VA worked & spent $$$ to oppose Institute of Medicine C-123 result

Documents released today under supervision of the US District Court Washington DC provide all the details: VA submitted the C-123 exposure question to the Institute of Medicine for evaluation, but then worked behind the scenes to insure the IOM gave only the desired conclusion...the conclusion VA staffers felt best met their own policies. Thank God (and IOM staffers,) IOM didn't fall for VA's tricks.

This week, after years of delays and obstruction by VA, hundreds of pages of internal correspondence and emails were released dealing with the C-123 Agent Orange exposure concerns of over 2100 veterans who flew these transports following Vietnam. The aircraft were contaminated, but VA from the beginning took extraordinary steps to prevent exposed veterans from receiving vital medical care and disability compensation.

The efforts seem to date back to 2007, when LtCol Aaron Olmsted's Agent Orange exposure claim was denied by VA on the basis he had no proof his C-123s were the ones actually used in Vietnam for spraying Agent Orange. Records show Olmsted flew hundreds of hours in these aircraft, but VA's legal "duty to assist" was viewed by the Department with disdain.

No effort was made by VA to locate readily available records to confirm Olmsted's assertions, something veterans themselves did with a simple phone call and two days' waiting for results from the Air Force Historical Records Agency. VA could and should have done this in meeting its duty to help the veteran locate records, but their victory over his claim was more important. Even when proof of Olmsted's claims was finally offered the VA, it was ignored by the BVA, by the regional administrator, and by the attorney who opposed Olmsted at the BVA hearing.

In more recent years, VA's tricks included paying its principal consultant while he appeared before the IOM to "defend the VA's science" and most certainly, to oppose the great volumes of science supporting the C-123 veterans. The consultant had been awarded his VA no-bid sole source $600,000 contract, the work product of which focused on obstructing C-123 exposure claims. The contract, and its obvious conflict of interest (or certainly the suggestion of that possibility) was not revealed to the committee by VA or the consultant.

Note also that in 2011 the consultant labeled C-123 veterans with disdain as "trash-haulers, freeloaders looking for a tax free dollar...I have no respect." One senses this profoundly negative attitude even better endeared him to the VA, rather than disqualifying him as it should have from any effect on the health care of these 2100 exposed veterans he dislikes so much.

His 2009 role in having recommended destruction of the stored surplus C-123s as toxic waste and to prevent veterans from learning of the contamination was not discussed with the IOM. It should have been...so many things should have been revealed, both to the veterans and the IOM.

Previously a paid consultant to both Dow and Monsanto in their efforts to fight veterans' claims, and with years as an Air Force officer manning VA's own Agent Orange desk helping prevent such claims, the consultant was the perfect go-to guy for VA's Veterans Benefits Administration and Veterans Health Administration, whose senior staffers personally opposed expanding Agent Orange coverages to anyone.

Records now show that VA coordinated closely with their consultant, who nonetheless insisted he wasn't before the IOM to represent the VA. Not only did VA pay him $600,000 for work including monographs attacking the veterans' claims, but he was under that lucrative VA contract even at the time. IOM's questions to the consultant were answered only after first being passed by the VA to insure they met the Department's policy objectives, before being released to the IOM:

In the following email, the consultant writes the US Air Force and clearly states he is presenting to the IOM C-123 committee "on behalf of Compensation Service and the (VA) Office of Public Health." No, not independent at all, but he was presenting to the IOM as VA's voice:

The VA consultant referred frequently to his many monographs being "peer reviewed." This is highly questionable, as no researcher is permitted to select the reviewers as was done here. Peer review is meant to be a critical challenge to protect the scientific record, not this buddy-stamp from close associates holding identical views. Despite VA's own high standards for scientific research, this was allowed to pass without challenge to its many violations of VA Directive 0005 (Scientific Integrity.)

This attitude persisted into more recent years, as detailed in this week's FOIA results. VA expressly sought to "counter" scientific materials with paid-for input from selected sources, rather than letting science and the IOM proceed independently:

Besides contracting with its preferred "go-to" Agent Orange consultant, Veterans Health Administration also paid Sandia Labs to construct arguments against the many scientific experts whose professional opinions were universally in support of C-123 veterans' exposures;

Veterans have tried to stress the fact that of the dozens of independent scientists and physicians who concluded the veterans were exposed and harmed, none were paid.

VA didn't waste a penny seeking any independent views or opinions which might agree with the veterans' claims, but spent hundreds upon hundreds of thousands of dollars to insure the defeat of those veterans' hope for VA recognition of Agent Orange exposures. Hardly "pro-veteran, non-adversarial, every benefit of the doubt rests with the veterans." 

Rather, we see the firm, steady determination to prevent C-123 veterans' access to medical care by spending VA dollars, bending rules and procedures, creating obstructions, implementing personal policies, and the deception of senior VA executives by staffers by feeding them error-laden memoranda to sign.

VA staff and contractors even tried to deceive IOM and senior VA leadership with data from tests performed on "Patches," the USAF Museum's former Operation Ranch Hand C-123. The contractor stressed a point about "only two areas" being TCDD contaminated. In fact, the testing officials determined that there were two "hot" spots but the majority of the C-123 interior was not contaminated, or was an area not tested for lack of accessibility. Big difference.

House Veterans Committee Chair Blasts VA

He said it, right out loud. In the stately halls of Congress.

"FUBAR on steroids." Congressman Miller was referring to the Department of Veterans Affairs. If the phrase FUBAR is unknown to you, enjoy watching Saving Private Ryan again!

FUBAR for VA wan't good. It was Chairman Miller shooting from the hip with a couple full belts from his verbal .50 cal M2, expressing the nation's concerns over VA construction, claims, appeals backlogs and other scandals.

We don't know if VA opposition to C-123 claims these past four years fits into his FUBAR F-bomb, but we do know the delay has denied us medical care and also has cost us money. Denied state benefits because we still wait for VA disability ratings. Denied property tax relief while waiting for the VA to process our claims. Our kids, all now past college age anyway, denied tuition waivers due children of disabled veterans. There is a "catch-up" check of VA disability benefits when a long-delayed claim is finally approved, but there is no catch-up for everything denied the veteran during the years of waiting for "the big brown envelope" to arrive with a disability decision.

In our case, scientists have had everything the VA needed to properly adjudicated our exposure claims since at least 2008. VA, on the other hand, had everything it needed to delay our service connection ratings for these past years, and now seems ready to help only because the Institute of Medicine report showed the way.

That's their job, it seems. Our was to fly aeromedical evacuation. Both are important jobs with people's lives in the balance. We did our jobs to perfection. The airplane business is like that...imperfection equals death. The medical business of aeromedical evacuation is like that, too. Imperfection equals patient suffering or death. We did our jobs to perfection.

Can you imaging their take on us if we waited four years to do our jobs, getting around to picking up a load of patients? And doing our job only when forced to?

No...we were volunteers. We were professional and we were caring. The nation, and our fellow servicemembers, could and did count on us. No four year delay like we were handed by the VA.

Inspector General Scolds VA VHA for Deceiving Congress & Veterans on Fact Sheet

More scandal added to VA's Year of Scandals. Here...a deliberate deception of the House Veterans Affairs Committee as confirmed by VA's own Inspector General today, and reported in USA Today and other journals. (note: see related C-123 post.) Secretary McDonald personally apologized, stating, "VA has a responsibility to communicate clearly and accurately to Congress, veterans and the American public."

OIG evaluated Veterans Health Administration’s (VHA’s) review of “unresolved” consults and the accuracy of VA’s summary, the National Consult Delay Review Fact Sheet (Fact Sheet), as requested by the Chairman of the House Veterans’ Affairs Committee (HVAC).

Unresolved consults are requests for consultations that are open or active in patients’ electronic health records. In September 2012, VHA initiated a multi-phased review of consults that were unresolved for more than 90 days. By May 2014, the number of unresolved consults had decreased considerably.

However, because VHA did not implement appropriate controls, we found it lacks reasonable assurance that facilities appropriately reviewed and resolved consults; closed consults only after ensuring veterans had received the requested services, when appropriate; and, where consult delays contributed to patient harm, notified patients as required by VHA policy. Our review of the Fact Sheet found several key statements related to the scope and results of VHA’s review of unresolved consults were misleading or incorrect.

These statements were repeated by VHA leaders at meetings with congressional staff and during media events. In July 2014, VHA issued a letter to the Chairman of the HVAC that included information intended to clarify statements in the Fact Sheet.

We recommended that the Interim Under Secretary for Health (1) conduct a systematic assessment of the processes each VA medical facility used to address unresolved consults during VHA's system-wide consult review; (2) ensure that if a medical facility's processes are found to have been inconsistent with VHA guidance on addressing unresolved consults, action is taken to confirm that patients have received appropriate care; and (3) after reviewing the circumstances of any inappropriate resolution of consults, confer with the Office of Human Resources and the Office of General Counsel or other relevant agency to determine the appropriate administrative action to take, if any.

VA DELAYS – 1330 Days Since C-123 Veterans Sought Help

Too much time has passed.

We sought VA help one thousand three hundred and thirty days ago. VA refused that help then, as they do now. In the interum, we've supplied more proofs and findings to support our claims.

But in the interum, VA has opted to redefine "exposure" to prevent exposure claims, and to order ROs to deny C-123 veterans' claims. They even assure us dixoin hasn't been shown to be harmful. They even refuse input from the CDC, EPA, NIH, US Public Health Service, and dozens of concerned scientists and physicians.

Too much time has passed. And VA continues to work hard, through the offices of its Post Deployment Health Section in Veterans Health Administration, to insure none of our Agent Orange exposed veterans are permitted VA hospital care and other benefits.

The suffering and deaths from such action were perfectly predictable back when we first asked VA for help. They refused us care anyway.

They have fought us at every turn, even by hiring outside consultants at a cost of $600,000 to prepare monographs opposing our exposure proofs. VA allowed Dow and Monsanto to submit arguments against our veterans. VA staffers also drafted deceptive and error-laden correspondence for Secretary Shinseki to sign and submit to the Senate Veteans Affairs Committee.

1330 days. Intolerable.

VA Office of General Counsel Moves to Nullify VA Federal Register Commitments

Last week VA's Office of General Counsel reviewed, and rejected, the Yale Law C-123 report which held that C-123 veterans had been exposed to Agent Orange and are due presumptive service connection for recognized Agent Orange illnesses. Rather than find in the Yale report a channel to include veterans, the VA knee-jerk was to, as usual, "draw the line somewhere" and insure their denial of care.

But the OGC went far, far further! They want to reserve the definition of "exposure" for their own purposes. Here's why that's critical to our C-123 exposure claims. VA: "Exposure = contamination field + bioavailability." To the rest of the scientific world, exposure = skin (or eye) contact, ingestion or inhalation of a chemical of any type.

The 1991 Agent Orange Act was the result of Congress' frustration with the Department of Veterans Affairs stalling Vietnam veterans' Agent Orange exposure claims. Congress simply told the VA that it had to presume that all vets with "boots on the ground" were presumptively exposed, and therefore, presumptively service connected for diseases recognized by the Institute of Medicine as associated with Agent Orange. The 1991 Agent Orange took away the power of the VA demand medical nexus, making it presumed by law. VA could no longer hide behind that requirement.

VA set about to obey this law and over the years, various illnesses were recognized by the IOM, and therefore by the VA, as Agent Orange illnesses. Over those years, illnesses like diabetes and heart disease were added, and the VA published in the Federal Register its regulations, and interpretations of regulations. Three times, the VA specified that veterans exposed to Agent Orange outside Vietnam would be treated with the same presumptive service connection as Vietnam veterans.

Not once, but three specific statements in the Federal Register. The only qualifier..."exposure." But there was no definition of exposure given. Nor is one needed, as the other federal agencies such as the CDC/Agency for Toxic Substances and Disease Registry, and the National Toxicology Program, publish glossaries for terms such as exposure.

But OGC is working on a runaround of both the Agent Orange Act and the Federal Register publications. They want now to redefine exposure as they see fit, which will be to require bioavailability...another word for the forbidden medical nexus. By reinserting a non-Vietnam veteran's requirement to prove bioavailability through the redefinition of exposure to include it, all such claims can be denied because so much time as past, medical nexus/bioavailability become impossible to prove.

Not only that. Ignoring the Supreme Court's Christopher v. SmithKline decision, VA OGC, caving to the agenda of Post Deployment Health, wants to make retroactive their definition of exposure via either a regulation or an announcement in the Federal Register.

Fortunately, the Supreme Court severely limits a regulatory agency's ability to make such retroactive changes, and this situation is a perfect example of the desired prohibition...but ignored by OGC.

How can they do this? They can't, at least, not forever. At some point, a legislative change, or a court decision, overcomes such shady activity and the agency is ordered to correct its act. Perhaps, although rarely successful, this is done by a writ of mandamus or a presidential order. In any case...the VA wins.

They win by denying sick C-123 veterans all VA medical care, unless otherwise qualified, until such time as some authority insists VA complies with the law. At some long-distant future point in time justice prevails – but all that happens is VA gets ordered to do the right thing, begin taking care of the veterans it has ignored, and send a catch-up check for whatever disability payments owed the veteran. Regardless of its size, any check is peanuts compared to the cost of medical care the VA saves by keeping C-123 vets out of their hospitals, especially given our ages and illnesses.

Incalculable is the cost of medical care not sought by the veteran due to cost, such as dental care...incalculable except as a deduction from the C-123 veteran's remaining life expectancy.

Every day a claim is delayed is money saved by VA.  No medical care, no rehab. No pharmacy. No prosthetics. No counseling, no travel expenses, no funeral costs, no Dependent's Indemnity Compensation, no dental or vision care. No hearing aids. Nothing...VA saves big bucks by keeping C-123 veterans out, using Medicare or Medicaid instead of the quality VA medical care we earned.

As VA's Veterans Health Administration sees it, the fewer vets on the VA roles the better for their budget and appointment lists.

They can't lose. Every claim denied is big VA"win." The longer VBA prevents an Agent Orange claim, the more money saved for VHA. It doesn't matter how outrageous their excuse, such as parsing the word "exposure" and making their regulations retroactive, might be...every day that a C-123 vet stays out of their hospitals is money saved, and they face no penalty or punishment or such outrageous, anti-veteran procedures. All the court can do is order the illegal or improper procedure corrected at some date years later.

But we're not going to see that day. VA has stalled C-123 claims for years, despite reams of proofs. They stalled on the IOM investigation for two years, then started it up again to stall for more time, with the charge to the committee not even addressing the specific question needed answering...were the C-123 veterans exposed or not? Exposed is the only question under the law. So VA intends to answer that question its own way, so that no exposures occur. Neat trick.

No wonder OGC wants to reinvent the word, so that VA can grab back the requirement that veterans establish medical nexus for whatever the exposure situation might be...dirty water, immunizations, radiation, Agent Orange, burn pits...unless some law specifically demands that VA treat a specific exposure, VA will hide behind the OGC opinion so it can redefine exposure to prevent exposure claims.

What a mess.

C-123 Veterans Seek VA Whistleblower to "Drop A Dime" And Inform New VA HOTLINE

The VA's new whistleblower hotline is vital to urging VA corrections from within its own ranks.

We hope it succeeds.

We also hope that a VA staffer, familiar with the weird three years we've gone through of VA redefining exposure, introducing extra-legal requirements for our claims, and denying Agent Orange exposure claims on the basis that the toxin is harmless, will come forward.

Many know of the conversations and withheld emails. Do what's right. Now.

Drop a dime on the VA and tell the hotline what's been done to us!

Here's the Fox News story about the VA Whistleblower Hotline.

President Obama Issues Statement on Veterans' Health and Benefits:

The White House, Washington D.C. –

For their service and sacrifice, warm words of thanks from a grateful nation are more than warranted, but they aren't nearly enough. We also owe our veterans the care they were promised and the benefits that they have earned. We have a sacred trust with those who wear the uniform of the United States of America. It's a commitment that begins at enlistment, and it must never end. But we know that for too long, we've fallen short of meeting that commitment. Too many wounded warriors go without the care that they need. Too many veterans don't receive the support that they've earned. Too many who once wore our nation's uniform now sleep in our nation's streets.                                                                                                                                        PRESIDENT BARACK OBAMA, MARCH 19, 2009

Dear Mr. President,

Why does the Department of Veterans Affairs obstruct Agent Orange exposure claims by inventing a VA-unique definition of exposure, by which no veteran of any war, of any service, in any circumstance could ever qualify?  Clearly, the redefinition by Veterans Health Administration was to prevent claims from succeeding.

Why does VA redefine exposure in an unscientific manner, challenged by other federal agencies and health experts, when that definition isn't used even elsewhere in the VA itself? Why permit VA to use a unscientific definition of such a fundamental term, when no juried publication would ever touch such work? Why did VA's own National Center for Ethics in Healthcare avoid dealing with the criminal and ethical questions such redefinition raises?

Why does the Veterans Health Administration game patient wait times by keeping veterans out of their hospitals? Are you and Secretary Shinseki aware that VA games their own system by blocking qualified veterans' disability claims for years, and constructing a three to five year additional delay through the VA Board of Veterans Appeals? What happened to your promises of 2009, and the VA's obligation to be "veteran-friendly" and non-adversarial? Would you ask America to wait five years for us to put on our uniforms to report for duty? 

Clearly, your Administration has waited five years to consider our situation, and the wait continues. Perhaps a solution will arrive, but it will likely interest our survivors more than us. Do you expect us to draw comfort from the words of VA's Chief Consultant of Post Deployment Health who, when asked if claims could be considered before veterans died, answered, "We all die."

How can you permit the Veterans Benefits Administration to order Agent Orange exposure claims denied with the excuse that that Agent Orange is harmless? Has your Office of General Counsel read the Yale Law C-123 finding? Has VA any intention of obeying the law without a court order to do so?

Why does VA refer complex medical and scientific issues to the National Academy of Sciences Institute of Medicine and pay only for arguments and testimony against the veterans' claims, but spend or offer nothing in support of the veterans' perspective? The VA obviously develops a scheme to prevent disability claims and is dedicated to funding that view in IOM meetings, and leaves it to the veterans' resources to argue their case. VA outspending the veterans works for the VA, but not the veterans. This isn't science. And it dishonors all involved.

God bless the United States. 

Respectfully,

FOR THE C-123 VETERANS ASSOCIATION:

Wes Carter, Chair
Fort Collins, Colorado

VA Veterans Health Administration: Gaming The Wait Lists Via Claims Process

VA Health Benefits Administration

The VA has two key agencies gaming the system against veterans' health.

These are the Veterans Benefits Administration (VBA) which decides disability claims, and Veterans Health Administration (VHA) providing the veterans health care and research. They're working together to keep their waiting lists, and costs, within management's goals.

We report on the prevention of claims by linguistic slight-of-hand: VA prevents exposure claims by redefining exposure to keep veterans from being considered exposed. A simple solution. VA invented for its own use a special definition of exposure, unique in medicine and science:
"Exposure = contamination field + bioavailability."

That redefinition works great. Using it, VA denies every exposure claim crossing their desk for Agent Orange, burn pits, radiation, dirty water, biohazards, toxins, immunizations...everything except situations where VA is compelled by law to provide care. No law=no exposure, regardless of proofs of exposure.

Legislation such as the 1991 Agent Orange Act protects veterans of the Vietnam War with "boots on the ground." That law, and various court decisions and announcements in the Federal Register also require VA to provide care to veterans exposed to Agent Orange outside Vietnam.

So, VA pretends it has the scientific and legal authority, and boldly redefines exposure to pretend no exposures take place. In the case of C-123 veterans, who flew the Agent Orange spray airplanes for a decade after Vietnam, the aircraft tested positive for Agent Orange residue many, many times up until their destruction as toxic waste in 2010. Too toxic for landfill, and the Air Force concerned about a threatened EPA HAZMAT fine of $3.4 billion for illegal storage, all C-123s were shredded and smelted as toxic waste, upon recommendation of the consultant to the Office of Secretary of Defense.

That same consultant then was retained by VA to construct arguments against the veterans' claims, and developed arguments that the veterans' dermal contact, inhalation and ingestion of the military herbicide residue did not constitute exposure, utilizing the VA's unique redefinition. His VA work continues decades of defending Agent Orange and its harmful effects.

This redefinition, and the decision against awarding C-123 veterans exposure benefits, is challenged by many universities as well as other federal agencies. The CDC/Agency for Toxic Substances and Disease Registry, the US Public Health Service, and the NIH/National Toxicology Program have all informed VA that tests prove the aircraft contamination and the veterans' exposure.

All input contrary to the VA's objective of preventing C-123 veterans' service connection is disregarded, explained away or simply ignored as with the input to VA from the Director, NIH/National Institute of Environmental Health Sciences who wrote, "Based on contact with the aircraft, exposure is assumed...the magnitude of these exposures is uncertain."

The VHA informs the Veterans Benefits Administration that none of the C-123 veterans were ever exposed, and therefore have no basis for exposure claims. In fact, VHA officials also insist that under their new exposure definition none of the ground soldiers during the Vietnam War were ever exposed, and perhaps only a few of the Air Force crews which sprayed from their C-123s. This directive flies in the face of Secretary Shinseki's repeated assurance to the Senate that all C-123 veterans' claims are considered on a "case by case basis," an obvious misstatement when VA has predetermined all the vets to be disqualified...thanks to that nifty redefinition of exposure from VA's Post Deployment Health Section.

"Unscientific" and "reflects a lack of understanding" are the judgements of leaders in the science of toxicology. But the claims remain denied, with vets told to get in line for appeals taking three to five years.

There, justice may await, but often only for the veterans' survivors. Complaints to the VA's National Center for Ethics in Healthcare resulted in recommendation that veterans turn to the VA IG because of the criminal and ethical implications of preventing medical care to eligible veterans. There, the issue has been ignored for years with inaction.

VA's National Center for Ethics in Health Care

Beginning in January, C-123 veterans brought a series of ethical concerns to the VA National Center for Ethics in Health Care. We had both intrinsic and extrinsic ethical concerns on a wide variety of VA actions.

 - UPDATE 01/03/2017: C-123 VET'S COMPLAINT ON VA ETHICS FAILURES -

We have been told the Center is not able to assist in our ethical questions. Although our confidential inquiries were elevated to the Center's chief, we were referred to the VA IG or perhaps US Attorney for any further discussions. It is disappointing to have a number of ethical concerns and not find understanding and resolution from the Center charged with that responsibility. We sought help understanding where we might be in error or have inadequate perceptions of situations. But as they suggested, many of the issues do seem to surpass "mere" ethical concerns.

As veterans, we are invited to turn to the Center for such a consult. This was very important because while we could describe the facts surrounding situations we were unskilled in correctly relating them to the highly sensitive area of ethical concerns...and wanted to insure that our situation, expressed with

caution and supporting materials, was received with the Center for help making a determination as to the ethical implications and search for a resolution with concern for avoiding any inferences of individual wrong-doing. Turning to the Center, however, turned out not to be the solution.

Among the many concerns about VA were raised:

• Selective use of references to achieve pre-determined conclusions against veterans' fundamental claims

• Improper reference to selective literature review as "all available scientific information which instead dismissed literature not contributing to predetermined conclusion

• Questionable scientific methods
• Failure to obey the laws, and regulations, concerning veterans proving exposure to military herbicides being entitled to seek VA service-connection for recognized illnesses

• Failure to seek peer review, and failure to respond when independently offered by leading experts

• Failure to react to veterans' claims in a pro-veteran perspective

• Misstatements by senior leadership to veterans' legislators denying blanket policy of denying all Agent Orange C-123 claims

• Redefinition of "exposure" for policy objectives, without peer review or regulatory authority, and failure to respond to peer input contesting the redefinition, to circumvent the laws and regulations requiring VA to recognized exposed veterans' claims for Agent Orange-associated illnesses

• Official findings by other federal agencies confirming veterans' claims being mischaracterized into failure to support the claims

• Providing "boilerplate" claims denial language to regional offices, with questionable rejection reasons such as "regulations prohibit recognizing C-123 exposure claims" (there being no such regulation)
• Overriding regional office recommendation for claim approval, directing all claim be denied (but telling the Senate each claim is evaluated on its own evidence)
• Denying claims citing "a thorough search for supporting evidence failed to substantiate" but ignoring all submitted references of valid scientific and medical input since 2011

• Failure to accept input from NIH/National Institute of Environmental Health Science finding confirming C-123 veterans' exposure claim, the NIESH having statutory authority in this area

• Failure to accept input from US Public Health Service confirming C-123 veterans' claims, the USPHS having scientific and medical expertise in this area

• Failure to properly characterize expert toxicologists' scientific input confirming veterans' exposure, instead dismissing input as from scientists unqualified to comment on medical nexus; rejecting all toxicological input in violation of both 8th and 9th US Circuit Court decisions

• Unscientific dismissal of federal agency confirmation of C-123 exposure, inserting manipulative and deceptive sentence implied to be part of that agency's finding, that  no "conclusive evidence exists of TCDD exposure implications." Additional failure to correct when deception was repeatedly brought to the attention of senior personnel in Veteran Health Administration. Veterans Benefits Administration, and General Counsel.

• Failure to honor obligations specified in Federal Register 31 August 2010, with VA determined to prevent veterans' exposure claims; general failure to assist
• Deceptive Internet pages, some stating the inclusion of C-123 veterans with proof of exposure as able to submit claims, but Catch-22 hyperlinks to other pages asserting these veterans disqualification by predetermined rulings from Post Deployment Health
• VA War Related Illness and Injury Study Center, which offers exposure assessments, has on its Internet site the VA's explanation as to how our exposures never occurred, despite all evidence to the contrary from other federal agencies and scientists (none of which is cited in "The science behind their conclusion"...which was instead a mere very selective review focused solely on C-123 exposures and designed for prevention of such claims, regardless of the law:

• Public Health releases their conclusion on TCDD and possible health effects

• The science behind their conclusion

• Failure to reveal large potential savings by denying C-123 veterans exposure benefits
• Failure to resolve confusion regarding veterans' access to Agent Orange Registry, with the Secretary earlier issuing a directive that all veterans believing themselves exposed can receive an exam, but Post Deployment Health overruling the Secretary and forbidding C-123 veterans those exams, without clarification on the Internet page for the Registry

• Highly questionable use of Agent Orange Committee of the Institute of Medicine. The 2012 promise by VA to contract with IOM for a study was broken, but raised again two years later with a forecasted two year delay in any results from the study. Improper to scheme to use IOM as a delaying tactic faced with recent significant legal and scientific evidence surfacing which confirms C-123 veterans' claims. Ample proof exists today to meet the fundamental qualification under the law...these C-123 veterans were exposed to military herbicides – no moral or legal excuse for denying medical care to these veterans. VA seeks to postpone providing expensive medical care to ill and elderly veterans – the longer the delay, the greater the savings by refusing all care and benefits (dental, prosthetics, vision, pharmacy, rehab, primary care, counseling, etc.)

• Questionable influence upon the Joint Services Records Research Center to obstruct collection of documentation confirming veterans' exposure claims

• Questionable influence upon DOD/DCS/Logistics & Mission Support preventing designation of Agent Orange Exposure Sites

This is the VA motto...Defining Excellence in the 21st Century. In medical care...yes, most certainly. But if this is how VA expects to define Department-wide excellence...with deception of our legislators, mistreatment, broken promises, delayed medical treatment, unjustified dismissal of valid claims, use of consultants hostile to veterans issues, and other failures, VA has indeed redefined "excellence" with the same scientific precision as in their unique redefinition of "exposure!"

There is no shortage of medical and scientific excellence – once a veteran gets past the VA hospital doors, guarded so carefully by Post Deployment Health The care is loving, skillful, and life-saving...we want it for all our C-123 veterans!

The only excellence evidenced outside those doors is in the recognized skill of C&P and PHD in obstructing valid veterans' exposure claims.

Where can we turn? We've sought help from our VA doctors, Patient Affairs, General Counsel, VA Ethics Center, senior VA executives, the press, other veterans' organizations, expert scientists and physicians...but nothing will permit a C-123 veteran's claim for exposure to military herbicide to be approved. So, the only excellence we're able to acknowledge is that of Post Deployment Health.

They were charged with preventing our claims and they have succeeded perfectly. 100% of the VARO claims have been denied, and, other than spreading unscientific and misleading information with the hope it will help prevent claims, PDH has only an indirect role with the BVA. This small staff took on all of science and medicine by redefining exposure just for their own use. This small staff took on multiple federal agencies confirming the C-123 veterans' exposure and dismissed them all. This small staff successfully stalled all C-123 veterans' claims for the last three years, and with their suggestion for another IOM study, skillfully employed another stall good for two and perhaps, even three more years of denying all care and benefits to these aircrews.