Friday, September 30, 2011

Our Take on the IOM Report

There were several things that struck us as significant when we read the Summary section of the Veterans and Agent Orange: Update 2011 yesterday. Two in particular got our attention as both were pointedly remarks aimed at the DVA for things they did/do, and things they should be doing.

First, let’s look at this statement:

This committee recommends that the VA should more actively query their own medical databases to identify potential associations between Vietnam service and specific health outcomes, particularly for those outcomes that are less common. Moreover, if a perceived conflict of interest exists in surveying their own databases, it is recommended that an external advisory group be formed to determine the best mechanism for mining this information so that these medical databases could be available for external study.

We have called for a study to be made. We suggested that all Vietnam Vets be asked to participate, not just those in the DVA databases. We would like to see the study determine who has what diseases, not just AO, but all diseases, and where and when they were in the Combat Zone, and whether they were air crew, ground troops or Naval personnel. We would include as a separate group, military personnel who served in locations where herbicides were stored, or in the case of Korea, used. As one control, we would suggest that Vietnam Era Veterans who did not serve in Theater, and did not receive either the Vietnam Service Medal, Armed Forces Expeditionary Medal for service in Vietnam, or the Vietnam Campaign Medal be similarly polled. As a second control we recommend a comparable cohort of civilians who were in the 17-35 age group during the Vietnam era.

We note this passage from the Summary as well:

It is especially important that longitudinal analyses be conducted on cancer, cardiovascular, and reproductive outcomes represented in the complete database assembled in the course of the Air Force Health Study. The committee endorses VA’s actions toward restarting the congressionally mandated National Vietnam Veterans Longitudinal Study, derived from the cohort originally studied in the National Vietnam Veterans Readjustment Study.

We agree, but in light of the previous quoted concern for a potential “conflict of interest” if the DVA conducted its own study, we think all studies should be removed from the purview of the DVA. And their Databases should be, MUST BE audited continually. Admiral Zumwalt, in his report of 1989 that led to the Agent Orange Act of 1991 called the DVA out for its meddling and corruption of data and results in studies regarding Herbicides and Vietnam Veterans from the very start of such studies shortly after the war ended, a period of about 15 years up until that time. Apparently such corruption by the DVA continues even today.

We note the words in the paragraph above, ”…if a perceived conflict of interest exists in surveying their own databases, it is recommended that an external advisory group be formed to determine the best mechanism for mining this information so that these medical databases could be available for external study.”, and we agree. We think the large Veterans Service Organizations such as the American Legion, the VFW, VVA, FRA, Amvets, and others toss their hats and their cash in the ring to fund the study, contracting it to a reputable university with a record of doing good statistical analysis studies.

Those same words are an implied slap at the reputation DVA has for meddling and corrupting scientific studies to suit their own agenda. The very concept that a Cabinet Level Department has an agenda of any kind beyond the mission of that department is reprehensible. Politics and ideologies simply cannot be allowed to influence the straightforward carrying out of the department’s mission.

It is time for the DVA to clean up its act and begin carrying out its self-described mission “…to care for him who shall have borne the battle…”

We have stated before, that ”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.", and it continues to be true today for all Veterans. The Department of Veterans Affairs is the shame of the Nation.


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 Obama 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 © 2005-2011: VNVets Blog -- Now in our Seventh Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.

IOM “Veterans and Agent Orange: Update 2010” Released

The Veterans and Agent Orange: Update 2010 has just been released. It contains some disappointing information such as the lack of proof of a connection between dioxin and cancers of the mouth, esophagus, stomach, intestines, colon, etc...essentially the entire alimentary canal. But it also contains some suggestive comments about the DVA.

The study was performed by the National Academies of Science's Institute of Medicine, in its biennial review. The review in this case began in 2009 and ended in 2010. The reports are usually released in late summer, but this one may have been delayed by Senator James Webb's call for a review of the IOM's previous peer review and conclusions and recommendations based on the Australian Study that found a path to exposure through water contamination and the shipboard evaporation system of making fresh boiler and potable water.

This study was to cover the following:

A) whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association;
B) the increased risk of disease among those exposed to herbicides during service in the Republic of Vietnam during the Vietnam era; and
C) whether there exists a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

The Committee is charged with, among other things:

In conducting its study, the present committee operated independently of the Department of Veterans Affairs (VA) and other government agencies. The committee was not asked to make and did not make judgments regarding specific cases in which individual Vietnam veterans have claimed injury from herbicide exposure. This report provides scientific information for the Secretary of Veterans Affairs to consider as VA exercises its responsibilities to Vietnam veterans. The committee was not charged to focus on broader issues, such as the potential costs of compensation for veterans or policies regarding such compensation.

In addition to the above charge, the VA made an additional request arising from the decision making at VA necessitated by the findings of Update 2008. The sponsor asked that, when summarizing the evidence available to support the association of a health effect with exposure to the components of the herbicides used by the military in Vietnam, the committee address whether or not all the points that have rather imprecisely become known as the Bradford Hill (1965) “criteria” for causality (strength, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, and analogy) had been satisfied by the information available.

The study made some recommendations, among them classifying specific diseases as to the relative likelihood of a causal connection between exposure to Dioxin/TCDD and the specific disease. They were ranked as:

Sufficient Evidence of an Association: Soft-tissue sarcoma (including heart), Non-Hodgkin lymphoma, Chronic lymphocytic leukemia (including hairy cell leukemia and other chronic B-cell leukemias), Hodgkin lymphoma, Chloracne.

Limited or Suggestive Evidence of an Association: Laryngeal cancer; Cancer of the lung, bronchus, or trachea; Prostate cancer; Multiple myeloma; AL amyloidosis; Early-onset peripheral neuropathy (category clarification from Update 2008); Parkinson disease; Porphyria cutanea tarda; Hypertension; Ischemic heart disease; Type 2 diabetes (mellitus); Spina bifida in offspring of exposed people.

Inadequate or Insufficient Evidence to Determine an Association.
Cancers of the oral cavity (including lips and tongue), pharynx (including tonsils), or nasal cavity(including ears and sinuses); Cancers of the pleura, mediastinum, and other unspecified sites in the respiratory system and intrathoracic organs; Esophageal cancer; Stomach cancer; Colorectal cancer (including small intestine and anus); Hepatobiliary cancers (liver, gallbladder, and bile ducts); Pancreatic cancer; Bone and joint cancer; Melanoma; Nonmelanoma skin cancer (basal cell and squamous cell); Breast cancer; Cancers of reproductive organs (cervix, uterus, ovary, testes, and penis; excluding prostate); Urinary bladder cancer; Renal cancer (kidney and renal pelvis); Cancers of brain and nervous system (including eye); Endocrine cancers (thyroid, thymus, and other endocrine organs); Leukemia (other than all chronic B-cell leukemias, including chronic lymphocytic leukemia and hairy cell leukemia); Cancers at other and unspecified sites; Infertility; Spontaneous abortion (other than after paternal exposure to TCDD, which appears not to be associated); Neonatal or infant death and stillbirth in offspring of exposed people; Low birth weight in offspring of exposed people; Birth defects (other than spina bifida) in offspring of exposed people; Childhood cancer (including acute myeloid leukemia) in offspring of exposed people; Neurobehavioral disorders (cognitive and neuropsychiatric); Neurodegenerative diseases, excluding Parkinson disease; Chronic peripheral nervous system disorders; Hearing loss (newly addressed health outcome); Respiratory disorders (wheeze or asthma, chronic obstructive pulmonary disease, and farmer’s lung); Gastrointestinal, metabolic, and digestive disorders (changes in hepatic enzymes, lipid abnormalities, and ulcers); Immune system disorders (immune suppression, allergy, and autoimmunity); Circulatory disorders (other than hypertension and ischemic heart disease); Endometriosis Effects on thyroid homeostasis; Eye problems (newly addressed health outcome); Bone conditions (newly addressed health outcome).
Please note that most of these indicate a direct causal relationship, and not an indirect one. For example, Diabetes Mellitus Type 2 often has associated peripheral nerve damage and eye problems, and coverage for those situations is included under the DVA's current Agent Orange policies.

Despite the assertions by the staff of Senator Webb to the contrary, the Institute of Medicine does indeed make recommendations to the DVA. In fact, that is specifically what these studies are all about. Accordingly, the IOM essentially calls for increased studies, including:

This committee recommends that the VA should more actively query their own medical databases to identify potential associations between Vietnam service and specific health outcomes, particularly for those outcomes that are less common. Moreover, if a perceived conflict of interest exists in surveying their own databases, it is recommended that an external advisory group be formed to determine the best mechanism for mining this information so that these medical databases could be available for external study.

The committee for Update 2008 concluded that it was plausible that exposure to the herbicides sprayed in Vietnam could cause paternally-mediated effects in offspring as a result of epigenetic changes and such potential would most likely be attributable to the TCDD contaminant in Agent Orange. There is a growing body of evidence that TCDD, and also arsenicals, can induce epigenetic changes in animal models, but there remains extremely limited data on the risk of paternal exposure to xenobiotics in general, and the VAO chemicals of interest in particular, resulting in adverse effects on their offspring. Consequently, this committee continues to recommend that laboratory research be conducted to characterize TCDD’s potential for inducing epigenetic modifications. Further, the committee recommends development of epidemiologic protocols to address the logistical challenge of determining whether adverse effects are being manifested in the adult children and grandchildren of Vietnam veterans as a result of paternal exposure. The best cohorts for revealing potential associations would be those with known, well-characterized exposure information. Another alternative would be to adopt a case-control approach and explore whether information about Vietnam exposure or specific herbicide exposure could be ascertained in any of the many birth cohorts that have been established in the past several decades. To hone in on a paternal effect, however, it will be necessary to establish that the mothers did not have the opportunity for exposure above background levels to the chemicals of interest.

As in previous years, this committee recommends the pursuit of additional research in toxicology. The development of animal models of various chronic health conditions and their progression would be useful for understanding the possible contributions of the chemicals of interest to compromise the health of aging Vietnam veterans. Specifically, determining the mechanism by which dioxin-like chemicals induce B cell cancers and how this exposure alters the susceptibility to developing obesity and components of metabolic syndrome would fill important knowledge gaps. Additional health problems, such as metabolic syndrome, COPD, and measuring meaningful biomarkers of immune/inflammatory disease merit study in human populations.

The committee notes that the earlier investment in studying several exposed populations is now producing useful findings; the National Institute for Occupational Safety and Health, Seveso, Air Force Health Study, and Army Chemical Corps cohorts all merit continuing follow-up or more comprehensive analysis. It is especially important that longitudinal analyses be conducted on cancer, cardiovascular, and reproductive outcomes represented in the complete database assembled in the course of the Air Force Health Study. The committee endorses VA’s actions toward restarting the congressionally mandated National Vietnam Veterans Longitudinal Study, derived from the cohort originally studied in the National Vietnam Veterans Readjustment Study.

The committee notes that its recommendations are similar to those offered in previous
updates and that there has been little activity in several critical areas. The fate of the assemblage of data and biologic samples from the Air Force Health Study remains unsettled; in the interim, critical integrative analyses such as longitudinal evaluation of the cancer data have not yet been made public, and the unique potential of this resource languishes. It is the committee’s conviction that work needs to be undertaken promptly to resolve questions regarding several health outcomes, importantly COPD, tonsil cancer, melanoma, Alzheimer disease, and paternally transmitted effects to their offspring. Creative analysis of VA’s own data resources and further work on cohorts that have already been established may well be the most effective way to address those outcomes and to gain a better understanding of the role of herbicide exposure in development of Parkinson’s Disease in Vietnam veterans.

You can read or download the report at the following link. Downloads in Adobe .pdf format are free.

http://www.iom.edu/Reports/2011/Veterans-and-Agent-Orange-Update-2010.aspx

We will assess this study tomorrow and post that assessment tomorrow evening.

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 Obama 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 © 2005-2011: VNVets Blog -- Now in our Seventh Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.

Thursday, September 01, 2011

More on Our Veteran and the Games DVA is Playing

What appears to be happening at the DVA is perhaps best defined as a bunker mentality.

For more than half a century the Department of Veterans Affairs [and prior to that name they were known as the Veterans Administration], has fought against granting benefits to ANYONE for exposure to Agent Orange.

It is a matter of record that the DVA and its predecessor, the VA, did everything within its power to prevent Agent Orange exposed Veterans from receiving one second of medical treatment, and one penny of compensation for the poisoning they received at the hands of their own government while doing their duty in Combat and Combat Support roles in the Vietnam War.

Indeed, this was an extraordinary effort by the DVA, one that included tampering with scientific studies, something that was at the very least highly unethical, probably highly illegal, and indeed, meets the level of malfeasance in office and criminal negligence when you consider what they were working so hard to prevent: benefits for those Veterans poisoned during the Vietnam War.

This went on for decades. Political and economic motivations were involved, probably from some members of the anti-Vietnam War movement who somehow obtained secure middle and upper level management positions in the DVA, and made every effort to see that those who fought in the war died an early death without benefits, treatment, and without leaving a legacy for their survivors. Legal issues were [and still are] in play as well. If this 19 million gallon spray job over about eight years and just about every square inch of the Republic of Vietnam [South Vietnam] was indeed a massive human and ecological disaster that we now know it to be, then someone was responsible and would be required to pay in a civilian court, and, who knows, perhaps even a criminal court. After all, the Chemical manufacturers warned the Department of Defense that the contracted strength of the chemicals was extremely toxic, and extremely hazardous to handle. Exposure was life threatening if the concentrations and exposure were high enough. Even lower exposure levels would result in serious deadly diseases. And the Department of Defense warned the Chemical Manufacturer that unless they provided the chemical as contracted, in the strength required, and without warnings on the barrels, those Chemical Companies would be subject to "criminal sanctions". [See Federal Court case Winters v. Diamond Shamrock.]

[That puts the onus completely on the United States Government. Nevertheless, when a group of Veterans, with the assistance of several Veterans Service Organizations, sued in Federal Court, the US Government bargained its way out of the suit, leaving the Chemical Manufacturers dangling in the wind. They paid.]

Enter our first hero. Admiral Elmo Zumwalt, Jr. Initially, Zumwalt, or Zum as he was somewhat affectionately known to the enlisted men under his command, was in charge of a Cruiser-Destroyer Flotilla in Vietnam, then became Naval Advisor to General Creighton Abrams, and Commander of Naval Forces, Vietnam. Zum was the man who ordered the spraying of herbicides in the southern half of South Vietnam. His son was a young officer in the Riverine forces [Brown Water], and he was exposed to herbicides regularly. Zumwalt's son died of cancer in 1988. Zum, who went on to be Chief of Naval Operations, went to work on his retirement, digging into the herbicide issue and there were plenty of Vietnam Veterans dying far too young from all kinds of cancers.

It was Zum who did enough scientific evidence gathering, and who provided much of the impetus to force Congress to pass the Agent Orange Act of 1991. He also exposed the DVA's efforts to "cook" some scientific evidence away from the herbicides, fudging numbers, and results in scientific studies, and applying pressure to scientists and government workers to go along with their efforts. Hence, the potential for criminal liability among those DVA, and Department of Defense personnel, who did the dirty work.

Grudgingly, the DVA gave way and began paying Agent Orange benefits to anyone with a Vietnam Service Medal. But right from the start they began eliminating, first carving out the Veterans who served in Thailand, Laos and Cambodia, where we now know herbicides were widely used around base perimeters, on bases to clear vegetation, and along the frontier with Vietnam where we had outposts. Then in 1993 they removed the Air Force Veterans from presumptive eligibility essentially saying "You flew over it." Never mind that mostly it was the Air Force that sprayed it, and that almost all the combat and combat support squadrons rotated through South Vietnam and Thailand during the war, meaning they set feet on the ground. In 2002 they removed the Blue Water Navy, essentially saying the chemical, and/or its effects, stopped dead at the shoreline. As we now know, thanks in large part to the government of Australia, neither the chemical, nor its effects stopped at the beach. Nevertheless, the Blue Water Navy remains largely ineligible, despite increasing evidence that a large part of it spent considerable time in brown water. Those ships, as the DVA is shown the evidence, are granted presumption of exposure for the crews that were on them when the ship was in brown water.

Enter our second hero. Commander Jonathan Haas, USN, Ret. Haas served on the USS Mt. Katmai AE 16, an ammunition ship, in Vietnam. He filed a claim for exposure claiming direct spray while the Katmai was close inshore. The case wound its way from the Regional Office into the US Court of Appeals for Veterans Claims.

Enter our third hero...or group of heroes. The National Veterans Legal Services Program is a non-profit organization comprised of attorneys and their staffs who work for Veterans, advocate changes in DVA and DoD policy, and generally do great things for a lot of Veterans. They argued the Haas case at the USCAVC and won, overturning the rejection of the Department of Veterans Affairs, Board of Appeals.

The word flashed around the country and many new claims were filed, and others were updated. The DVA appealed the decision of its own court, and won at the US Court of Appeals for the Federal Circuit in Washington, DC. NVLSP, and Haas, appealed to the Supreme Court of the United States, which declined to hear the case.

But now the cat was out of the bag. US Naval Veterans of the Vietnam War were armed with the knowledge that the Veterans Court saw things differently than the policy wonks and lawyers at the DVA, and with the new knowledge of the Australian government's great work in the scientific study of how Navy ships make fresh water. The study showed that if the seawater was contaminated by dioxin, from runoff, or spillage, or overspray, when processed to make fresh water for the ships' crews, the dioxin would not be eliminated, but in fact, concentrated. The sailors showered in it, drank it in their coffee, ate it in their mashed potatoes, and drank it right from their scuttlebutts [water fountains] on the ships.

Now there are Veterans groups comprised of Blue Water Sailors, and those groups advocate in Congress to get the DVA policy changed, they advocate in the offices of the DVA to change the policy to include the Blue Water Sailors, and they push the media to increase public awareness of the situation. The pressure is on the DVA.

It's been over four decades, this fight.

A VA Press release yesterday announced that since the addition a year ago of the three new diseases [Parkinson's Disease, Hairy [B-cell] Leukemia, and Ischemic Heart Disease] to the list of diseases eligible for treatment under the Agent Orange Act, the DVA has paid out:

2.2 BILLION DOLLARS IN RETROACTIVE BENEFITS FOR THOSE THREE NEW DISEASES!
That had to stick in the craw of those miscreants at the DVA who have been responsible for over four decades of misinformation, malfeasance, criminal negligence, and other illegalities and felonies perpetrated on the American Veterans of the Vietnam War.

There is a new bill in congress which will restore benefits to the Blue Water Navy. There are other efforts underway currently as well. The American Legion, the VFW, the Fleet Reserve Association, and the VVA are all keenly aware of the issue and are actively advocating the restoration of benefits to the Blue Water Navy Veterans of the Vietnam War in Congress and with the DVA, and the public. The heat is on. And the DVA is now making some whopper sized mistakes.

We have been informed that Our Veteran received word from the DVA Regional Office that two letters were written on his behalf and sent to President Obama. No one seems to know who wrote the letters, exactly, but the suspicion here is that those letters were generated by a certain Regional Office in a large southern state, not by any advocates for Our Veteran, knowing that such letters seriously slow a claim. The claim gets pulled and a slow investigation is made. It can take months, perhaps years before that claim gets put back into the hands of a rater. Additionally, our Veteran received letters from his Regional Office that STILL claim he or a relative worked for the DVA, thus requiring his claim record be sealed. Once sealed, it takes a pretty high-up person to open it, as happened when Our Veteran's Representative's staffers went to the DVA in DC. And they are still denying claims for diseases which Our Veteran never filed a claim.

Needless to say Our Veteran's Representative and his staff, and the attorneys working on Our Veteran's case are asolutely irate.

The DVA keeps making decisions based on their own say-so, that they have no way to back up, and prove their own assertions. These decisions range from the Office of the General Counsel all the way down to the claims raters in the Regional Offices.

For example, they deny Blue Water Navy Veterans presumption based on their assertion that there was no Blue Water exposure. They have not one whit of scientific evidence to back that decision. Nothing! Zip! Zilch! Nada! But the Blue Water Veterans have the Australian Study. And we here have been advocating a Vietnam Veterans Morbidity and Mortality Study for years. And the DVA absolutely KNOWS the outcome of such a study would force them to grant presumption to Blue Water Navy Veterans.

Also, the story told by our Second Veteran, the one who works in a Regional Office, tells of the raters making decisions to deny claims in the face of well grounded claims from the Veterans.

Yes, the miscreants in the DVA hierarchy are feeling the heat. They are making mistakes in their fight to prevent those benefits. And someone, at some point, might just call for an investigation by the Department of Justice into the actions at ALL LEVELS of the DVA regarding these issues.

Four decades of abuse by a government cabinet department is entirely too long for a crime to continue.

Stop the madness now. Restore the Vietnam Service Medal as the qualifying criteria for exposure, and let the last of us die with what little we have left. Stop making those who fought that unpopular war pay for the decision to fight it. We did the honorable thing and went to war for our country. Our country, those who lead it, but do not fight the wars, made the decision to fight. Whoever you are at the DVA, your ill will is egregiously misguided and misdirected. May you rot in Hell for all of eternity for what you and your minions have done to several million honest men and women.

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 Obama 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 © 2005-2011: VNVets Blog -- Now in our Seventh Year of Service to Veterans; All Rights Reserved. Reprinting or copying of the contents of this blog without the express permission of the author is unlawful.