VA Ups Their Opposition – Claims Are Now Denied On VA & DOD "Specific Guidance"

The VA in Montana has shot down another C-123 veteran's claim. This vet, with more problems than I
want to type, received his claim denial in March and it has Compensation and Pension attitude all through it.

What is chilling is the justification for denying the Agent Orange-related illnesses of this former mechanic who worked on Patches:

"The VA and DOD have specifically provided guidance that such secondary exposure cannot be granted service connection, to include working on planes that carried or sprayed, or being stationed on vessels which transported the herbicide."

So much for empty assurances from the Secretary on down that each claim is considered on a case-by-case basis. They should have assured us instead, and more honestly, "each claim is denied on a case-by-case basis, regardless of justification."

How can they promise pro-veteran, non-adversarial claims processing? They ought to simply put a paragraph that C-123 veterans need not apply.

We have no idea where the DOD "specific guidance" comes from, unless it is the 2006 list Battelle and Al Young prepared for DOD.

C-123 Exposure & Health Studies Withheld by USAF in Defiance of Freedom of Information Act

Subject: August Release of Freedom of Information Act materials by the USAF Surgeon General's Office – USAF Defied the Law But Accidentally Let Vital Information Leak*

The C-123 Veterans Association had requested information about the May 2012 USAF C-123 Consultative Letter and how its conclusions were reached, and details about the scientific studies performed. Nothing secret, nothing personal. Stuff we're entitled to!

Instead, the USAF released two sets (Release One and Release Two) of documents last Friday, each a duplicate of the other, and each redacted past the point of honesty and respect for the law. The only information not redacted was an irrelevant EPA document on radiation assessment....nothing was revealed about the C-123 study of post-Vietnam exposures.

What the heck? President Obama assured the American people on his first public act that a citizen's right to access to information is "a fundamental element of American democracy." The Air Force, perhaps, missed that press release, and also the one where the President ordered Federal agencies to be as open as possible.

Here, in their response to my 2012 FOIA request, and to my October lawsuit filed in the US District Court of Washington DC, the Air Force sent me blank pages, devoid of meaning. Remember – these are publicly-funded studies by the USAF Surgeon General's Office and the USAF School of Aerospace Medicine, about whether or not 2100 veterans were exposed to Agent Orange. Further, the Air Force study is the foundation of the VA refusal to permit a single C-123 veteran's Agent Orange claim to be considered. So...VA refused to permit us to have our cancers treated because of a secret Air Force study...not classified in any way, but still hidden from public view, and denied us as we seek VA benefits, by the USAF Surgeon General.


What arrogance and abuse of discretion. This "Freedom" of Information Act response was anything but freedom! Virtually every line of every page released was redacted, denying C-123 veterans access to USAF School of Aerospace Medicine in May 2012.
the studies completed about our Agent Orange exposure by the Air Force after they agreed to look into our concerns with scientific integrity. That study, however, failed to meet the true definition of scientific integrity, with command interference, unnecessary JAG interventions, and close cooperation with the VA but not with CDC/ATSDR nor NIH.

The AF C-123 study meekly concluded that individual exposure assessments were impossible, but then illogically also concluded that because of that impossibility, the C-123 veterans were probably not exposed to harmful amounts of Agent Orange. What an amazing twist of logic!

* But there was a single paragraph, truly golden hidden among the pages of white, a paragraph that they missed redacting and which perfectly explains our eligibility for Agent Orange exposure care:

"USAFSAM concludes that there is not enough data to evaluate or model individual exposures and performing an epidemiological investigation would not be possible.   They then looked at the results that were available from a general population and occupational perspective and conclude that although dried residuals of dioxins were present, the exposures to anyone encountering the Aircraft either occupationally or from the general public should be within the exposures experienced by the Ranch Hand personnel that were exposed in Vietnam.   The Air Force conducted an extensive epidemiological study of the Ranch Hand personnel (referred to as the Air Force Health Study) and to date the results do not provide evidence of disease in the Ranch Hand veterans caused by elevated levels of exposure to Herbicide Orange."

Read the paragraph's middle carefully, especially the fact that USAFSAM considered post-Vietnam C-123 exposures

"within the exposures experienced by the Ranch Hand personnel that were exposed in Vietnam." That confirms our exposure which is the only issue under the law to be eligible for Agent Orange illness care and benefits. The exposures were not hypothetical, not imaginary, not remotely possible...but "within the exposures experienced by Ranch Hand." There was no conclusion that we were not exposed, only that harm had yet to be proven by the exposures.

The USAFSAM study illogically concluded that because the Ranch Hand spray veterans have not evidence elevated illnesses, then the C-123 veterans must not be harmed either.

The logic failure is in failing to note that post-Vietnam C-123 vets were never tested, as was the Ranch Hand population. Further, our exposures were long term/low dose exposures, and over a ten year period versus a Ranch Hand eleven month tour in Vietnam. We were older, with more women, and during the decade we flew our sick crew members were removed from service when they presented developing Agent Orange illnesses, such as cancers, diabetes, and IHD.

Both groups of aircrews remain distinct from the "general population" in that we had flight physicals, everyone was a high school graduate (or more) if enlisted and a college graduate if commissioned. We had enlistment or commissioning physicals, which separated many who were already ill, used illicit drugs, had significant arrest records, or who did not meet education, physical or mental requirements. We had excellent medical and dental care, constant drug testing, weight control, excellent prospects of post-military graduate education and employment, and in so many ways were healthier and fortunately likely to stay healthier than the general population, Agent Orange issues not withstanding.

Conclusion: both Ranch Hand and post-Vietnam aircrews should be in better health than their contemporaries, and it seems they are. But, the overall group of Vietnam veterans, a large enough population for meaningful epidemiological studies, continues to show the ravages of Agent Orange-releated diseases.

VA even prohibits the kind of testing on us for the presence of dioxin which the Ranch Hand vets have had for decades. Ranch Hand remains the only studied population, one made up of under 2,000 veterans, similar in size to the post-Vietnam C-123 group of about 2,100. Both, too small for meaningful examination. Which is why Congress, in frustration with VA foot-dragging, simply directed with the 1991 Agent Orange Act that all Vietnam veterans, and those veterans able to prove their exposure to Agent Orange, will be treated for recognized illnesses.

Three times the VA "more clearly" explained the agency's policy toward non-Vietnam Agent Orange exposures in the Federal Register. VA stated that exposed veterans would receive the same presumptive service connection for recognized Agent Orange illnesses, providing exposure itself was established. We've done that.

As can be read above, the Air Force established our exposure. ATSDR confirmed the exposure, as did the NIH/National Institute of Environmental Health Sciences and the US Public Health Service. There is a pro-veteran requirement in the VA claims process....we'd like to see some!

USAF and VA: A great partnership in denying responsibility along with denying medical care for the harm done.

By the way, below is an example of the Air Force perspective on what they feel veterans are permitted to see in military studies about us, paid for by the public, requested by the veterans. It is the first page of what AF sent out last week following two years of our actions to compel release of material which should be in the public domain:

Brothers...

Once a Soldier, Always a Soldier

Senate Staffer Support!

They're still working hard for us! Senators and their staffs, from both parties, have given countless hours to the C-123 problems. We're not forgotten. There seem to be weekly meetings and conferences between the senators and VA, their staffs and VA, anybody and everybody who is involved. Before his confirmation, now-Secretary McDonald had the C-123 issued briefed by Senator Merkley's staff.

So they know we're here, and they know full well we're not getting younger and we're not getting better. This is the plain situation, and the years VA is taking seem to be a tactical approach on their part....wait us out, given our life expectancies, and the fact that the only thing potentially lost is the catch-up disability check.

In the interim, for every day VA delays a claim and for every year a denied claim sits awaiting BVA attention, both VBA and VHA save millions by ordering our vets out of their hospitals, telling us seek care elsewhere as best we can. Waiting lists for appointments are gamed this way, too, by keeping our eligibility delayed as long as possible.

VA pays no penalty, regardless of how illegal or outrageous their claims decisions
. VA raters face no criticism or correction...the claims sit on desks for years, get denied for improper reasons following orders from C&P or VHA that they be denied, and then years pass before the widows get a big brown envelope long down the road.

But we have highly motivated staffers working for our senators (particularly Senators Merkley, Bennet, Burr, Udall, and Chambliss.) In the House, it seems to be only Congresswoman Bonamici, although others have signed her joint letter to the Secretary, and Congressman Neal wrote a letter himself just this year, although we've been detailing the problem to his office for three years without response.

As for VA employees, including SES, there have been changes and start-up orientations, but while smiles are friendly and they are mostly our fellow veterans, their oft-stated mission seems unchanged: they want to "draw a line somewhere," "VA cannot permit any C-123 claims," etc.

Anything that they can do to prevent C-123 exposure claims, including wording the charge to the Institute of Medicine to avoid asking the relevant question, "were they exposed," and instead asking IOM to decide "how much harmful exposure was there" to which they've responded in several studies that individual assessments just cannot be made, especially with such a small population.

Corrections Gladly Accepted

My most recent post was improved when a scientist offered clarification. Thank you. Much of what this

blog and our web site address involves scientific information for which I try to draw inferences relevant to our C-123 issues. But as a layman, I don't have the background to make the right interpretation all the time, of course.

This is not a platform for debate, but I have tried to correct every error or misstatement that has been explained to me, or to defend a post when challenged and I think I'm right. I may not be friendly towards every perspective in this issue but within my ability everything here is as accurate and honest as possible.

I'll remind readers that most of the leaders in our C-123 Veterans Association are not affected by any VA changes we advocate. Most are like me... retired military and either Vietnam veterans or have other VA disabilities, meaning we as individuals aren't affected by VA recognition of C-123 exposure claims.

We're doing this for our crew mates who need the VA care and benefits appropriate for Agent Orange exposures.

PLEASE: corrections and suggestions gladly accepted.

AF May 2012 C-123 Exposures Report Differs from 1978 Draft of AFHS re: Aircrew Exposure: Command Interference?

Found in a 1982 report (covering Oct 78-Dec 82) of  USAF School of Aerospace Medicine report on Epidemiological Investigation of Health Effects in Air Force Personnel Following Exposure to Herbicides." The report is available in full at the USDA A.L. Young Collection, Item # 01570. Ranch Hand issues, to include comments on C-123 Ranch Hand veterans and non-Ranch Hand veterans, "

No. 01570, pages 21-22

The important observations to make are:

1. The C-123 non-Ranch Hand aircrews are acknowledged as "may have been exposed to significant Herbicide Orange residue in these aircraft. Therefore, this group may not have been truly unexposed to herbicides..."

2. No distinction is made as to routes of exposure

3. The May 2012 USAFSAM C-123 exposure report concluded the AF was unable to determine the amount of exposure post-Vietnam veterans had, and illogically then concluded there was too little exposure to consider them exposed. In VA-speak, this is equipoise, or "as likely to as not."

4. The Ranch Hand study addressed only Ranch Hand personnel. Only RH veterans had serum levels tested, at $1000 per test. As a small population, studies such as have but little epidemiological, especially for want of a proper control group.  The only real cohort to study is the larger body of Vietnam veterans of all services.

5. The Air Force Chief Medical Research Officer, Dr. Richard Albanese*, testified under oath that about 10% of his reports were modified by his supervisors and that about 10% of all reports he was aware of, such as the Ranch Hand Study of which he was principal investigator, also had command interference for policy objectives.

6. Ranch Hand and post-Vietnam C-123 crews are similar only in flying the same toxic airplanes and being exposed to the same military herbicide. They differ in amounts of exposure, duration of exposure, short vs. long term exposure, ages, years flying the toxic airplanes, gender (post-Vietnam crews began including many more female medical technicians and flight nurses, and some maintenance workers.) But again...both cohorts were exposed to the same military herbicide, Agent Orange, although VA policy prohibits testing the post-Vietnam veterans. 

Conclusion: USAFSAM is shown in their 1982 report to have opined that C-123 crews may have been exposed but changes it mind even in the face of additional exposure evidence in their 2012 report, and contradicts itself for reasons of command interference.
* Dr. Albanese later detailed the multitude of failures in the USAF Ranch Hand study.  He went into specifics regarding the interference by a  White House science committee (White House Working Group "WSWG") made up of military and VA representatives...and they don't seem to have changed anything in the last 22 years!
Additional Conclusion: USAFSAM again proved susceptible to command interference with their 2012 C-123 report. "Look

again" was the order from above when preliminary conclusions favored the possibility of aircrew exposures. "Drop it" was the order when one analysis supported the veterans' assertions. This called for an IG complaint to the 75th Air Wing Inspector General. I filed it in person in early 2013, but without any action or response...they dropped it.

No wonder the Air Force has refused to release the 2012 USAFSAM C-123 report materials, despite two years of FOIA requests and our suit in the US District Court of Washington. At least, AF has promised to allow "some" documents to flow by the end of September. 

Like VA, the AF is keeping source documents locked up until after the Institute of Medicine completes its study and report to the Secretary. Neither agency wants any materials likely to help support the veterans' claims to be made available.

My Most Recent Claim Denied – For Want of VA Records

Typical VA Claims Result

My latest claim for various VA disabilities (not the Agent Orange-related ones) was denied last week, mostly because the VA regional office in Denver maintained I had no new information to submit against earlier denials, thus the original denials were final.

VBA was especially clever in this response: the adjudicator avoided addressing several elements of the claim (different injuries,) knowing that once the claim reaches the Board of Veterans Appeals they don't have jurisdiction, and the claim will be remanded. That will mean more time at the regional office, and then back in line for more years of waiting for BVA to decide.

They don't do this stuff without strategy, you know! What looks like an oversight is meant to provide VA with several more years of stalling, waiting for the vet to lose interest, or die.

For some reason, eBenefits has been accepting electronic documents for several months, at least since the end of April, but not showing them in the list of either requested or unrequested materials. Things get posted on eBenefits only if mailed or if a vet calls IRIS. Thus all my responses to VA inquiries for the last ten weeks have disappeared, so VA denied my claim.

That's one problem. The other is that the FOIA I submitted in April, which was acknowledged, still hasn't been fulfilled. That was where I'd expected to find the Air Force line-of-duty determinations for the specific injuries in the claim. Originally VA had somehow failed to even note the LODs and denied the claim because the LOD-specified injuries "did not occur during service nor in one year after." Heck, I was even hospitalized in Bethesda Naval Hospital on AD and they missed that.

I should have asked the Denver FOIA office about this earlier, because from their response letter I had no idea their current backlog is actually between six to nine months for a "C" file FOIA response. I'd gone in to see my files but they could only let me see a few pages on their computer, so a trip to Denver was wasted.

Yesterday, Denver FOIA offered to move my request for a copy of my records up and get them here in about a week because I'm so sick. Great. Now I can face two to five years in an appeal but that's way, way past my life expectancy.

Nice folks. Lousy system. Everybody at VA solves claim problems with a vet by telling us to "just appeal."

That's like a kiss of death. They know it. Perhaps their greeting at the 800-number should be "sorry for your loss" instead of "thanks for your service."

C-123 Veterans Agent Orange Exposure: August 2014 Update

The C-123 Veterans Association has updated its summary of our situation thus far, with the next major events being VA's redefinition of exposure through some sort of regulatory process, and the anticipated September Institute of Medicine C-123 report to Secretary McDonald. Included is an updated document list in chronological order and with hyperlinks.

The problem with the C-123 IOM report is that even if the investigators' findings support us, there is still a year or so for the Secretary to take any action. Then, claims will sit around on the VA regional office desks for a year or so, making any solution, however positive, years away.

We don't have those years. VA knows it. Which is why they stall. Every day's delay is money saved for Veterans Health Administration and Veterans Benefits Administration. Every claim denied is big money saved!

Policy rather than law makes for today's VA claims process.

More Inquiries About the Agent Orange Registry Exam for C-123 Vets – NOT ELIGIBLE!

We're NOT eligible! I keep getting inquiries, which I'm glad to answer but the answer hasn't changed about us taking, or being permitted to take, the VA Agent Orange Registry exam. An earlier decision by a Secretary of Veterans Affairs to permit any veteran who claims to have been exposed has been overturned by VHA Public Health, Post Deployment Health. Their policy is that we are not permitted the exam. Please don't be misled by VA internet pages because VHA has made it clear and in writing (below.)

Several Agent Orange Registry sites have written us that any veteran may be examined, but they are apparently not aware of the reversal of the Secretary's policy by VHA Post-Deployment Health.

Last year several C-123 vets were refused by various VA medical centers, and I inquired of VA's Deputy Chief Consultant in Post-Deployment Health. She explained why we're now ineligible in an email to us:

Walters, Terry
5/6/13
to me
Mr. Carter:
The information Mr. XXXX received is correct. The registry exam is essentially a physical exam and is not part of the disability exam.  The Agent Orange registry is available for the following Veterans.

  Vietnam
Veterans who served in Vietnam between 1962 and 1975, regardless of length of time.
Veterans who served aboard smaller river patrol and swift boats that operated on the inland waterways of Vietnam (also known as “Brown Water Veterans”)
   Korea
Veterans who served in a unit in or near the Korean Demilitarized Zone (DMZ) anytime between April 1, 1968 and August 31, 1971.
   Thailand
U.S. Air Force Veterans who served on Royal Thai Air Force (RTAF) bases near U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang, near the air base perimeter anytime between February 28, 1961 and May 7, 1975.
U.S. Army Veterans who provided perimeter security on RTAF bases in Thailand anytime between February 28, 1961 and May 7, 1975.
U.S. Army Veterans who were stationed on some small Army installations in Thailand anytime between February 28, 1961 and May 7, 1975. However, the Amy Veteran must have been a member of a military police (MP) unit or was assigned a military occupational specialty whose duty placed him or her at or near the base perimeter.
   Other potential Agent Orange exposures
Veterans who may have been exposed to herbicides during a military operation or as a result of testing, transporting, or spraying herbicides for military purposes. Learn about herbicide tests and storage outside Vietnam. Agent Orange or Dioxin dried on surfaces does not present a significant threat to human health. Veterans are eligible if they were in the presence of liquid Agent Orange such as when Agent Orange was sprayed, tested or transported.

Terry Walters MD MPH
Deputy Chief Consultant Post-Deployment Health
Office of Public Health
Veteran Health Administration

VA Secretary Orders Each VA Medical Facility to Hold Town Hall Meeting by End of September

Today, Secretary McDonald ordered every VA medical center and regional office to conduct Town Hall meetings by the end of September.
  
FOR IMMEDIATE RELEASE
Secretary McDonald Announces Town Hall Events at Veterans’ Facilities Nationwide

WASHINGTON – Secretary of Veterans Affairs Robert A. McDonald has directed all Veterans Affairs (VA) healthcare and benefits facilities to hold town-hall events by the end of September to improve communication with, and hear directly from, Veterans nationwide.
  “Caring for Veterans is a calling, and our first commitment is to provide Veterans and their families the timely, quality care and benefits they have earned and deserve through their service to our Nation,” said Secretary McDonald. “As we seek continual improvement and to rebuild trust among Veterans, it is critical that we continue to listen and learn directly from those who use our system.”
Secretary McDonald has informed the Under Secretaries of Health and Benefits that each VA medical center and regional office should hold at least one town-hall meeting with Veterans between now and the end of September. Meetings are designed to allow feedback from Veterans, family members and other beneficiaries. Each facility will also welcome input from Congressional stakeholders, Veteran Service Organizations, Non-Governmental Organizations, and other community partners. Details of events in each location will be forthcoming from local facilities.

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 Vet's Recent Clinic Experience, Fort Collins CO

I'd sought an appointment at Fort Collins VA Clinic upon being discharged from the VA Palo Alto War Injuries and Illness Center, which recommended I see my primary care provider within two weeks.

I gave all the details to the telephone operator who finally called back eight days after two messages were left on their machine...I repeated the situation, my medical issues of cancer and heart disease plus the newly-found cervical and lumbar damage, and Palo Alto's recommendation to see my doc in a couple weeks. I was given an appointment three months out and told I was to be seen twice a year...although if I had a medical emergency I could be seen earlier. This didn't feel top-notch, and I told the scheduler I had the resources to be seen elsewhere more promptly.

VA Clinic, Fort Collins, CO

At last month's American Legion Town Hall meeting in Fort Collins, the VA folks had no trouble rescheduling me the following week..."what day, what time is most convenient?" I don't know why one attempt by me resulted in an unacceptable three month delay, and another with a VA clerk using a laptop at the American Legion was immediately satisfactory.

The appointment itself was perfect: I was quickly processed through the front desk, waited about five to ten minutes before I was called by my doctor himself, received thorough counseling and review of the Palo Alto information, and escorted to the door by him when our visit was over.

A disappointment: I asked to see the administrator but after ten minutes, was told she was at an urgent event in Greeley. I left my card but have not been called back. I wanted to relate the initial appointment difficulty, express my satisfaction with the care that day and the rescheduled date, and discuss an upcoming Vietnam Veterans of America Town Hall meeting.

Timeline Added to C-123 Veterans' Document Resources

We have added a very detailed timeline, using Dipity. The scale must be set to 50 years or so to get an overall idea of the timespan, but set to months to get details in busier years so all the date entries can be seen individually

(Our veterans' C-123 Agent Orange Timeline on dipity.com)

Support Grows for Westover's C-123 Veterans' Agent Orange Claims

deforge@repub.com By Jeanette DeForge | jdeforge@repub.com
Follow on Twitter Springfield Republican, 1 August 2014

CHICOPEE — Support for Westover Air Reserve Base veterans who believed they were exposed to Agent Orange while flying contaminated C-123 Provider planes is expanding, but the scandal at the U.S. Department of Veterans Affairs may complicate their efforts to receive benefits.

U.S. Rep. Richard E. Neal, D-Springfield, has joined several other members of Congress across the country in urging the Department of Veterans Affairs to reverse its decision and grant benefits to the veterans, some of whom still live in Western Massachusetts.

Veterans who served on C-123 Providers at Westover between 1972 and 1982 learned about three years ago the planes had previously been used in Vietnam to spray Agent Orange over the countryside.

When one after another started falling ill with some of the more than 20 diseases known to be caused by Agent Orange exposure including diabetes, prostate cancer, heart disease and neuropathy, retired Maj. Wesley T. Carter, now of Colorado, started researching government documents and found the planes, which have since been shredded and smelted because they were considered hazardous, were contaminated.

Some of the most compelling documents revealed 11 of the 16 planes from Westover tested positive for dioxin when they were examined from 1994 and 1996 – more than a decade after they were retired. One Westover C-123 was labeled “highly-contaminated.”

Since then the veterans have been fighting for benefits that would give them access to free health care and disability payments through the Department of Veterans Affairs, if they fall ill from one of the Agent Orange diseases. The benefits would be similar to those of Vietnam veterans, who are eligible if they spend as little as a day in Vietnam.

The Veterans Affairs scandal, which unveiled alleged manipulation of medical records to hide long wait times for patients, is resulting in additional press coverage and other attention of the plight of the C-123 veterans.

But Carter said he also believes it will take longer to settle their case since it has caused disruption and personnel changes within the agency.

“It will require time to settle out. As for C-123 veterans, it means we're dealing with many new VA faces, but apparently the same VA intransigence,” Carter said. “Our need remains: Let our veterans into VA hospitals for care of their Agent Orange illnesses.”

Carter said he is hoping the increasing support may eventually help the cause of the C-123 veterans, but at the same time is seeing little interest on the VA’s part to change their opinions.

In the letter to Sloan, the executive directors called the continued use of the consulting firm “reprehensible.”

“As you move forward in your efforts to reestablish the trust of veterans in the VA (including the strong united support of the nation’s veterans service organizations), we caution that employing that particular consulting firm will be seen as an inappropriate, anti-veteran choice,” the letter said.

Most recently Young testified on behalf of the Department of Veterans Affairs in a public hearing of the National Academies of Sciences Institute of Medicine Committee on the exposure of the C-123 veterans to Agent Orange and again said there is no proof that any contamination from the planes directly caused the veterans’ cancer and heart disease, according to the letter.

Congressman R. Neal and then-Captain Wes Carter, 1990

Around the same time, Neal also joined in to show his support for the C-123 veterans. He follows several other congressmen including Sen. Richard Burr, R-N.C., the ranking member of the Veterans’ Affairs Committee, and Sen. Jeff Merkley, D.-Ore., who have been pushing for benefits for the C-123 veterans.

“Taking into account…the high levels of illnesses known to be linked to Agent Orange occurring in these Westover veterans, I believe these men and women are entitled to the same benefits granted to those who served on the ground in Vietnam,” Neal wrote.

The letter came after a staff member with local lawyer Archer Battista, of Belchertown, who is a C-123 veteran who is fighting cancer. Battista, like many of the veterans, already has benefits because he served in the Vietnam War but is fighting to help others who do not.

VA Lays Groundwork for Redefining Exposure – Any Way It Wants!

At our request this Wednesday Dean ​Michael ​Wishnie from Yale School of Law sent their C-123 report directly to Richard Hipolit, VA OGC. This was after Mr. Hipolit and several VBA and VBA senior leaders met on Tuesday with Senate staff to discuss the C-123 and other vital exposure concerns and indicated unfamiliarity with the Yale report...which laid out the legal qualification of C-123 veterans for Agent Orange presumptive service connection.

The OGC response cranked out almost immediately and in a very reactionary manner...holding high its royal mace VA trumpets "VA does whatever it wants" throughout. VA is trying desperately to redefine exposure ahead of our claims, and ahead of any action on congressional action on the Toxic Exposure & Research Act (which critically fails to include a definition of "exposure.")

I challenge OGC's perspective on exposure's redefinition as something VA simply lacks authority to do. Other federal agencies (NTP, ATSDR, EPA) have statutory and scientific sovereignty in this area and will not be pleased that one federal organization deviate from a unified perspective on such issues. Exposure should mean the same thing at EPA, CDC, NIH, Boy Scouts, Town Hall, WalMart, WHO...and VA!

I see it as the VA's reservation ​to define ​exposure ​for its purposes in the future, but nothing ​(except their attitude and preferences, certainly not the law) ​prevents their pro-veteran, non-adversarial, benefit-of-the-doubt actions now or in the future. ​ A redefinition would require regulatory action, announcement in the Federal Register, public comment and a final regulation...none of which has happened yet, so today's law is that these C-123 veterans are due today's interpretation of exposure.

VA can deny our claims, or delay them, only after such time as it changes the rules in full view of Congress, the veterans' service organizations, and other federal agencies.

Clearly, VA overreaches here to exclude, not to include. Clearly, over ten years of VA publications in the Federal Register about non-Vietnam Agent Orange exposures without parsing the word exposure was meant to leave that word in place, intact, whole and complete, not fractured or blended somehow to now reverse each of the Federal Register assurances...including the effort by VA on 31 August 2010 "to make clear."

Neither does anything in today's law, regulation or even the OGC opinion prohibit acknowledging C-123 exposures today.​..on a case by case basis, however every single claim is denied...on a case by case basis.

​Mr. Hipolit's parsing the word "exposure" to prevent exposure claims is profoundly anti-veteran. It reeks of personal preferences, personal VHA prejudices: "We have to draw the line somewhere." "We cannot permit C-123 claims." "We all die."

Dr. Young is the lynchpin who called the C-123 vets "trash-haulers, freeloaders" and who organized the destruction of evidence by destroying the C-123s in 2010. Al is the writer whose papers for years explained why none of the Vietnam ground troops was ever exposed to Agent Orange and who created the base idea that no exposure occurs without subsequent bioavailability (no proof of bioavailability = no exposure = denied Agent Orange claim, even decades past any point of TCDD remaining in the body of the veterans.)

It seems VA learned valuable PR lessons watching Big Tobacco stall legislation and the public with "the tobacco controversy"...when in fact, as with Agent Orange, there is no controversy. Calling it one, however, works wonders for denying VA claims. That's why Congress and the American people, in an act of distrust, in the 1991 Agent Orange Act stripped VA of its authority to determine medical nexus (AKA "bioavailability") and assigned it to the Institute of Medicine. Congress and the American people assigned VA with what VA acknowledged as its duty...recognize that veterans exposed to Agent Orange will be treated for the illnesses such exposure causes, as designated by the Institute of Medicine. OGC is profoundly in error in attempting to seize this power of determination back by reserving "exposure" as a term for it, and it alone, to define.

Dr. Young is the contractor who created DOD's list of Agent Orange exposure sites in 2006, deciding which sites went on...and which off, for both DOD and VA to hide behind. Dr. Young uses his doctorate in Agriculture who tells the sciences of Toxicology and Medicine about the medical implications of TCDD exposure. He is the recipient of a juicy $600,000 no-bid, sole-source VBA contract to create a catalogue system of post-Vietnam Agent Orange materials...but who proceeds to create those materials himself.

He immediately began creating one-sided articles for VBA to challenge C-123 veterans' claims, rather than a "catalogue system." He even specifically guided VA in how to create specific challenges to each of the many items of evidence submitted to support C-123 veterans' claims...calling it  "Assessment of New Information on the Former UC-123K Post-Vietnam Issue" and "Talking Points". Clearly, Young's contract should more honestly have been titled, "Project to Prevent C-123 Veterans Claims" as the work seems to have little to do with a catalogue system which was what the public purchased for $600,000.

Dr. Young played the role of VA spokesperson before the Institute of Medicine...without detailing his financial involvement with the VA. He injected passion into the IOM on June 16, not detached scientific objectivity...and answers to committee questioning seemed misleading in several areas.

But the real point: VA Office of General Counsel bowed to the wishes of its associates in VHA and thereby, abuses the law and disserves the veterans OGC is sworn to protect. Bad move, boys. We thought you were on our side, and that we were your true clients.

Senate Confirms McDonald as Secretary of Veterans Affairs

Today the Senate approved President Obama's nomination of Mr. McDonald as the new Secretary of Veterans Affairs. He will take office after being sworn in.

Welcome aboard, Mr. McDonald. Your Department and the veterans' community look forward to constructive changes under your leadership.

VA Internal Survey Released Today Reveals Scandal Worse Than First Thought

From USA Today (reporters Gregg Zoroya and Meghan Hoye)

Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some

cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system.

Auditors found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows.

Workers at the Department of Veterans Affairs outpatient clinic in Wilmington, N.C., told auditors they "were fearful of retaliation" if they did not manipulate appointment data.

At the Edward HInes Jr. VA hospital in Hines, Ill., near Chicago, "staff felt they would be subject to disciplinary action" if appointment records were not changed, one report shows.

Managers instructed or "encouraged" schedulers to falsify appointment data at such VA medical facilities as those in Leeds, Mass.; Jacksonville, N.C.; Virginia Beach and Cleveland, according to the documents.

The audit by the VA's Veterans Health Administration was ordered earlier this year by then-VA Secretary Eric Shinseki. The results were provided to President Obama on May 30, the day Shinseki resigned.

The Senate on Tuesday confirmed Obama's nomination of former Procter & Gamble CEO Robert McDonald as Shinseki's successor. McDonald, 61, of Cincinnati, was approved on a 97-0 vote to replace Acting VA Secretary Sloan Gibson, who took over after Shinseki resigned.

Auditors interviewed more than 3,200 employees at more than 700 clinics and hospitals to gather their findings.

A broader investigation underway by the VA Inspector General and the Justice Department is scheduled to be completed next month. Gibson has testified in Congress that "several supervisors" are being investigated in connection with potential criminal charges.

The VA issued a statement late Tuesday saying it is seeking disciplinary action against six employees working at a hospital in Cheyenne, Wyo., and at an outpatient clinic in Fort Collins, Colo., for manipulating appointment data.

One of the six is a regional director; others include the director of the Cheyenne hospital and the chief of staff there. The VA said it is seeking to have two of the six fired. The agency said it found evidence that supervisors personally manipulated data, instructed subordinates to do so and withheld accurate information from higher officials.

Internal investigations found that clinic or hospital chiefs may have manipulated appointment data in order to look better on performance evaluations upon which their bonuses were based.

"As these new details make painfully obvious ...some VA executives are so driven in their quest for performance bonuses, promotions and power that they are willing to lie, cheat and put the health of the veterans they were hired to serve at risk," said Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans' Affairs.

The internal audit made public Tuesday shows that schedulers who said they did not manipulate data worked at medical centers that reported the longest wait times, according to official VA data.

Westover Veteran Dan Kibe Dies, July 29

Friends, sad news.

Westover veteran Dan Kibe, a retired member of the 74th Aeromedical Evacuation Squadron passed away an hour ago, around 1:00PM Tuesday. He will be missed by all, and admired for a life of service to our country. God bless!

Its a Deal – House & Senate Agree on Veterans Bill

They pulled it off somehow. 

Last week's mess with the House and Senate Veterans Affairs leaders disconnecting over funding for a vital veterans' bill was alarming. The congressional recess beginning this Friday might have spelled continued disaster for veterans nationwide, with proposed solutions to the current scandal abandoned.

But they did it. Senator Bernie Sanders, supported firmly by his Ranking Member, struck a compromise over the weekend with Congressman Miller, reducing the Senate's $35 billion goal, but increasing the House amount of just $10 billion, to $17 billion.

Amazing that this is the same figure quoted by Acting Secretary Gibbons for VA's immediate needs. Amazing, too, that Congress did something real for a change.

Congratulations for all the hard work on the Hill! 

Secretary-Designate McDonald Not in Step with Post Deployment Health – Big Mistake Under Oath

VA Secretary-Designate McDonald

Post Deployment Health in VA's Veterans Health Administration had better get the word to the Secretary-Designate! According to those folks, Mr. McDonald's uncle was never exposed to Agent Orange while serving in Vietnam. His uncle's present care from the VA is only provided because VA is forced to by the Agent Orange Act of 1991.

In his confirmation hearings before the Senate Veterans Affairs Committee last week, Mr. McDonald described his service, and the service of his family, in the military from World War II, where his dad was a POW, to Vietnam, where his uncle was "exposed" to Agent Orange for which he now receives VA care. He said it, under oath. His uncle was exposed to Agent Orange in Vietnam.

...and under oath, too!

Careful there with your sworn testimony, Mr. McDonald. Big, big mistake!

You really should have run your testimony past your experts at Post Deployment Health. They have carefully explained to us, and to the Institute of Medicine, that none of the Vietnam ground troops was exposed to Agent Orange. Because your uncle can't prove bioavailability, he was never exposed! Give your uncle a call with the good news!

Forgive the sarcasm, please. We're on your side of the truth, but Post Deployment Health isn't.

What's the basis for this? Following the lead of their $300,000 per year consultant, VA Post Deployment Health has redefined exposure to require veterans also prove bioavailability...the presence of dioxin in the body. Like all other Vietnam vets, Mr. McDonald's uncle can't prove that, just as C-123 veterans can't prove such a thing three decades after our last flights.

Because of such an impossible barrier which VA used to deny their disability claims for decades, in 1991 Congress simply provided presumptive exposure for Vietnam veterans. For non-Vietnam vets like C-123 folks, we have to prove an exposure situation, and then the presumptive eligibility for Agent Orange benefits applies.

At least, that's the law. Its not the way the VA sees it, in their determination to "draw the line somewhere."

VA unscientifically redefined exposure to skip out on its own commitments made in the Federal Register regarding post-Vietnam Agent Orange exposures..."exposure = contamination field plus bioavailability."

We wish Mr. McDonald great success in leading the VA to new levels of excellence. We certainly wish his

uncle well in the care he receives from the VA for his Agent Orange exposure. We wish VA would not reinvent "exposure" as their tactic to prevent giving us the same vital care.

C-123 Veterans Charge to the Institute of Medicine C-123 Committee, June 16 2014

INDEPENDENCE.

The IOM web site, and staff emails, end in “.edu.” and not “.gov.” The Institute of Medicine is independent, say both the Department of Veterans Affairs and the IOM. Respectfully, we ask for your independence to be exercised.

But the VA charge restricted your independence, and gave rise to confusion when instead VA should have sought useful answers. We listened to the confusion and attempts to clarify the charge back on May 15 at the first public meeting.

Back on May 15, you weren’t briefed by VA that the report of this committee, if strictly in response to the VA’s charge, still won’t affect C-123 veterans’ access to VA care. The wording on the charge was chosen most carefully.

Yale Law, and other legal scholars, and the VA itself through publications in the Federal Register, have made it abundantly clear that the sole qualifier for Agent Orange illnesses to be treated by the VA is a veterans’ proof of exposure, or proof of service in Vietnam or on the Korean DMZ.

The real question is not how much harm. The real question is not how much exposure. The real question is not about bioavailability.

The answer to the real question is vital, yet the real question itself wasn’t even raised in the charge to the committee.

That question, one you are asked by us to answer more fully, is whether or not we were exposed and are thereby due care. Last month we discussed the “as likely to as not” decision point for medical claims. The level of proof, by veterans’ law, is only equipoise. We’re far past that.

The charge, as worded, avoided the real question of simple exposure. The reason for that has become clear: By not directly asking IOM to determine C-123 veterans’ exposure on a yes or no basis, there is no response to the challenges raised in our disability claims.

The C-123 contamination has been repeatedly proven over the decades by the military. The harm from our exposure, although the law frees us from having to prove it, has also been established. Please consider that the findings supporting our exposure claim were all offered by experts without compensation. If we’d paid as much to support our claims as the VA to oppose, we’d certainly have even more to offer.

Stretch the boundaries of your charge, to answer the real question before this committee, which is simply whether our C-123 crews were exposed and are due the care for ailments already identified by the IOM as Agent Orange-presumptive illnesses.

Certainly, your work on this committee to address the fullness of the VA charge is important and there are important answers you’ll uncover. But you must go further for the real problem to be resolved. Three years of this misery is enough.

I say there must be no barrier, no evasion, no acceptance of rigid blindfolds disguised as a committee charge. As worded, the charge which takes from you the independence needed to meet the real mission of the IOM and the National Academies, fulfilling what President Lincoln sought in 1863, a body of distinguished scholars “charged with providing independent, objective advice to the nation on matters related to science and technology.”

Please: Independently answer the real question the veterans and the Department of Veterans Affairs are contesting, and form an effective as well as scientifically accurate report.

C-123 veterans, the focus of all your work, ask you to provide the nation your advice in the fullest way with a more complete, responsive answer to the real question at hand: QUESTION – In fulfilling our duty to fly this transport for a decade, were we, more likely than not, exposed and are thereby due VA care for illnesses previously associated by the IOM with Agent Orange exposure?

That should have been the real charge to this committee.

VA Designs Institute of Medicine C-123 Study to Prevent Exposure Claims

Skillful folks, the staff at VA Post Deployment Health. And they're not there to let any more veterans onto the Agent Orange disability lists! As they told the Associated Press, "We have to draw the line somewhere."

But three years of their policy of simply telling us "no" began to face some opposition in early 2014 with publication in Environmental Research of the article, "Post Vietnam Military Herbicide Exposures in C-123 Spray Aircraft." While VA could, and would prefer to, ignore that and all other evidence of veterans' exposures, at about the same time Yale Law School released a detailed white paper confirming the C-123 veterans' rights to presumptive service connection for Agent Orange exposures.

Together, these developments added to political suggestions that VA pretend, at least, to follow the law. After all, VA had repeated three times via the Federal Register their commitment to treat non-Vietnam Agent Orange exposures the same as vets exposed in Vietnam. Those repeated commitments needed to be skirted somehow, which VA has successfully done by having reinvented the basic word, "exposure." Simply put, VA decided to redefine the word to include bioavailability, or the proven impact of Agent Orange on the body. Perfect solution...just change the words around so that nobody exposed to anything qualifies for any exposure claims. With Agent Orange, many decades after exposure, the bioavailability of dioxin is impossible for us to prove...and VA even prohibits the test anyway.

But VA had continuing pressure to comply with the 1991 Agent Orange Act, which is to refer fundamental disputes or inquiries about Agent Orange to the Institute of Medicine. Here VA excelled! They complied, yet insured that the IOM process will defeat veteran's exposure claims.

VA gets to make up the ground rules in this game. One is that VA issues a "charge," or assignment, to the IOM to investigate. Since the only question under the law regarding non-Vietnam exposures is exposure, the VA skillfully avoided tasking the IOM with deciding whether we'd been exposed. Instead, VA asked IOM to address fairly irrelevant issues, of interest of course, but irrelevant in terms of whether VA should be treating our Agent Orange illnesses.

Here's their "charge" to the IOM which is currently investigating C-123 issues:

This committee will determine whether there is an excess risk of adverse health among crew members who, after the Vietnam War ended in 1975, flew and/or maintained C-123 aircraft that had been used to spray Agent Orange in Vietnam. The committee will: 

• Evaluate the reliability (including representativeness, consistency, methods used) of the available information for establishing exposure; and, 

• Address (qualitatively as a degree of certainty, rather than in a quantitative fashion) whether any documented residues represent potentially harmful exposure (i.e., consider biological availability of dioxin), by characterizing the amounts available and the degree to which absorption might be expected.

You see it, don't you? The second bullet item specifically asks for an IOM conclusion about bioavailability, which isn't a requirement for any veteran, Vietnam or non-Vietnam, to prove in order to seek care for exposure to Agent Orange. But VA sneaks in the term, knowing in advance that forty years after the last spray missions and thirty years after our last flights in 1982, no such proof is possible.

The IOM committee can't but help to repeat conclusions about bioavailability from earlier IOM reports...that it can't be established for this population.

When the C-123 veterans spoke before the IOM C-123 committee on June 16, we asked them to act independently of their charge from the VA. They have that authority and responsibility. We have, however, repeatedly been told that the committee is interested only in the scientific data required to form a response to the VA charge.

If they do this, they play the VA's game. The IOM avoids meeting its responsibility to us, and avoids answering the only real question on the table: 

Were C-123 vets exposed and, if so, are they to be treated as per law?

Earliest VHA Reference to Bioavailability in Exposure Definition Found

Yesterday, the Air Force released some of the documents requested by the C-123 Veterans Association...back in 2012! So much for the 20-day response provided for in the Freedom of Information Act laws. While most of the requested materials were simply not included at all. one of interest was VHA's 1 August 2011 "VHA Issue Brief."

As readers know, VA has redefined exposure to prevent exposure claims. We thought the earliest reference to this was the VHA Post Deployment Health poster display presented at the 2012 Society of Toxicology. Yesterday's USAF set of papers included VHA Issue Brief on the C-123. We don't know the genesis of the brief but it, and its insertion of bioavailability, showed up in the Air Force document set. We find that very disappointing.

The reason? The USAF Surgeon General's office was emphatic from the start...the USAF School of Aerospace Medicine was to conduct its research on the C-123 independently, without cross-pollination of opinions or perspectives between USAF and the VA. This high-minded approach failed immediately, with VA providing carefully selected materials to provide (shall we say, guide?) the Air Force researchers.

Both agencies had relevant materials directly supporting C-123 veterans' exposure...so both agencies made sure those were suppressed. VA's set of materials mailed to the Air Force included the Blue Water Navy IOM Report (why?) and the usual copies of the OSD consultant's Agent Orange articles.

How to block Agent Orange exposure claims

After losing the "Agent Orange is harmless" battle, VA's campaign against veterans shifted to claiming that none were ever exposed, not even the Vietnam War ground troops. In case that argument fails to convince, the VA also insists that even if Agent Orange was present, it couldn't expose via dermal, inhalation or ingestion.

Second reason for VA's opposition is its novel bioavailability dodge. VA tells us that Ranch Hand veterans have tested highest in dioxin levels yet seem to have reasonable health. VA suggests that "logically" other veterans' body levels of dioxin (bioavailability) are necessarily lower and thus proof that they weren't exposed. And certainly, VA insists that no C-123 exposures occurred because we have never been tested for bioavailability. And VA blends bioavailability into exposure so as to deny exposure.

Get it? No matter what, no problems with Agent Orange. Ever. The VHA and VBA realize that the law simply demands non-Vietnam vets establish exposure, so together they blend the two words into one – 'exposure'– in a scheme to block any and all exposure claims.

This is illogical, and even labeled "unscientific" by toxicologists. "Ludicrous" is Dr. Wayne Dwernychuck's appraisal of the VA definition. And because of the impact of VA refusing C-123 veterans vital medical care, ethics are also a consideration.

Exposure is defined as "skin (or eye) contact with a chemical (of any type) or its ingestion or inhalation." Simple definition from the CDC/Agency for Toxic Substances and Disease Registry, and one generally accepted in science and medicine. VA's weird definition, now is "exposure = contamination field + bioavailability."

Remember that our only problem with the VA is their gate keepers, not the clinicians. Their objective since Day One of our C-123 problems, as shown by VHA's brief, was to insure all C-123 claims are denied. They had to redefine "exposure" to do this, and at some point in our struggle they'll get caught in the deception.