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
was a 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.
[top]
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-di-oxin (also known as TCDD or
dioxin), which has caused a variety of illnesses in laboratory
animals. More recent studies have suggested that the
chemicalmay be related to a number of malignancies and other
disorders.
[top]
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. Agent Orange
accounted for over 80 per-cent of the herbicides sprayed in
Vietnam. Agent Orange 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 per-cent 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.
[top]
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. Veterans who served in
Korea in 1960 or 1969 are also eligible for the examination. An appointment usually can be
arranged within two to three weeks.
[top]
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.
[top]
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 300,000 Vietnam veterans have participated in
this program. For more information about the VA Agent Orange
Registry, see Agent Orange Brief, B1.
[top]
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.
[top]
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.
[top]
What
conditions have been "service-connected" based on
evidence of an association with Agent Orange (or other
herbicides used in Vietnam)?
The number of diseases that VA has recognized as associated
with, but not necessarily caused by, Agent Orange exposure has
expanded considerably during the 1990’s. The following
conditions are now presumptively recognized for
service-connection for Vietnam veterans based on exposure to
Agent Orange or other herbicides: chloracne (a skin disorder),
porphyria cutanea tarda, acute or subacute peripheral neuropathy
(a nerve disorder), Type 2 diabetes and numerous cancers
[non-Hodgkin’s lymphoma, soft tissue sarcoma, Hodgkin’s
disease, multiple myeloma, prostate cancer, and respiratory
cancers (including cancers of the lung, larynx, trachea, and
bronchus)]. In addition, Vietnam veterans’ children with the
birth defect spina bifida are eligible for certain benefits and
services. In 1999, VA announced that statutory authority would
be sought for similar benefits and services for children with
birth defects who were born to women Vietnam veterans.
Legislation was enacted November 1, 2000. Implementing
regulations must be issued by December 1, 2001.
[top]
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, l987, 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.
[top]
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 1997 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.
[top]
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. The second update was released on February
11, 1999. A special report on the relationship between
herbicides used in Vietnam and Agent Orange was released on
October 11, 2000. 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.
[top]
What
is being done now to determine whether a large-scale study can
be completed with the latest technologies?
VA contracted with the NAS to develop a historical exposure
reconstruction model for Agent Orange. The NAS issued a call for
proposals to develop the exposure model. Dr. Stellman at
Columbia University was selected by NAS for this study. The NAS
will review the results and report to VA on the validity of the
exposure reconstruction model. Based on the NAS assessment of
this model, VA will determine whether it provides an adequate
scientific basis for large-scale epidemiologic studies of
Vietnam veterans.
In July 1997, in response to NAS recommendations, VA
announced a research initiative designed to determine whether it
is possible to conduct an epidemiologic study of the long-term
health effects of exposure to Agent Orange (and other herbicides
used in Vietnam) on Army Chemical Corps Vietnam veterans. The
feasibility study analyzed response rates, availability of
medical records to validate veterans-reported health history,
and other study requirements show that a large-scale study is
feasible.
The feasibility study demonstrated that Army Chemical Corps
Vietnam era veterans, a group of veterans with significant
exposure, could be located and were willing to participate in
this telephone health interview. The data also confirmed that
these men, often with assistance from their wives, were able to
provide considerable detail regarding reproductive history.
Serum concentrations of dioxins were found to be significantly
correlated with the self-reported history provided by the
veteran that he actually participated in herbicide spraying
during their Vietnam experience. The main study, which began in
February 1999, includes about 2,500 Vietnam and 2,500
non-Vietnam veterans who served in the Army Chemical Corps. The
main phase is expected to take 30 months to complete.
[top]
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 Registry 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 VA medical
centers nationwide. The following Agent Orange Briefs are now
available: A1.Agent Orange – General Information; A2.Agent
Orange Class Action Lawsuit; B1.Agent Orange Registry; B2.Agent
Orange – Health Care Eligibility; B3.Agent Orange and
VA Disability Compensation; B4.VA Information Resources
on Agent Orange and Related Matters; C1.Agent Orange –
The Problem Encountered in Research; C2.Agent Orange and
Vietnam Related Research – VA Efforts; C3.Agent Orange
and Vietnam Related Research – Non-VA Efforts;
D1.Agent Orange and Birth Defects; D2.Agent
Orange and Chloracne; D3.Agent Orange and Non-Hodgkin’s
Lymphoma; D4.Agent Orange and Soft Tissue Sarcomas; D5.Agent
Orange and Peripheral Neuropathy; D6.Agent Orange and
Hodgkin’s Disease; D7.Agent Orange and Porphyria
Cutanea Tarda; D8.Agent Orange and Multiple Myeloma; D9.Agent
Orange and Respiratory Cancers; D10.Agent Orange and
Prostate Cancer; D11.Agent Orange and Spina Bifida; and D12.Agent
Orange and Diabetes.
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 updates
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 these reports 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.
[top]
More information about Agent Orange is available on
Department of Veterans Affairs Web site at "Agent
Orange Health Effects and Vietnam Veterans"
|
