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Report: VA lags on Agent Orange research

Even as an Institute of Medicine report expanded a list of health issues possibly linked to the defoliant Agent Orange, researchers lamented that the Department of Veterans Affairs had taken little action on previous recommendations on that issue.

The OIM committee that wrote the report noted that its recommendations “are similar to those offered in previous updates and that there has been little activity in several critical areas.”

“It is the committee’s conviction that work needs to be undertaken promptly to resolve questions regarding several health outcomes, most urgently tonsil cancer, melanoma, and paternally transmitted transgenerational effects,” states the report, “Veterans and Agent Orange: Update 2008,” released on July 24.

But house Committee on Veterans’ Affairs Chair Bob Filner said Friday that while research should be continued, VA should cover every claim from every Vietnam-era veteran who served in Southeast Asia, thereby ending the need for veterans to prove their claims are related to Agent Orange.

“This has been going on for 30 to 40 years now,” said Filner, D-Calif. “These guys are now made more sick from fighting the bureaucracy. We know that it causes cancer. We know that it causes Parkinson’s.”

Filner said he had been told that 500 vets in Illinois had been hit with Parkinson’s disease at the age of 50 — about 20 years earlier than it strikes most people. He said he would work to get House Bill 2254 passed this year, and he plans to talk about that bill Saturday at the Vietnam Veterans of America annual conference.

The new report says that as the Defense Department sprayed herbicides over Vietnam from 1962 to 1971, it inadvertently sprayed U.S. troops with “the most toxic form of dioxin,” which was a byproduct of Agent Orange. Since 1991, the committee has been tasked with producing a research review every two years about the harmful effects of dioxin. The latest report is the eighth in the series.

The Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides is chaired by Richard Fenske, a professor in the School of Public Health and Community Medicine at the University of Washington. The other board members are all civilians who work in health departments of universities throughout the nation.

The committee looks at any new research related to herbicides and connected health issues to see if there is a statistical association — not proof of causality — between health issues and Agent Orange. For the latest review, they looked at 300 new studies published since 2006, but only four of which were directly related to Vietnam veterans.

For the 2008 report, the committee was asked “whether the occurrence of hairy cell leukemia should be regarded as being associated with exposure to the components of herbicides used by the military in Vietnam.”

The committee “concluded that not just hairy-cell leukemia, like chronic lymphoid leukemia, but all chronic B-cell neoplasms belong in the category of ‘sufficient evidence of an association’ with Hodgkin’s disease and non-Hodgkin’s lymphoma.”

It also found that ischemic heart disease and Parkinson’s disease should move from the category of “inadequate or insufficient evidence of an association” with Agent Orange into the category of “limited or suggestive evidence of an association.”

The committee also checked for developmental problems late in veterans’ children and concluded that it is “considerably more plausible than previously believed” that exposure to the herbicides sprayed in Vietnam might have caused “paternally-mediated transgenerational effects.”

“As the offspring of Vietnam veterans grow older, the possibility of a parental effect on the incidence of adult cancers, cognitive problems and other diseases of maturity are of increasing interest,” the report said.

The committee also recommended that VA pursue research in toxicology using animal models to see how diseases progress.

Committee members noted that they also have asked in the past that biologic samples from an Air Force study be released for further review and research, but the samples are still in warehouse storage. “In the interim, critical analyses such as longitudinal evaluation of the cancer data have not yet been made public, and the unique potential of this resource languishes,” the report said.

According to the committee, that material is supposed to be maintained and managed by the Institute of Medicine under the law.

“What is required is a strong commitment by the federal government to provide sufficient funds to develop the infrastructure necessary to meet the goals of further research using this invaluable database,” the report states.

The committee also complained that VA contracted a study in 2001 to look at the current physical and mental well-being of people in the National Vietnam Veterans Readjustment Study, but the effort came to a halt within two years.

“The VA Office of the Inspector General ruled that ‘the study was not properly planned, procured or managed,’ but directed that the study be completed, making provisions to avoid the previous problems,” the OIM committee report said.

The study still has not been completed.

Other recommendations in the report:

• As Vietnam veterans age, they should be studied further for Parkinson’s disease because most cases of Parkinson’s occur in people in their 70s and 80s.

“The lack of data relating [Parkinson’ disease] incidence to exposure in the Vietnam veteran population is of concern to the committee, and we strongly recommend that such studies be performed,” the report states, adding that “the preponderance of epidemiological evidence” already supports an association between herbicide exposure and the disease.

• More research is needed on neurological disorders. The report said only one study since 2006 has focused on exposure to dioxin and neurology in Vietnam veterans. “Over the last 50 years, a body of literature has accumulated that suggests an association” between dioxin and peripheral neuropathy.

• Further study should be done on other veterans who served in Southeast Asia and may have been exposed to Agent Orange through drinking water or other means.

The committee also called for more research on the Vietnamese population and, more specifically, the children of Vietnamese veterans.

Filner agreed that the research is too little, too slowly.

“The VA has a history of deny, deny, deny,” he said. “Then it’s cover-up, cover-up, cover-up. Then, when it’s unavoidable, they make them go through bureaucratic hoops. Jump, jump, jump. We ought to make the process easier for the veteran.”

He said his bill could cut VA’s one-million-case backlog by 20 percent.