Institute of Medicine Criticizes VA & Air Force

In its C-123 Agent Orange Report, published under consulting contract to the Department of Veterans Affairs, the National Academy of Sciences Institute of Medicine made a startling accusation. Startling, because of the obvious intrinsic and extrinsic failures of which the IOM was accusing both the Department of Veterans Affairs and the United States Air Force. 

Citing numerous examples, the IOM broadly condemned these authorities for failure to accurately and objectively report, and then utilize, information about military toxic exposures and veterans' illnesses. From page 5:

Reports "from those in the military or associated with the VA tend to minimize the possibility of an increased risk of exposure and adverse health outcomes."

The IOM made clear the fact that veterans' exposures were treated by the VA in a manner calculated to either dismiss altogether or at least minimize the harm done military personnel whose duties presented toxic hazards.

This certainly made clear the VA failure to be pro-veteran and non-adversarial. Get the picture? Our VA doctors and scientists (including its consultant with his $600,000 no-bid sole source VA contract) were saying we were not exposed when they had facts in hand that we were exposed.

An analogy would be your doctor saying your arm isn't broken while both of you look at the x-ray of your broken arm. Plus, other medical experts and federal health agencies had already told your doctor the arm was broken. But the doctor and your insurance company had decided that they don't cover broken arms. Especially from you.

And for four years, our VA doctors in Post Deployment Public Health were determined to send us on our way untreated for our cancers and other illnesses because they had already reached a policy decision not to acknowledge any exposures. Especially from us.

In fact, as we were repeatedly told to our faces by VA officials, no amount of proof from whatever source would ever permit our claims even to come up to the minimum standard of "as likely to us not." And this was after the CDC/ATSDR had already informed the VA that we had a 200 times greater risk of cancer then screening standards. This was after dozens of university scientists and medical experts to Agent Orange aboard our old airplanes. But still, the VA Agent Orange Desk insisted to one and all, both inside and outside the VA, that VA had "an overwhelming preponderance of evidence" against us... But it didn't!

Remember, a veteran's claim is to be assumed truthful and factual on its face, but in case of a question the claim need only arise to equipoise – a level of "as likely to has not," or a 50-50 balance of the question. In fact, every benefit of the doubt is to be given the veteran in the claim. We know now, however, that no amount of proof would be accepted to support these claims – VA policy, rather than VA regulations and science had already been implemented at both VHA and VBA against the veterans.

Our association made accusations of ethical failures, all supported with documentation, against the Department of Veterans Affairs in our presentation to the Society of Toxicology at its 2014 Phoenix convention. Sponsored by a former president of the society ,we addressed the scheme by the VHA Post-Deployment Public Health Section which used a similar presentation to the SOT in 2012 which attempted to redefine the medical-scientific term "exposure." The VA presenters reinvented their use of the word exposure as "exposure = contamination field +bioavailability."

In fact, their redefinition of exposure by the addition of the word bioavailability as a required part to the concept of exposure made impossible most exposure claims from veterans, especially those like us, exposed years earlier and with illnesses such as prostate cancer or soft tissue sarcoma taking years to evolve after our toxic exposure event.

No expert we could find, insider or out of government, agreed with the VA redefinition. All took exception to it, even the director of the National Toxicology Program who said she had never heard of such a thing. She explained bioavailability is a separate but related term. Inventing its own definition rather than use the standard ATSTR glossary of terms Dorlands Illustrated Medical Dictionary (the VA standard reference,) Post-Deployment Public Health was driven by its unofficial, improper but rigidly applied policy to block C-123 Agent Orange exposure claims.

So one has to ask: Did the medical and scientific errors revealed by the IOM in the VHA Post-Dedeployment Public Health Section ever result in comment or criticism, or did they get their full bonuses? One wonders if questions arose about VHA intrinsic and extrinsic ethical failures as regards veterans health? At least one of the 2012 VA poster team still works in that section of VHA... were there any career implications for her participation in this campaign against C-123 veterans?

Finally one must also ask were these experts more disappointed in their failure to implement VA VHA policy against C-123 vets than in the IOM accusations?

Department of Justice Confirms...AND EXCUSED...VA PHONY SCIENCE

VA Post Deployment Health simply made it up. Since accepted science didn't agree with VA policy objectives, VA simply revised science to insure veterans' claims were denied.

On December 1, the US Department of Justice confirmed that for years a handful of VA staffers had twisted science into a policy goal. That twisted goal: denial of valid Agent Orange exposure claims from C-123 veterans.

Please try to follow this. It is how VA refused years of medical care and other vital benefits to thousands of veterans who flew or maintained the former C-123 Agent Orange spray airplanes.

In 2012, faced with Agent Orange exposure claims from C-123 veterans, VA's Veterans Health Administration Post Deployment Health Section simply invented their own unique VA-only redefinition of "exposure" to prevent all such claims. The proper standard definition of exposure (Dorlands Illustrated Medical Dictionary, VA's standard reference) confirmed the veterans' claims, so VA twisted that word into phony science, meant only to further VA policy, not justice or good medical care.

All they had to do was bury a simple deceptive and scientifically-flawed sentence into a poster presentation VA gave at the 2012 Society of Toxicology conference in San Francisco:

"Exposure = contamination field + bioavailability."

VA poster redefinition of "exposure"

Other government agencies deny any bioavailability requirement for
exposure to occur; NIH labeled VA definition "unscientific"

In their terminology slight of hand, VA said that exposure couldn't exist without a contaminate plus proven bioavailability of that contaminante. No proof of bioavailability, however impossible to actually prove, was to mean no exposure...at least to the VA. Burn pits, immunizations, dirty water, biohazards, toxins...all the things a veteran might encounter via inhalation, ingestion or dermal contact, VA would refuse to concede exposure unless the impossible was done...a vet had to prove the bioavailability of the contamination. 

Not only did this piece of VA newspeak conflict with Dorlands Illustrated Medical Dictionary, but also with other VA and government with VA's own standard source for scientific and medical terms. Other VA agencies used the proper definition of exposure, but not VHA's Post Deployment.

Other government agencies and other VA departments simply use the proper definitions published by the CDC Agency for Toxic Substances and Disease Registry, where "exposure = Contact with a substance by swallowing, breathing, or touching the skin or eyes." That's the CDC definition, the EPA definition, the NIH definition.

So back to the Department of Justice report on VA and its reinvention of "exposure" back in 2012.

In 2013, C-123 veterans filed suit against the VA in the US District Court of Washington, demanding the background for VA's "exposure" redefinition and the basis on which VA's Society of Toxicology poster came to be. This week, DOJ finally revealed: 

 Dr. XXXX did not create the poster based on existing documents, but upon her experience assessing that and other exposure scenarios.  The statement "exposure = concentration present + bioavailability" did not previously exist in any documents of which she is aware.

So the redefinition, published over the names of Dr. Terra Irons, Dr. Wendy Dick, Dr. Terry Walters and Dr. Michael Peterson (all of VHA Public Health) was simply made up. Never existed before, and created for this poster to then be used to block C-123 veterans' claims.

And that's exactly how it was used. In February 2013, C-123 vets met with Mr. Thomas Murphy, Director of VA's Compensation and Pension Service. Besides telling the veterans no amount of proof would be acceptable to establish their exposure claims, he explained that Dr. Terry Walters had already concluded no C-123 veteran's Agent Orange exposure was to be permitted based on her own redefinition of exposure.

Invited by Mr. Murphy to discuss the issue with Dr. Walters, we found her redefinition just as we'd been told, with the additional point she made that few, if any, Vietnam veterans were ever exposed to Agent Orange based on her new definition of exposure. And it was a definition of exposure contrary to every other federal agency, including the National Institutes of Environmental Health Sciences as well as other VA departments.

But we have to ask: how did a PhD one year out of grad school at Carolina opt to redefine a fundamental term in toxicology, just so OPH could deny exposure claims? And again, the Department of Justice simply reported to us that she did it, pretty much by herself, calling on her specialty of mollusk toxicology to provide enough scientific wherewithal to refuse medical care to thousands of Agent Orange exposed veterans.

And on that weak, policy-driven basis, VA continued to order C-123 veterans' Agent Orange exposure claims denied until June 2015. That date was the publication of the Secretary's Interim Final Rule, recognizing the Institute of Medicine finding that C-123 vets had indeed been exposed. And exposed in the true scientific meaning of that word!

VA Redefines "Exposure" All By Itself

Definitions. VA regularly uses standard definitions of medical and scientific terms. After all, the more inclusive the definition of any scientific term, the more scientific it is. But if VA simply doesn't like definitions universally accepted in medicine and science, VA has no problem creating its own definitions. And VA's Office of General Counsel suggests it can do just that, even if the redefinition is specifically to disqualify veterans claiming disability benefits.

"Exposure" per Dorlands Medical Illustrated Dictionary

The CDC definition wasn't good enough for VA. Neither was the National Toxicology Program. Not even Dorlands Medical Illustrated Dictionary, otherwise perfect for the VA throughout the medical and legal systems. But no reference, no glossary of terminology, was good enough to help VA ignore exposure claims, so it decided to redefine "exposure" all by itself, for its own purposes of preventing veterans' exposure disability claims. All other medical and scientific definitions in Dorlands were fine for VA's use all the way up to the Supreme Court, but VA needed a special definition for that single word of exposure.

Why? VA finds itself stuck with the word exposure already used in the 1991 Agent Orange Act, and used by the VA itself in at least three separate Federal Register announcements it published regarding how they would treat non-Vietnam Agent Orange exposures. No other qualifiers were used...only the word exposure.

But once veterans began pointing out to the VA that VA's own regulation, VA M21-1MR, and the Federal Register and the 1991 Agent Orange Act simply and clearly specified exposure as the principal qualification for veterans to be eligible for exposure care and other benefits, VA needed to find a way to escape constraints it had created for itself so that it could better deny exposure claims from exposed veterans.

What to do? What might work to help VA avoid providing exposure care and benefits to exposed veterans, having found itself stuck with the word?

VA found their perfect solution in Lewis Carroll's  Through the Looking Glass. Specifically, the wise, and slippery, words of Humpty Dumpty who tells Alice:

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’
’The question is,’ said Alice, ‘whether you can make words mean so many different things.’
’The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.”

 VA's approach: redefine the word exposure within the VA to prevent the exposure claims. VA's Post Deployment Health Section simply created its own definition: "Exposure = contamination field + bioavailability." Adding the separate term of bioavailability was the master stroke, because most exposure situations leave the exposed vet without such proof, especially when medical problems are manifested only decades later, as in the case of Agent Orange exposures.

Confounding exposure with bioavailability, which is actually an element in risk assessment, let VA redefine away any threat that it might have to honor its commitments to veterans suffering from Agent Orange illnesses. VA simply disqualified the veterans by changing the meaning of the word.

VA's determination to have exposure mean only what VA chooses to make it mean was first noted in Post Deployment Health's 2011 VHA Issue Brief, and soon thereafter in the Agent Orange poster presentation several staffers made at the 2012 Society of Toxicology conference. It was years before veterans even noticed the slight-of-hand, years before anyone noted how VA had played the vets.

In 2010 President Obama termed the overall Agent Orange problem "the 40-year wait." Decades of misery which, as described in the White House press release, the President offered his "unwavering support" for "justice long overdue." Promising words indeed, eagerly accepted five years ago by veterans whose cancers, heart disease and other maladies were among the presumptive illnesses associated with Agent Orange exposures. A 40-year wait seems still too short, from the VA's perspective.

"The question is," said Humpty Dumpty, "which is to be master – that's all."

By its unique redefinition of exposure, VA indeed resolved the question of who is the master (hint; its not the veteran!) and resolve its concerns about how to prevent treatment for exposures suffered by veterans. VA had the clear obligation to honor exposure claims from post-Vietnam veterans who had proof of their exposures, but VA created an escape clause for itself. And thereby, dishonored the Department.

The Department of Veterans Affairs has reasonable discretion in addressing veterans' claims. Congress and the public expected VA to use that discretion in a more inclusive manner, to evaluate various situations and honor legitimate claims under the law in a responsible manner.

Neither Congress nor the public expected VA to instead be resolved to prevent veterans claims.

Rather than keep Lincoln's promise, VA is more determined to show veterans "which is to be master!" After all, as Post Deployment Health told the Associated Press, "We have to draw the line somewhere." And Post Deployment Health is firmly dedicated to drawing its lines however necessary, just so long as claims can be denied. Somehow, policy trumps law in Veterans Health Administration.

All Veterans Alert: VA Develops Scheme to Prevent All Exposure Claims

Burn pits, radiation, toxin, biological hazards...everything. Everything a veteran might have been exposed to can now be denied by the VA.

That's right. VA did this by redefining the word exposure to their own liking. Since 2012, VA's redefinition of exposure is, "Exposure = contamination field + bioavailability."

This means VA won't acknowledge an exposure event unless and until the veteran can prove some biological harm specifically from the exposure. Unless VA or Congress establishes presumptive service connection, as was done with the "boots on the ground" Vietnam veterans, VA can now block any exposure claim unless the impact of the exposure is so immediate as to be indisputable.

Few veterans claiming burn pit exposure, disease, or Agent Orange exposure, or any other type of exposure, can ever prove its bioavailability. Example: you're exposed to biological hazards drinking local water in some remote wasteland and later develop an illness. While statistically you can suggest the association of your illness with the local water, VA won't recognize the exposure unless you prove it.

The VA definition is unique to science. In fact, challenged by the rest of science. The Director, National Toxicology Program reports, "In all my years as a toxicologist, I have never heard the term bioavailability as part of the exposure field."  In their determination to prevent claims, VA Post Deployment Health invented this just for us veterans!

VA won't concede your exposure if you walk into a tent of Ebola patients...unless you develop Ebola and can prove it was from that tent. But in fact, you've been exposed to Ebola, bioavailability or not, and VA won't treat you unless and until you develop Ebola as proof of your exposure.

But you can't prove it and the VA will deny your claim. That's their purpose of the redefinition of exposure...to prevent exposure claims from veterans who have been exposed.

Makes sense from their perspective: VA saves serious money by not treating disabled veterans ill from their exposures. Makes no sense from a veteran's perspective, finding VA hospital doors locked when we're ill.

In the case of C-123 veterans and our Agent Orange-contaminated aircraft exposing us to dioxin, VA employs their redefinition of exposure to prevent exposure claims, regardless of substantiation, electing to have their redefinition trump all evidence affirming the claim.

The list is long...occupational hazards such as asbestos and lead, inoculations, dirty water, radio frequencies, smoke, toxins, chem warfare, dust, bugs...everything for which a veteran might actually experience exposure can be denied with VA's handi-dandi redefinition of exposure, the magic of defining away your disability claim!

Look at the University of Washington exposure graph below, which shows outcome (bioavailability) as an event after exposure. Do you get it? VA now says exposure requires outcome to be exposure. If you can't prove the outcome you haven't been exposed...for example, if you can't prove your prostate cancer came from contact with Agent Orange, VA's definition says you were never exposed.

Using that definition VA can deny service connection for virtually every exposure. Indeed, using it, Post Deployment Health's Acting Chief Consultant informed The C-123 Veterans Association last year that no veterans were exposed to Agent Orange in Vietnam (other than perhaps some Ranch Hand crews.)

Dr. Linda Birnbaum, Director Nat'l Institute of Environmental Health Sciences Recognized by C-123 Veterans

Members of the C-123 Veterans Association had the opportunity this weekend to recognize Dr. Linda Birnbaum and her staff for the dedication shown over the years by NIEHS and the National Toxicology Program, as they helped meet the needs of military families. Indeed...our profound thanks!

Unfortunately, having met this dynamic leader, I can't imagine there being a space left on her office walls for our plaque, but it certainly felt wonderful to express our appreciation and respect to this lady!

Dermal Exposure – Denied by VA But Confirmed by Science

VA rejects all C-123 clams based on their selective literature review which was designed to avoid reference to publications not fitting their predetermined objective of preventing any acknowledgement of exposure aboard the C-123s. It is not a "blanket policy" for denials, but instead a 100% rejection with what they call a "claim-by-claim" process. We fail to see the distinction...the fact of the matter is the same, total rejection of all C-123 exposure claims. The Senate was misled with Secretary Shinseki's letter.

The fact that the VA's position was formed against us is based on their obvious decision to ignore publications not fitting VA's objective of pretending no exposure occured. Publications such as Leung and Paustenbach and the many government publications addressing hazards of TCDD exposure were dismissed as through they didn't exist.

As mentioned before, exposure is the only qualification we must meet under the law, but VA overlooks that and denies claims not on exposure facts but their redefinition of exposure to include bioavailability. Not very nice of them, indeed, but VA's objective was met...a barrier was constructed to prevent C-123 exposure claims by redefining away our exposure facts.

No C-123 claims are permitted on their watch because they decided in 2011 to prevent claims. That was Job #1. Job #2 was automatic to these folks...just say "no." Then VA Compensation and Pension simply provided boilerplate denial language for the VAROs to use, and twisted VA21-1MR's requirement for the VAROs to consult C&P into similar orders from DC to deny. 

Deny, deny until they die. It doesn't take long to get that impression, true or not.

Further, VA uses their reinvented concept of exposure which requires proof of bioavailability, yet then forbids testing for TCDD bioavailability. Their experts know it is unlikely that any TCDD would be still found, as one study showed known intensive exposures to twelve people only had two showing TCDD still in the body two decades later.

Our exposures, between 1972-1982 were so far back, and TCDD has a half-life in body tissue of about seven years, so testing wouldn't be an effective way to make any conclusion about our own bioavailability.

But studies do support our having had TCDD enter our bodies via dermal contact and inhalation of TCDD-laden dust. 

Check it out. Go to the OSHA Technical Center at Salt Lake City website which states how OSHA wants a surface contamination exposure assessment done.  On pg 2 of the website, in the section titled: Exposure Evaluation:  The fourth reference by Leung and Paustenbach includes a bioavailability dermal factor specific to dioxin and they even included a surface wipe example of dioxin in the paper on pg 194 and use a 1 percent bioavailability factor for dioxin.  

https://www.osha.gov/SLTC/surfacecontamination/

Leung and Paustenbach (1994) Techniques for Estimating the Percutaneous Absoprtion of Chemicals Due to Occupational and Environmental Exposure, Appl. Occup. Environ. Hyg. 9(3) 187-19 cite Shu, et al (1988) Bioavailability of Soil Bound TCDD: Draml Bioavailability in the Rat.  Fund. Appl. Toxicol. 10:648-654 for this bioavailability factor.  In other papers, Paustenbach noted the bioavailability was as high as 1.75% for dioxin.  

So basically, we claim that there is bioavailability of TCDD or dioxin and it was established as early as 1988 and again cited in a peer-review article in 1994 and presented in the OSHA website for how to conduct an exposure assessment of surface contamination of chemical.

And always remember: the law requires only exposure, which we've proven. The VA

pretense that bioavailability is necessary is wrong, but literature supports our having had TCDD bioavailability as well. The most recent scientific article from Environmental Research was "Air Force Aircraft Returned from Vietnam Identified as Source of Post-War Agent Orange Contamination." (Stellman, Berman, Lurker, Clapp)

If you have exposure claims before the VA, consider submitting additional material to counter the VA stacking the deck against us with only half the science. 

Check over the hundred or more source documents on our blog. Submit the rest of the science by including copies of:

1.  Federal Register 31 August 2010, page 53205
2. Air Force Aircraft Returned from Vietnam Identified as Source of Post-War Agent Orange Contamination
3. CDC/ATSDR determination that C-123 crews were exposed and had greater risks of cancer
4. OSHA Chemical Sampling Card
5. NIH/National Institute of Environmental Health Sciences C-123 Finding
6. Columbia University Mailman School of Public Health C-123 Finding
7. Concerned Scientists and Physicians Letter to Secretary of Veterans Affairs re: C-123 Exposures
8. US Public Health Service C-123 Exposure Findings
9. University of Texas Medical School C-123 Exposure Finding
10. Oregon Health Sciences University Toxicology Department C-123 Exposure Finding
11. C-123 Aircrew VA Claim Approval (Paul Bailey)
12. C-123 Maintenance Personnel VA Claim Approval (Rickenbacker–Name Withheld for Privacy)
13. Washington Post Article, Agent Orange's Reach Beyond the Vietnam War
14. ATSDR Terminology, including official definition of EXPOSURE

Most likely, your claim will still be denied on order of Compensation and Pension, but you will have ample evidence to show the Board of Veterans Appeals clear error on the VA's part in denying exposure claims.  The BVA and other officials know that C-123 veterans are being required to submit more documents, reach a much higher threshold of "as likely to as not" proof, than any other veterans ever have been.

Further, as with Paul Bailey, your medical evidence and the documents listed above can motivate a claims official to actually do the right thing and concede service connection.

C-123 Veterans Present at Society of Toxicology Conference, Phoenix

We're going to set the record straight. 
In 2012, the VA's Post Development Health unit presented a misleading poster at the Society of Toxicology conference, titled "Agent Orange, 50 Years History." In this poster they inserted a unique redefinition of "exposure" which added a requirement of bioavailability to complete...no bioavailability equals no exposure, according to the VA, and thus our denied disability claims!

This is unscientific and unique to the VA...no other agency or professional organization has such an unusual definition, and it has been called both "unscientific" and "ludicrous" by other experts.

Why did VA do this? By redefining exposure, VA attempts to deny the on-board exposures of C-123 veterans. Decades after our exposures, bioavailability is virtually impossible to prove and the VA even prohibits such testing. This linguistic maneuver was solely to prevent C-123 veterans' Agent Orange exposure claims, and it has been used since then with VA insisting no exposure was possible aboard the aircraft.

We're challenging VA on this, presenting our poster addressing VA science and ethics, and we are sponsored by Dr. Linda Birnbaum, Director of the National Institute of Environmental Health Sciences. (Click for coverage from The Arizona Republic, published 5 Apr 2014)

Our Pictorial History of Post-Vietnam Agent Orange Exposures

 1961-1971
C-123K medium assault transports modified to spray as UC-123K, dispersed Agent Orange throughout South Vietnam from although in later years spraying was gradually reduced. 1971 –aircraft returned to the US; spray tanks were removed, the airplanes then flown to their new units without any decontamination.

1972-1982
Wearing standard flight suits, C-123 fleet was then flown by Air National Guard and USAF Reserve squadrons (Massachusetts, Ohio, & Pennsylvania) as the Vietnam War ended. 1979 tests identified herbicide contamination. Crews assured all aircraft safe. 1982 – C-123s retired to desert “boneyard” at Davis-Monthan AFB, AZ.

1994-2009
1994 AF toxicologists reported C-123 “heavily contaminated” with dioxin. Full HAZMAT then ordered for all personnel in or near the toxic airplanes.
2001 – all C-123s were gathered into a special, high security quarantine area, reacting to base employee TCDD IG complaints.

June 2010 – on recommendation of the Office of Secretary of Defense Senior Consultant to several civilian and military officials, with concerns expressed that veterans already exposed might seek VA medical care, all C-123s destroyed by USAF as hazardous waste with special measures taken to insure the "below-the-radar" operation.

2011-2014: "VA will permit no C-123 Agent Orange exposure disability claims" 

Society of Toxicology Declines Involvement in VA "Exposure" Redefinition

The Society of Toxicology on Friday announced that they'd take no action in our request to challenge the VA's redefinition of the fundamental term "exposure." VA had used an SOT meeting for a poster display, on on that poster stated "Exposure=contamination field+bioavailability."

Bioavailability is not a prerequisite for the fact of exposure, but rather flows from it. The VA's redefinition was policy-driven because the law simply states Agent Orange exposed veterans will be cared for...thus VA had to claim we were never exposed. They did so by adding an impossible proof...that of bioavailability...to their in-house redefinition. Our request for SOT to challenge this deception was formally denied Friday.

Our response to SOT leadership:

Please thank Dr.  Lehman-McKeeman for her response to my requests. Although disappointing, her letter makes clear the role of SOT, and the Society's views. 

In my layman's world, however, good people seek to make right the wrongs which befall one another. Flying aeromedical evacuation missions in peace and war, I spent 26 years of my life, and became disabled for the rest of my life, doing so on behalf of my fellow citizens. 

Our concern now is for my fellow veterans of the C-123 warplanes, upon which we were exposed to Agent Orange residue. Here, using their poster display as their vehicle, the VA has hijacked a fundamental term ("exposure") vital to SOT, and, for purposes of the VA itself, has redefined that term within their agency without even a comment from their peers. This is a wrong, not yet challenged, which has been dealt veterans of the C-123. 

This is a wrong dealt us by the VA through the facilities of the SOT. While President Lehman-McKeeman understandably and quite properly defends the neutrality of SOT, I cannot imagine her accepting without comment any such unscientific redefinition of basic toxicological terms to achieve policy objectives had the actions been FDA, NIH, CDC or other agencies, or especially, commercial firms. 

However such a redefinition were to be attempted...poster display, articles, speeches, product literature...it calls for a challenge if it is unscientific and incorrect. The VA shouldn't be entitled to hide behind the scientific skirts of the SOT to hurl out policy decisions via redefinition of scientific terms. 

Too often, if veterans are involved, researchers, universities, federal agencies and professional societies such as SOT abandon us. Here again, veterans are abandoned by professionals from whom we simply sought comment. 

Right or wrong? It still seems a modest and appropriate request.  

Does SOT define exposure as does the ATSDR, or does SOT yield to VA's definition?  

Should I also understand from her letter that my parallel requests for submitting a poster display from The C-123 Veterans Association, and the submission of a letter from us in Toxicological Sciences are both denied? 

Very Respectfully,

Wesley T. Carter, Major, USAF Retired  

Chair, The C-123 Veterans Association

Society of Toxicology Takes No Notice of VA's Redefinition of "Exposure"

Repeated requests to the leadership of the Society of Toxicology (SOT) as suggested to us by senior federal government scientists and agency heads, has proved unproductive.

In sum, the SOT let stand unchallenged, and therefore passively endorsed, an action by the VA to redefine "exposure" to require proof of bioavailability as a component. In 2012, the VA presented a poster display at the SOT's San Francisco conference, using the poster to review Agent Orange issues and to introduce VA's internal redefinition of a standard scientific term – exposure. In their poster, VA stated "Exposure=Contamination Field+Bioavailability."

'Tain't so! Exposure is defined, according to the CDC's authoritative Agency for Toxic Substances and Disease Registry, as:

Exposure Contact with a substance by swallowing, breathing, or touching the skin or eyes. Exposure may be short-term [acute exposure], of intermediate duration, or long-term [chronic exposure].

Anybody see "bioavailability" there? Nope. Bioavailability, which is the specific impact of a substance on the body (such as caffeine in coffee making the blood pressure increase) is impossible to establish for individuals exposed to Agent Orange. In fact, it takes huge populations, such as the entire corps of Vietnam War veterans, to establish significant epidemiological conclusions about Agent Orange illnesses such as prostate cancer, ALS, IHD and other life-threatening diseases.

So why did VA introduce a redefinition of a scientific term which flies in the face of toxicologists and other health science professionals? Simple...they made bioavailability a requirement of exposure to prevent C-123 veterans from claiming Agent Orange exposure. Policy, not science, in this step!

The law states that exposed veterans will be treated for their Agent Orange illnesses, regardless of where they were exposed. That word...exposed...is what VA needed to challenge in order to deny dioxin-exposed veterans' claims. They couldn't challenge the fact of our duties aboard contaminated former Agent Orange spray aircraft. They couldn't challenge either our diseases or the fact of the C-123's lingering contamination.

So...they invented the pretense that nobody is exposed to a toxin unless and until proof of bioavailability can be offered by the individual. And we can't do that. We obviously have the Agent Orange illnesses and we meet the definition of "exposed" used by the EPA, CDC, USPHS and other authorities, so the VA invented their own definition of the word to insure they had an out for denying our claims.

Thus our appeal to SOT leadership. We asked that they comment on the VA's use of the SOT San Francisco meeting as a platform for attacking veterans benefits through twisted, phony science.

But repeated requests for SOT to do something have failed. They stand mute. Weeks ago, we were assured their leadership would discuss the issue during a high-level conference call, but nothing has happened even with several recent inquiries and reminders of how important this word "exposure" has become.

They should read the definition of "professional" and should also re-read their own definition of "toxicology" because it includes the communication of the effects of agents.

That communication, so important to science, was twisted by the VA and the SOT has failed to challenge their twisted, policy-driven deceptions. In their passivity, SOT, even though the posters weren't juried, in effect endorses this new VA definition of "exposed" to the harm of veterans and our families.

Veterans Benefits Administration REDEFINES Science to Prevent Agent Orange Claims

PART ONE: The Grand Deception
A simple line deep in the middle of a poster presentation offered at the Society of Toxicology convention is where VA did it to the C-123 veterans, and other vets exposed to Agent Orange in situations other than "boots on the ground" during Vietnam. Here is where VA showed its eagerness to prevent service-disabled veterans from, as VA and DOD consultants have put it, becoming "freeloaders looking for a tax-free dollar from a sympathetic congressman."

The Society of Toxicology invites poster displays as well as scientific and medical presentations from members, and VA's Veterans Benefits Administration and Veterans Health Administration prepared their large poster for that San Francisco meeting.

Their objective: enjoy a freebee trip to the Golden Gate city justified on the basis of doing something useful like the poster, but also engineer a special way to skirt the law and insure Agent Orange veterans, in particular, C-123 veterans, all be denied exposure benefits clearly provided for by law. What law? The Agent Orange Act of 1991, and also Title 38, as well as the 8 May 2001 Federal Register, page 23166 which has the force of regulation.

These laws, regulations and announcements provide that veterans exposed to military herbicides will receive exposure benefits without requirement that they provide proof of medical nexus...which is virtually impossible for any individual to do. Think here of a non-smoker getting lung cancer. Where and when cannot be proved with today's science, but it surely came from somewhere. Same here with military herbicide exposure and the "Agent Orange" presumptives, a list of illnesses acknowledged the the VA and the National Academy of Science/Institute of Medicine to be associated with dioxin exposure.

Seems simple enough. Exposure proof would result in claim approval. Nope! Faced with the possibility of C-123 veterans continuing their legitimate pursuit of essential, life-saving medical treatment for Agent Orange illnesses, VA executives realized that the Agency needed to focus on exposure. The Air Force had already determined that C-123s used for spraying Agent Orange during the Vietnam War remained contaminated ("heavily contaminated on all test surfaces" and "a danger to public health" read the AF toxicology reports.) That left the VA weak on any challenge to the fact of contamination of the aircraft, and any veteran's confirmed diagnosis of an Agent Orange illness prevented any challenge on that issue, so the only approach would be to deny the exposure itself.

VHA Poster Display

Here is where VA gets amazingly creative. Simply disregarding the law, and challenging the entire world of science and medicine, Veterans Health Administration utilized the Society of Toxicology conference to present a non-juried poster display entitled "AGENT ORANGE: 50-Year History and Newest Chapter of Concerns." Folks, C-123 veterans were cited as the VA's "chapter of concerns." Folks, the "concern" was the VA's in dread of eligible veterans actually receiving the benefits to which our Agent Orange exposure entitles us!

So somebody at 810 Vermont Avenue, Washington D.C.  got the clever idea, "Let's redefine the word "exposure" to prevent any exposed veteran from ever being approved. Let's pretend, just here at the VA, that "exposure" will mean something extra...that "exposure," the simple and precise word used in the various laws, will mean only what we say it means. And that definition is going to be that "exposure equals contaminant plus bioavailability." This way, with our special private redefinition, we can pretend that the laws of the United States do not apply, that science, logic and justice do not apply, and we can once again require proof of medical nexus!"

VA associates us much too closely with the tens of thousands of Blue Water Navy veterans, and VA is frightened that approving C-123 vets will lead to approving Blue Water Navy also.

Midway down the SOT poster made up by the VA, left column, at the fourth paragraph, the reader comes to the alarming deception employed by VA's Post Deployment Health staffers who wrote this poster. C-123 Veterans Association leaders encountered them all at the March 2013 conference hosted by Senator Burr's staff as we tried to find common ground. Sadly, this non-juried piece of policy-driven verbiage is the result!

Read carefully, won't you? Chew carefully on the highlighted items. We'll discuss this vicious VA deceptions in our next post. Meantime, Google words like "medical nexus, "exposure," and take a moment to read Page 23166 of the 8 May 2001 Federal Register, the last section of the middle column. Very revealing!

Museum Visits and Research

Yesterday I visited the Hill AFB Museum and checked out their C-123. Strictly a cargo bird as it seems from the outside...no left-over pipes under the wings in from the engines, anyway.

Thursday I will be at the National Museum of the Air Force to look over Patches again, and hope to also visit their Research Section on the main base to learn more about its decontamination and any details about the post-Vietnam use of the fleet. LtGen Hudson recently wrote us about the dioxin issues involving Patches and I hope to get more particulars about the firm which did the work cleaning up the bird.

Paul Bailey is contacting Dartmouth and University of New Hampshire to get their medical professionals and toxicologists to look over our data and offer opinions as to whether or not we "are as likely to as not" have been exposed to dioxin during our crew days.

Please...ask your own state university or state department of health to look this situation over...letters from them would be extremely persuasive, especially as we head to the first of our disability claim denials or approvals followed by appeals.

We're Going to aToxicology Conference!

We're taking our case to the experts! The Society of Toxicology meets in 2012 and we'll be there, or at another professional gathering if better suited to our needs. This week arrangements were investigated for a tabletop display of our C-123 Agent Orange contamination, focusing on the VA explanation that aircrews serving aboard the Provider weren't exposed to dioxin. Basic "flavor" is how could the VA twist contamination studies to conclude against the interest of its veterans and the ethical implications. That last part is under discussion as it might not be territory which the Society wants to address...their call, not ours.

The Society also publishes a journal and we're waiting to see if our one page add will be accepted...it has to meet their editorial approval. As for a professional juried article...that's in the works also with interest expressed by different researchers and their institutions.

Wow...a terrific storm of support for the FACT that C-123 aircrews were MOST LIKELY (we don't say absolutely but use the VA phrase "more likely to than not") exposed to Agent Orange. The planning on the article outline is underway, and we also hope to have a ethical, not just technical perspective.

Ideas, all you budding toxicologists and bioenvironmental scientists?