Sunday, July 26, 2009

Pertinent Citations from the IOM Veterans and Agent Orange: Update 2009

The following citations are taken from the IOM (Institute of Medicine). 2009. Veterans and Agent Orange: Update 2008. Washington, DC: The National Academies Press. This report was issued Friday, July 24, 2009

Pages 29-30:

Increased Risk in Vietnam Veterans
When all the available epidemiologic evidence has been evaluated, it is presumed that Vietnam veterans are at increased risk for a specific health outcome if there is evidence of a positive association between one or more of the chemicals of interest and the outcome. The best measure of potency for the quantification of risk to veterans would be the rate of the outcome in exposed Vietnam veterans compared with the rate in nonexposed veterans, adjusted for the degree to which any other factors that differ between exposed and nonexposed veterans might influence those rates. A dose–response relationship established in another human population suitably adjusted for such factors would be similarly suitable.

It is difficult to quantify risk when exposures of a population have not been measured accurately. Recent serum TCDD concentrations are available only on subgroups enrolled in the Air Force Health Study (AFHS) (the Ranch Hand and Southeast Asia comparison subjects) and from VA’s study of deployed and nondeployed members of the Army Chemical Corps. Pharmacokinetic models, with their own set of assumptions, must then be used to extrapolate back to obtain the most accurate estimates of original exposure available on Vietnam-era veterans. The absence of reliable measures of exposure to the chemicals of interest among Vietnam veterans limits the committee’s ability to quantify risks of specific diseases in this population.

Although serum TCDD measurements are available for only a small portion of Vietnam-era veterans, the observed distributions of these most reliable measures of exposure make it clear that they cannot be used as a standard to partition veterans into discrete exposure groups, such as service on Vietnamese soil, service in the Blue Water Navy, and service elsewhere in Southeast Asia. For example, many TCDD values observed in the comparison group from the AFHS exceeded US background levels and overlapped considerably with those of the Ranch Hand subjects.

As explained in Chapter 1, the committee for Update 2006 decided to make a general statement about its continuing inability to address that aspect of its charge quantitatively rather than reiterate a disclaimer in the concluding section for every health outcome, and this committee has retained that approach.


Page 46-47:

Exposure of Personnel Who Had Offshore Vietnam Service
US Navy riverine units are known to have used herbicides while patrolling inland waterways (Zumwalt, 1993; IOM, 1994), and it is generally acknowledged that estuarine waters became contaminated with herbicides and dioxin as a result of shoreline spraying and runoff from spraying on land. Thus, military personnel who did not serve on land were among those exposed to the chemicals during the Vietnam conflict. A particular concern for the personnel has been possible contamination of drinking water. Most vessels serving offshore but within the territorial limits of the Republic of Vietnam converted seawater to drinking water through distillation.

Higher than expected mortality among Royal Australian Navy Vietnam veterans prompted a study of potable-water contamination on ships offshore during the Vietnam conflict (Mueller et al., 2001, 2002). Specifically, the study investigated the potential for naval personnel to ingest TCDD and cacodylic acid in drinking water. The study focused on the evaporative distillation process that was used to produce potable water from surrounding estuarine waters. The study found that codistillation of dioxins was observable in all experiments conducted and that distillation increased the concentration of dioxins in the distillate compared with the concentration in the source water. The study also found that dimethylarsenic acid did not codistill to a great extent during evaporation and concluded that drinking water on ships was unlikely to have been contaminated with this herbicide. In a follow-up discussion of the study with its authors, it was noted that vessels would take up water for distillation as close to shore as possible to minimize salt content (Wells, 2006). On the basis of that study and other evidence, the Australian Department of Veterans Affairs determined that Royal Australian Navy personnel who served offshore were exposed to dioxins that resulted from herbicide spraying in Vietnam even if they did not go ashore during their tour of duty (ADVA, 2005).

The current committee engaged Steven Hawthorne as a consultant to review the Mueller et al. (2002) publication and to comment generally on the ability of organic compounds to codistill during the production of potable water. Hawthorne is an environmental chemist at the University of North Dakota’s Energy and Environmental Research Center and has specific expertise in the study of organic emissions from water (Hawthorne et al., 1985). He affirmed the findings of the Australian study, citing Henry’s law for an explanation of how contaminants with low water solubility would evaporate from water and noting that the distillation process would enhance the process by adding heat and reducing pressure (Hawthorne, 2008). No measurements of dioxin concentrations in seawater were collected during the Vietnam conflict, so it is not possible to ascertain the extent to which drinking water on US vessels may have been contaminated through distillation processes. However, it seems likely that vessels with such distillation processes that traveled near land or even at some distance from river deltas would periodically collect water that contained dioxin. Thus, a presumption of exposure of military personnel serving on those vessels is not unreasonable.

In its charge to the original VAO committee, the Department of Veterans Affairs asked the committee to include military personnel who served in inland waterways, offshore of the Republic of Vietnam, and in the airspace above the Republic of Vietnam. A presumption of exposure to Agent Orange and other herbicides used as defoliants applied to each of those groups as well as to those who served on land. In light of the findings of the Australian study regarding potential drinking-water contamination and those serving offshore, the presumption seems well founded.


Pages 564-565:

COMMITTEE RECOMMENDATIONS
As part of its charge, the committee was asked to make recommendations concerning the need, if any, for additional scientific studies to resolve uncertainties concerning the health effects of the chemicals of interest sprayed in Vietnam: 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5- trichlorophenoxyacetic acid (2,4,5-T) and its contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), picloram, and cacodylic acid. This chapter summarizes the committee’s recommendations.

Although great strides have been made over the last several years in understanding the health effects of exposure to the chemicals of interest and in elucidating the mechanisms underlying them, gaps in our knowledge remain. The scope of potential research on the chemicals is wide, and what follows in this chapter is not an exhaustive listing of future research that might have value. There are many additional opportunities for progress in such subjects as toxicology, exposure assessment, the conduct of continuing or additional epidemiologic studies, and systematic and comprehensive integration of existing data that have not been explicitly noted here. It is the committee’s conviction, however, that work needs to be undertaken promptly, particularly to address questions regarding several health outcomes, most urgently tonsil cancer, melanoma, paternally-mediated transgenerational effects, and Parkinson’s disease.

• The current definition of Vietnam service is not supported by existing data.
The evidence that this committee has reviewed makes a definition of Vietnam service limited to those who set foot on Vietnamese soil seem inappropriate. The ongoing series of hearings and appeals in the US Court of Appeals for Veterans Claims (Haas v. Nicholson) reflect this controversy. As discussed in Chapter 3, there is little reason to believe that exposure of US military personnel to the herbicides sprayed in Vietnam was limited to those who actually set foot in the Republic of Vietnam. Having reviewed the Australian report (NRCET, 2002) on the fate of TCDD when sea water is distilled to produce drinking water, the committee is convinced that this would provide a feasible route of exposure for personnel in the Blue Water Navy, which might have been supplemented by drift from herbicide spraying.

The epidemiologic evidence itself supports a broader definition of “service in Vietnam” to serve as a surrogate for presumed exposure to Agent Orange or other herbicides sprayed in Vietnam. For instance, the Centers for Disease Control and Prevention (CDC, 1990) study of selected cancers among Vietnam veterans found that the risk of the “classic AO cancer” non-Hodgkin’s lymphoma was highest and most significant among Blue Water Navy veterans. More recently, the AFHS has demonstrated that TCDD concentrations in Vietnam-era veterans deployed to Southeast Asia, not just the “Vietnam veteran” Ranch Hand subjects, are generally higher than US background concentrations (although notably lower than in Ranch Hand sprayers themselves).

The committee notes that all previous VAO committees evaluating the epidemiologic evidence concerning exposure to the herbicides sprayed in Vietnam and the full spectrum of health outcomes have always considered information from naval Vietnam veterans to pertain to possible Agent Orange exposure. This committee considers that exposure assignment to be appropriate. No new studies considered in this update contained Navy-specific information, but such information has been factored into the evolving conclusions of VAO committees.

Given the available evidence, the committee recommends that members of the Blue Water Navy should not be excluded from the set of Vietnam-era veterans with presumed herbicide exposure.
This ends the citations from the IOM Veterans Agent Orange Update 2009.

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Bush Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

Copyright © 2005-2009: VNVets Blog -- Now in our Fifth Year of Service to Veterans; All Rights Reserved.

Friday, July 24, 2009

IOM Report Backs Blue Water Navy Vets!

FLASH NEWS

The Institute of Medicine today issued its Veterans and Agent Orange Update 2008 and it contains some VERY good news.

The report introduces the Australian Study into the mainstream US Government scientific community and also the report done by Commander John Wells, USN [Ret] during the Haas case. By doing so, the IOM clearly states that a presumption of exposure to Agent Orange should be applied to Blue Water Navy Vietnam Veterans.

Here, finally, is the science the DVA has been claiming is not science. Indeed, it is the first bit of science of any kind about the Blue Water navy that the DVA will now have at its disposal. And it goes 100% against everything the DVA has been saying about Blue Water Navy Veterans.

We urge you to go to this link and page to pages 46-47 and read what the IOM has to say:

Veterans And Agent Orange Update: 2008 page 46

Much of the honor for this is due to VASVW Member Commander Wells who testified last year before the Institute of Medicine.

More details when they become available.

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Bush Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

Copyright © 2005-2009: VNVets Blog -- Now in our Fifth Year of Service to Veterans; All Rights Reserved.

Tuesday, July 07, 2009

PTSD is not caused by society

War has been part of man's culture since he picked up the first rock and threw it at his neighbor. But PTSD has been there longer than that. Watching your family get eaten alive by a saber-toothed tiger would cause it. Seeing the stragglers in your column of family get overtaken by molten lava would cause it.

And I'll bet he had nightmares about it, too.

Do you think there was no "shell shock", or "Battle Fatigue" or PTSD after the Civil War? After the Revolution? Do you think Civilians did not experience it during the French and Indian Wars, or the Indians experience it after what we did to them during our westward expansion? Do you think Napoleon's troops did not experience it after their march home from Moscow -- those that survived?

Do you think that little boy down in Florida doesn't grow up with PTSD after seeing an alligator eat his little sister?

Do you think the young mother who lost her baby in a tornado as it was ripped from her arms doesn't have PTSD?

Do you think the four survivors of a train wreck that killed 150 people don't have PTSD?

The only influence war has on PTSD is the statistically increased occurrences in war that provide the stressors that trigger it.

Culturally, it is our prejudice against persons with any form of mental condition, be it a disease, or a birth defect. In fact, no mental illness, or disease, no abnormalities are caused by the individual in whom the illness or abnormality exists, yet we shun and mistreat, bully and mock, belittle and ostracize those who are retarded, mentally ill, insane, or scarred from a stroke, a brain injury, a long bout with a high fever, or a tumor. Our ignorance is based on old societal fears and the fact that in general we know so little about the brain and the mind and what makes it work, though we are a lot farther down the road than when I was taking psychology courses forty years ago.

[For what it is worth, and this is NOT scientific, I suspect that PTSD is the result when the mind is so overwhelmed with horror that the normal mechanism of coping, forgetfulness, is unable to kick in. I think there are a few in whom PTSD is controllable...perhaps recurrences only happening once or twice a year...you can function like that...but of the rest, I believe that most who have it hide it, either trying to "man up", or ashamed of the perceived weakness, when it is, indeed, not a weakness, but an illness. But there is a stigma attached to any form of "mental condition" because of which most who have PTSD will not come forward about their own problems.]

Mostly, it is ignorance that allows people to treat persons with brain disorders the way we do. How we treat PTSD victims comes from the same root of ignorance in the way we treat Schizophrenics when we call them "Schiz", or say, "He went all schizoid on me!", and the same root as when we refer to the Mentally Retarded as "Tards" or "Morons", or confuse a person who is recovering from a stroke with a drunk, or a retarded person. Ignorance.

War does not cause PTSD, it provides the stressors that do, and they are different for each and every individual affected. Our culture does not cause PTSD. It is not something inflicted by our society.

I will repeat, The only influence war has on PTSD is the statistically increased occurrences in war that provide the stressors that trigger it.

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Bush Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

Copyright © 2005-2009: VNVets Blog -- Now in our Fifth Year of Service to Veterans; All Rights Reserved.


Wednesday, July 01, 2009

The Wives' Letters

[Note: This is a reposted and updated entry that needs to be put up over and over to remind folks of the role played by the wives in all of this struggle.]

They write. They call. They fax. They file form after form. They drive wherever they need to go in order to document, present, appeal, or argue their case. And they are frequently shut out.

No sailor wants to make that last voyage without providing for his widow, and/or his family. One of the ways to do so is to file a claim with the Department of Veterans Affairs under the Agent Orange Act of 1991. Unfortunately, and apparently illegally, the DVA stopped approving claims in 2002 for Navy Veterans who served in the “off shore waters of Vietnam”.

…John was hospitalized three nights ago with what has been diagnosed as pneumonia resulting from multiple myeloma. The doctors aren’t holding out much hope. What can I do? We’re out of money. John’s claim was denied because he did not set foot on the ground…

In many cases, those sailors with pending claims died before their claims were decided. Their claims died with them. Their widows got…absolutely nothing.

In 2002, the DVA modified their procedural manual to stipulate that a veteran filing for Agent Orange Presumptive benefits must provide proof that he actually set foot on the ground in the Republic of Vietnam. The DVA made this change after issuing a “precedential opinion” in 1997 from their own office of General Council. They did all of this on their own, without any instigation from Congress, or the various Veterans Service Organizations. But they also made the manual change without offering it up for public comment first.

…My husband served three tours on Destroyers off the coast of Vietnam between 1965 and 1971. He never set foot on the ground there. In 1998 Bob was diagnosed with Type II Diabetes, and a year later with cancer of the prostate. They operated, and he tested clear of the cancer for a while, but in 2005 his PSA suddenly skyrocketed. He went in for tests and they found the cancer was back and it had spread throughout his body. They removed one of his lungs late last year, but by summer the other was full of cancer. He was hospitalized repeatedly. None of the treatments really worked. They sent him home last week, in time for his 60th birthday, with days to live. His claim with the VA died with Bob this morning at 5:17 AM. I have no idea what I will do now…

I receive four to seven of these a week. Every week. Fifty two weeks a year. I read them through my tears, and theirs. God! How could so many sailors have been so blessed with such strong wives!?

How could an agency of the United States Government act in such a crass and inhumane manner? Not only was their action illegally done, it was unjustified and unjustifiable, and we felt confident the court would say that in its decision in the Haas case. It was a cruel and heartless action, done coldly. My first claim was rejected in 2003 with the words, “You did not serve in Vietnam.” I have the medals, and the cruise book, and the envelopes and letters sent home free from the combat zone to prove it.

To be perfectly honest, I pray that people like Anthony Principi, Jim Nicholson, and the author of the precedent that was used to change the manual, May Lou Keener, rot in the lowest level of Hell for all eternity. So grievous were their actions that even that fate may be too good for them.

…he had been treated for heart disease and other problems for about five years, all after being diagnosed with Type II Diabetes. Yesterday after lunch he went in to take a short nap. When I went to wake him for our afternoon walk, he was gone. He should have gotten VA benefits, but he was denied and never appealed it. The Lord knows we could use the money for his funeral, and to pay off the mortgage on the house. I don’t want to lose this place. It has too many memories of us in it…

They come in emails, and in their words, through our tears, I see theirs. And in their words I see behind their tears an aura of nobility, grace and strength. These are not women to be trifled with, to be shunted aside with barely a glance, or ignored completely.

These women fulfilled a compact with their sailors, and because their sailors fulfilled a compact with their government, and died as a result of that compact, their wives must be compensated, even though their husbands were not.

We strongly urge the citizens of this nation to take up this cause and make it one of their goals, to see that justice is done for these good and strong women – the wives, widows, and daughters of our Blue Water Naval Veterans of the Vietnam War.

What the DVA did in 2002 was not only illegal, but because it was illegal, it was stupid. Because they did not follow due process of the law, they made a clear and unmistakable error in changing their policy without asking for public comment first, as required by law. Any of their actions subsequent to that policy change are therefore illegal if the DVA personnel followed that policy in the changed manual section.

The Courts, or better yet, Congress, which could save the Veterans and their Wive's a lot of unnecessary legal action, should issue a law connecting prior claims denied under these illegal changes. Because the DVA erred, anything that was ruled subsequent to that error based on that error, must be reviewed and overturned and benefits issued retroactive to the date of the claim. That includes any claims that died when the claimant died, any claims that were rejected based on the erroneous policy change, and appeals that were denied based on that change. Everything in those categories should be reconnected and reprocessed back to the date of the original claim, non-severed by any failure to appeal as well. It was the DVA that erred, not the claimants.

The court or Congress, should also rule that all these claims should be processed to the issuance of benefits within 6 months, including retroactive benefits.

…God gave me thirty wonderful years with my sailor, and I treasure every second of those years. Even the cross words that were sometimes exchanged will be sorely missed. When he took that final voyage last spring, the VA had not completed his claim. Now they won’t even answer my letters and calls. I had to put the house up for sale last summer, and am now living in a small apartment downtown so I can get around. But it is a dangerous neighborhood. I’ve been mugged twice, but all they got was a few dollars. They could have asked me for it and I would have given them the money. Ralphie would have given them each a bloody nose for their trouble. Sometimes, when I am trying to make a decision, I think, “what would he have done?” I was a housewife, I get no retirement from Social Security. I have a little bit left from Ralph’s IRA, and from the sale of the house, but that will be gone in a few years. I don’t know what I’ll do then…

We owe these courageous women a debt that goes far beyond mere gratitude. In many cases, we owe them our lives. Not many of us are financially secure. The presence of VA Benefits will go along way toward building that financial security for us to leave behind. Our wives, and children deserve it because we earned it, and they did, too. They care for us in our pain and illness, they comfort us, they haul us around to doctors, clinics, labs, and offices, and in between all that other stuff they write, phone, fax, and email on our behalf.

Gentlemen, Attention on Deck! To the indomitable and courageous wives, widows, sweethearts, and daughters of the Blue Water Navy Vietnam Veterans, hand salute!

Two!

VNVets

”It is a stain on this nation's honor that the Department of Veterans Affairs has become a deadlier and more difficult adversary to the American veteran than any they have ever faced on a battlefield."-- VNVets

"The concept that Agent Orange, and its effects, stopped dead in its tracks at the shoreline is simply too illogical, and too ludicrous to accept. What does that say about the Bush Administration and his Department of Veterans Affairs?"--VNVets

"With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation's wounds; to care for him who shall have borne the battle, and for his widow, and his orphan--to do all which may achieve and cherish a just and lasting peace, among ourselves, and with all nations." --President Abraham Lincoln

"It follows then as certain as that night succeeds the day, that without a decisive naval force we can do nothing definitive, and with it, everything honorable and glorious."--President George Washington

Copyright © 2005-2009: VNVets Blog -- Now in our Fifth Year of Service to Veterans; All Rights Reserved.