemens and colleagues initiated their study after observing similar patients in their clinic over the last few years. The researchers emphasize that their study has some important limitations—including the lack of detailed information on TCDD exposure and the absence of a comparison group of Vietnam-era veterans not exposed to Agent Orange.

Nevertheless, the results strengthen the previously reported association between TCDD exposure and the development of NMISC, even many years after exposure. Certain groups appear to be at particularly high risk, including veterans actively involved in spraying Agent Orange, those with chloracne, and those with lighter skin types.

Open Letter to VA About "Blanket Claim Denials"

Subject: VA Assistant General Counsel Assures C-123 Veterans "No Blanket Denials" 

We C-123 veterans appreciate VA Associate General Counsel Mr. Richard Hipolet's assurances that the Department of Veterans Affairs has no blanket policy prohibiting C-123 veterans' exposure claims. I'm grateful that he wrote to explain VA's perspective.

He reminds us that the late LtCol Paul Bailey's claim was approved, but does not note that this was on appeal after denial months earlier using the standard boilerplate:

"VA regulations do not allow us to concede exposure to herbicides for Veteran's who claim they were exposed to herbicides after the Vietnam war while flying in aircraft used to spray the se s chemicals "
Other statements provided VAROs to deny claims are generally the remark that " Please tell the Veteran 'We are unable to verify or document that aircrew members were exposed..."

In any case, no C-123 veterans' claims have been approved short of reconsideration by a review officer or BVA. There, with more careful reading of the law and Federal Register of 31 Aug 2010 and 8 May 2001, and a somewhat more veteran-friendly and non-adversarial forum, claims are approved. Years later, after improper denials.

On 28 Feb 2013, in his office meeting between himself, his staff, myself and Major Marlene Wentworth NC USAF, the Director of Compensation and Pension Services (C&P) explained that the Deputy Consultant of VHA's Post Deployment Health had already concluded no C-123 veterans were exposed to TCDD. I was told no amount of proof from whatever source would permit C-123 veterans' claims to rise to the level of "as likely to as not" because of her determination. (A similar statement was made to Major T. Redd, an Army officer, following a meeting of C-123 representatives, Senator Burr's staff, and VHA representatives.)

Soon after our 28 Feb 2013 meeting with Compensation and Pension, the Deputy Consultant graciously explained to me by telephone that her decision was reached because no C-123 veterans could ever establish bioavailability. Helping me better understand bioavailability, she explained that with the bioavailability requirement none of the Vietnam War veterans were exposed either (except perhaps some Ranch Hand flyers) but they are covered by "boots on the ground" laws.

Bioavailability does not exist in the law, as Mr. Hiplot explains, but he does offer us the opportunity to appeal any of our claims denied by VA's new requirement for it. I have checked a wide variety of toxicological references and do not find exposure defined as has the VA, "exposure = contamination field + bioavailability."

Adding bioavailability was an effective way for VHA to reintroduce medical nexus, otherwise proscribed, and upon which for VBA to deny claims. It does not seem, however, to be scientifically accepted, and is unique to the VA...and within VA, to Post Deployment Health.

I've asked many experts, and most offered responses similar to that of the Director, NIEHS:
"In all my years as a toxicologist, I have never heard bioavailability as part of the exposure field. Exposure is contact between a chemical (of any type) and the skin." (Dr. Linda Birnbaum)

C&P earlier explained to me that Dr. Birnbaum's opinion is not acceptable, nor those of Dr. Stellman, Dr. Berman, Dr. Garzotto, Dr. Sheers, Dr. James, Dr. Dwernychuk, Dr. Portier, Dr. Sinks, Dr. Schecter, Dr. Miller, and others. He explains that only physicians (but somehow, not the civil or VA physicians whose opinions were overlooked) are qualified to comment on medical nexus...of course, the scientists were commenting on exposure, and not medical nexus.

C&P might note VA's respect for the Institute of Medicine of the National Academies. This last biennial report had only two physician members...all the rest were scientists. Scientists, experts to whom VA turns by law, whom C&P would disqualify for commenting on Agent Orange.

With varieties of sample denial language provided to VAROs, with regulations being cited which prohibit conceding our exposure, with the very word "exposure" redefined to exclude our qualification, with TCDD claims denied with assertions that TCDD isn't harmful, with assurances given us by both Compensation and Pension and by Post Deployment Health that no amount of supporting evidence would permit a successful claim, perhaps "blanket policy" against us could be the wrong words, but any independent viewer would likely reach that conclusion. We have.

Last week I visited with a VA claims specialist, asking about what "regulations" might be the ones mentioned in the claims denials. She pointed to the claim itself, the sentence saying "regulations do not permit," and she insisted that was the regulation. The denied claim, with no other substantiation, was her regulation. She explained that the Federal Register, other federal agency findings, nothing else matters...that was the regulation. She would look no further.

Today I spoke with Master Sergeant Richard Matte, hospitalized at Boston's Brigham and Women's Hospital. He lost his right leg last week to infections. Sergeant Matte earlier underwent a heart transplant, and his health is precarious. Sergeant Matte's claims for service connection for herbicide exposure have been denied.

Sergeant Matte evidences a variety of Agent Orange illnesses as did LtCol Bailey. Sergeant Matte flew the same airplanes on the same days from the same bases performing the same missions eating the same food sleeping in the same facilities with the same duties as LtCol Paul Bailey...whose claim for Agent Orange illnesses was approved. I know the details...I was Sergeant Matte's flight instructor and flight examiner in the C-123K.

We've already watched our first sergeant, Master Sergeant George Gadbois, die in pain with soft tissue sarcoma. Said farewell to General Mike and Doc Jones with prostate cancer, and Lou Patcowitz with ALS, and many others with cancers and heart disease.

Agent Orange exposures aboard Patches and the other toxic C-1123s caused so many leave us, far too early. Sergeant Gadbois and the other men's VA claims were all denied. Yet they, too, flew the same missions, the same days, the same airplanes as did LtCol Bailey.

I was the flight instructor and flight examiner for LtCol Bailey and Sergeant Gadbois. I went to both men's funerals. We've had too many funerals.

Would somebody from VA kindly look into Sergeant Matte's situation...somebody who has read the law regarding herbicide exposures and who is uncomfortable with VA's unique redefinition of "exposure" done by
Post Deployment Health
just to prevent TCDD exposure claims?

Respectfully,

   Wes Carter, Chair
   The C-123 Veterans Association