Department of Veterans
Affairs
Agent Orange Brief
A1
Prepared by the Environmental
Agents Service (131)
VA Central Office, Washington,
DC 20420
December 1997
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AGENT ORANGE - GENERAL
INFORMATION
What is Agent Orange?
Agent Orange was a herbicide, or defoliant, which was used in Vietnam
to kill unwanted plant life and to remove leaves from trees which otherwise
provided cover for the enemy. Agent Orange as mixture of chemicals containing
equal amounts of the two active ingredients, 2,4-D and 2,4,5-T. The
name, "Agent Orange," came from the orange stripe on the 55-gallon
drums in which it was stored. Other herbicides, including Agent White
and Agent Blue, were also used in Vietnam to a much lesser extent.
Why are Vietnam veterans concerned about Agent Orange?
In the 1970's some veterans became concerned that exposure to Agent
Orange might cause delayed health effects. One of the chemicals (2,4,5-T)
in Agent Orange contained minute traces of 2,3,7,8- tetrachlorodibenzo-p-dioxin
(also known as TCDD or dioxin), which has caused a variety of illnesses
in laboratory animals. More recent studies have suggested that the chemical
may be related to a number of malignancies and other disorders.
When and where was Agent Orange used in Vietnam?
Fifteen different herbicides were shipped to and used in Vietnam between
January 1962 and September 1971. Over 80 percent of the herbicides sprayed
in Vietnam was Agent Orange, which was used between January 1965 and
April 1970. Herbicides other than Agent Orange were used in Vietnam
prior to 1965, but to a very limited extent. The total area sprayed
with herbicides between 1962 and 1965 was small, less than 7 percent
of the total acreage sprayed during the Vietnam conflict. Rapid increases
in the annual number of acres sprayed occurred from 1962 to 1967. The
number of acres sprayed reached a maximum in 1967, leveled off slightly
in 1968 and 1969, and declined rapidly in 1970 prior to the termination
of spraying in 1971. During this time more than 20 million gallons of
herbicides were sprayed over 6 million acres, some of which were sprayed
more than once. More than 3.5 million acres of South Vietnam -- approximately
8.5 percent of the country -- were sprayed one or more times. Spraying
occurred in all 4 military zones of Vietnam.
Heavily sprayed areas included inland forests near the demarcation zone;
inland forests at the junction of the borders of Cambodia, Laos, and
South Vietnam; inland forests north and northwest of Saigon; mangrove
forests on the southernmost peninsula of Vietnam; and mangrove forests
along major shipping channels southeast of Saigon. Crop destruction
missions were concentrated in northern and eastern central areas of
South Vietnam.
What should concerned veterans do?
In 1978, the Veterans Administration, now known as the Department of
Veterans Affairs (VA), set up a special examination program for Vietnam
veterans who were worried about the long-term health effects of exposure
to Agent Orange. Vietnam veterans who are interested in participating
in this program, known as the Agent Orange Registry, should contact
the nearest VA medical center for an examination. An appointment usually
can be arranged within two to three weeks.
What can a veteran expect from this examination?
Veterans who participate in the examination program are asked
a series of questions about their possible exposure to herbicides in
Vietnam. A medical history is taken, a physical examination is performed,
and a series of basic laboratory tests, such as a chest x-ray (if appropriate),
urinalysis, and blood tests, are done. If the examining physician
thinks it is medically indicated, consultations with other physicians
are scheduled.
No special Agent Orange tests are offered since there is no test to
show if a veteran's medical problem was caused by Agent Orange or other
herbicides used in Vietnam. There are tests that show the level of dioxin
in human fat and blood, but such tests are not done by VA because there
is serious question about their value to veterans. In January 1992,
VA signed a contract with the National Academy of Sciences (NAS) under
which, among other things, the NAS considered the feasibility and possible
value of dioxin level blood tests for Vietnam veterans who apply for
VA medical care or VA disability compensation. In its July 1993 report,
the NAS concluded that individual TCDD levels in Vietnam veterans are
usually not meaningful because of common background exposures to TCDD,
poorly understood variations among individuals in TCDD metabolism, relatively
large measurement errors, and exposure to herbicides that did not contain
TCDD.
How does a veteran benefit from taking VA's Agent Orange Registry
examination?
The veteran is informed of the results of the examination during a personal
interview and gets a follow-up letter further describing the findings.
Each veteran is given the opportunity to ask for an explanation and
advice. Where medically necessary, a follow-up examination or additional
laboratory tests are scheduled. The examination and tests sometime reveal
previously undetected medical problems. These discoveries permit veterans
to get prompt treatment for their illnesses. Some veterans think they
are in good health, but are worried that exposure to Agent Orange and
other substances may have caused some hidden illness. The knowledge
that a complete medical examination does not show any medical problems
can be very reassuring or helpful to Registry participants. All examination
and test results are kept in the veteran's permanent medical record.
This information is also entered into the computerized VA Agent Orange
Registry. So far, more than 250,000 Vietnam veterans have participated
in this program. For more information about the VA Agent Orange Registry,
see Agent Orange Brief, B1.
Can a veteran get treatment for Agent Orange-related illnesses?
Yes. Section 102, Public Law 104-262, the Veterans' Health Care Eligibility
Reform Act of 1996, provides that VA is required to furnish hospital
care and medical services, and may furnish nursing home care to veterans
exposed to herbicides in Vietnam. There are some restrictions. VA cannot
provide such care for a (1) disability which VA determines did not result
from exposure to Agent Orange, or (2) disease which the National Academy
of Sciences has determined that there is
"limited/suggestive" evidence of no association between occurrence
of the disease and exposure to a herbicide agent. For additional information
about eligibility, see Agent Orange Brief, B2.
Can veterans get disability compensation for Agent Orange illnesses?
VA also pays disability compensation to many Vietnam veterans with injuries
or illnesses incurred in or aggravated by their military service. Veterans
do not have to prove that Agent Orange caused their medical problems
to be eligible for compensation. Rather, VA must determine that the
disability is "service-connected." A Veterans Benefits Counselor,
at any VA medical center or regional office, can explain the compensation
program in greater detail and can assist veterans who need help in applying.
For more information about the VA disability compensation program, call
1-800-827-1000 or see Agent Orange Brief, B3.
What else is VA doing?
In addition to the efforts described above (that is, Agent Orange Registry
examination program, medical treatment eligibility, and disability compensation),
VA is doing research to learn more about the possible adverse health
effects of Agent Orange exposure. The Environmental Epidemiology Service
(EES), in Washington, DC, is the premiere office for Vietnam/Agent Orange-related
research within VA. EES investigators have completed two studies about
possible connections between Vietnam service and specific kinds of cancers
called soft tissue sarcomas, a large scale study of mortality among
Vietnam veterans, a study regarding the relationship between Vietnam
service and non-Hodgkin's lymphomas, a study of dioxin in adipose (fat)
tissue, several mortality study follow-up efforts, mortality studies
of individuals in the Army Chemical Corps in
Vietnam, an analysis of post-traumatic stress disorder (PTSD) among
Vietnam veterans in the Agent Orange Registry, a study of the relationship
between Vietnam service and Hodgkin's disease, a study of the relationship
between military service in Vietnam and the risk of death from trauma
and selected cancers, an analysis of testicular cancer among Agent Orange
Registry participants, a study of suicide among wounded Vietnam veterans,
and a study of the relationship between lung cancer and military service
in Vietnam. EES had assistance from others on several of these research
projects. For information about these studies and ongoing VA research
efforts, see Agent Orange Brief, C2.
In 1981, VA published a two-volume report reviewing scientific literature
on herbicides in the United States and throughout the world. This publication
was updated with an additional two volumes in 1984, 1985, 1986, 1987,
1988, 1989, 1990, 1991, 1992, 1993 and 1994. (These annual updates were
discontinued to avoid duplication of the ongoing scientific literature
review by the National Academy of Sciences, a non-governmental organization
under contract with VA.) Lay language summaries of the VA's scientific
reviews have been published to help non-scientists understand this complex
issue. VA has also published a series of monographs regarding Agent
Orange-related matters. For additional information on these publications,
see Agent Orange Brief, B4.
From 1979 to 1994, VA was part of an interagency group monitoring and
coordinating Agent Orange-related and dioxin-related research within
the Federal government. The interagency group ceased operation in 1994.
VA also has been aided by two VA-administered advisory committees, which
made valuable recommendations to the Administrator/Secretary of Veterans
Affairs regarding appropriate policy for compensation, research, outreach,
and related matters.
What are other government departments and agencies doing?
Many other Federal departments and agencies have pursued and/or are
also conducted scientific studies on this subject. The Centers for Disease
Control and Prevention (CDC), Air Force (USAF), National Institute for
Occupational Safety and Health (NIOSH), National Cancer Institute (NCI),
and Environmental Protection Agency (EPA) have all been involved in
research. The CDC published an important study, partially funded by
VA, in 1984 regarding Vietnam veterans' risks of fathering babies with
birth defects. CDC investigators found that overall Vietnam veterans
were not at increased risk of fathering a child with birth defects.
VA also funded the CDC Vietnam Experience Study published in 1987 and
1988, and the CDC Selected Cancers Study published in 1990. The
USAF is conducting a long-term study of mortality and morbidity among
the men involved in the herbicide spraying missions. Air Force researchers
have issued numerous reports regarding their findings in this ongoing
project. NIOSH is maintaining a registry of individuals exposed to dioxins
and other chemicals in the workplace. NCI has studied the health effects
of herbicides on selected agricultural workers. EPA worked with VA on
the determination of dioxin in adipose tissue. The Armed Forces Institute
of Pathology collaborated with VA on soft tissue sarcoma research.
Obviously, a considerable amount of research has been undertaken by
Federal departments and agencies. According to the final report of the
Domestic Policy Council's Agent Orange Working Group issued in 1994,
"There are 38 ongoing projects and 189 completed projects."
The report indicates that "over $127 million has been spent on
the completed projects, an additional $86 million has been spent"
on the ongoing projects, and that "$70 million is estimated to
be necessary over the next ten years to complete the current ongoing
projects."
Several States also have undertaken research efforts to learn more about
the possible health effects of Agent Orange and the Vietnam experience
upon our Nation's veterans. Research being done by non-VA agencies and
organizations is more fully described in Agent Orange Brief, C3.
What is the National Academy of Sciences doing regarding this issue?
The National Academy of Sciences (NAS), a non-governmental organization,
is reviewing all relevant scientific literature and providing advice
to the Secretary of Veterans Affairs on a wide range of issues relative
to herbicides and dioxin. The NAS project is being undertaken in accordance
with Public Law 102-4, the Agent Orange Act of 1991, signed by President
Bush on February 6, 1991. The NAS reported its initial findings to VA
and Congress in July 1993. The first update report was released on March
14, 1996. Future reports are anticipated biennially. The NAS is also
considering the feasibility of developing a historical herbicide exposure
reconstruction model that could be used in Agent Orange-related research
efforts.
Where is additional information available?
There is at each VA medical center a "Registry Physician"
responsible for the conduct of Agent Orange Registry examinations. These
individuals participate in regularly scheduled nationwide conference
calls and receive mailouts from VA headquarters updating them on the
latest developments on Agent Orange. Each facility also has an "Agent
Orange Coordinator" to facilitate the Agent Orange program.
As indicated above, other Agent Orange Briefs provide additional information
on specific Agent Orange concerns and issues. The Agent Orange Briefs
are available at all VA medical centers.
The Environmental Agents Service (131), Department of Veterans Affairs,
810 Vermont Avenue, N.W., Washington, DC 20420, is another good source
of information on this subject. The telephone number is 202-273-8580.
The Environmental Agents Service used to be known as the Environmental
Medicine Office. (It was also previously named the Agent Orange Projects
Office.)
Veterans service organizations (such as The American Legion, Veterans
of Foreign Wars of the United States, Disabled American Veterans, Vietnam
Veterans of America, and VietNow) and State government entities (including
Agent Orange Commissions, Departments or Divisions of Veterans Affairs,
Departments of Health) have also provided helpful information to individuals
seeking information on this subject.
The initial NAS report,
an 832-page document, and the 1996 update, 384-pages, are available
for purchase from the National Academy Press, 2101 Constitution Avenue,
N.W., Lockbox 285, Washington, DC 20055. The telephone numbers are 1-800-624-6242
and 202-334-3313. Copies of both books were sent to all VA medical center
libraries.
Congressional committees, especially the House Committee on Veterans'
Affairs and the Senate Committee on Veterans' Affairs, have conducted
numerous hearings regarding the long-term health effects of exposure
to Agent Orange. A great deal of information has been gathered during
these hearings. Both committees are located in Washington, DC. The zip
code for the Senate Committee is 20510. The zip code for the House Committee
is 20515.
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DioxinKills!
Agent
Orange Brief
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