Vietnam Vets, Agent Orange, and PD

An article in yesterday’s New York Times might be of interest to Vietnam
War vets with neurodegenerative disorders… .

October 13, 2009
Door Opens to Health Claims Tied to Agent Orange
By James Dao
New York Times

Under rules to be proposed this week, the Department of Veterans
Affairs plans to add Parkinson’s disease, ischemic heart disease and
hairy-cell leukemia to the growing list of illnesses presumed to have
been caused by Agent Orange, the toxic defoliant used widely in Vietnam.

The proposal will make it substantially easier for thousands of
veterans to claim that those ailments were the direct result of their
service in Vietnam, thereby smoothing the way for them to receive
monthly disability checks and health care services from the department.

The new policy will apply to some 2.1 million veterans who set foot
in Vietnam during the war, including those who came after the
military stopped using Agent Orange in 1970. It will not apply to
sailors on deep-water ships, though the department plans to study the
effects of Agent Orange on the Navy.

The shift underscores efforts by the secretary of veterans affairs,
Eric Shinseki, a retired Army chief of staff and a Vietnam veteran
himself, to reduce obstacles to sick or disabled veterans’ receiving
benefits. The department has come under sharp criticism from Congress
and veterans groups for long delays in processing disability claims.

“Since my confirmation as secretary, I’ve often asked why, 40 years
after Agent Orange was last used in Vietnam, we’re still trying to
determine the health consequences to our veterans who served in the
combat theater,” Mr. Shinseki said in a statement. “Veterans who
endure a host of health problems deserve timely decisions.”

The veterans department already recognizes more than a dozen
conditions as being presumptively connected to Agent Orange exposure
in Vietnam, including Hodgkin’s disease, prostate cancer and Type 2 diabetes.

But for diseases not on that list, veterans are required to provide
evidence directly relating their service in Vietnam to their illness,
a requirement that often leads to application rejections and prolonged appeals.

Veterans department officials estimate that about 200,000 veterans
might seek benefits under the proposed change in policy. But they
said they could not estimate the cost of the change until the policy
underwent public review and was published in final form, which could
take several months.

Mr. Shinseki’s decision is a victory for groups like Vietnam Veterans
of America, which has been pushing the department to add Parkinson’s
disease, ischemic heart conditions and hypertension to the list of
diseases presumptively linked to Agent Orange.

But the new policy is also likely to prompt debate over how much
responsibility the federal government should take in compensating and
caring for aging veterans who are exhibiting a growing list of
physical and psychological problems.

The most common of the three illnesses, ischemic heart disease,
restricts blood flow to the heart, causing irregular heartbeats and
deterioration of the heart muscle.

Parkinson’s disease is associated with a loss of cells that secrete
dopamine, a brain chemical essential for normal movement. Patients
develop tremors, rigid posture, impaired balance and an inability to
initiate movement.

Hairy-cell leukemia, a rarer condition, is a slow-growing cancer in
which the bone marrow produces too many infection-fighting cells,
lymphocytes, that crowd out healthy white blood cells, red blood
cells and platelets.

Agent Orange, named after the color-coded band on storage drums, was
the most common herbicide used in Vietnam to clear jungle canopy and
destroy crops. It contained one of the most toxic forms of dioxin,
which has since been linked to some cancers.

Aides said Mr. Shinseki’s decision was influenced by a report
released in July from the Institute of Medicine that found “limited
or suggestive evidence” of an association between exposure to
herbicides and an increased chance of Parkinson’s disease and
ischemic heart disease in Vietnam veterans. The report also found
“sufficient evidence,” a stronger category, of an association between
herbicides and hairy-cell leukemia.

The report, written by a 14-member panel appointed by the institute,
was based on a review of scientific literature. The institute is
required by Congress to monitor the health effects of herbicides used
in Vietnam and produce updates every two years.

In its report, the panel warned that there was a paucity of
epidemiological data about Vietnam veterans. As a result, the panel
said, its findings did not represent “a firm conclusion” about
herbicides and Parkinson’s and herbicides and ischemic heart disease.
It said it could not estimate the chances of veterans’ developing
either disease.

Despite those caveats, the Institute of Medicine report has been
cited by veterans advocates as providing sufficient evidence to
justify a rule change. Under laws governing Agent Orange policies for
veterans, the department cannot make benefits decisions based on
cost, only on the scientific evidence. Aides to Mr. Shinseki said the
Institute of Medicine report provided that evidence.

Some doctors and researchers say the expansion of Agent Orange
benefits has been based on weak or inconclusive science, given the
lack of studies on Vietnam veterans. Those skeptics argue that
diseases like prostate cancer or Type-2 diabetes are just as likely
the result of aging, lifestyle or genetic predisposition as exposure
to Agent Orange.