Veterans Affairs: Health Care and Benefits for Veterans Exposed to Agent Orange
Veterans Affairs: Health Care and Benefits for
Veterans Exposed to Agent Orange
Updated August 25, 2008
Sidath Viranga Panangala
Analyst in Veterans Policy
Domestic Social Policy Division
Douglas Reid Weimer
Legislative Attorney
American Law Division
Veterans Affairs: Health Care and Benefits for Veterans
Exposed to Agent Orange
Summary
Since the 1970s, Vietnam-era veterans have attributed certain medical illnesses,
disabilities, and birth defects to exposure to Agent Orange and other herbicides
sprayed by the U.S. Air Force to destroy enemy crops and remove forest cover.
During the last 30 years, Agent Orange legislation has established and updated the
health and disability benefits of Vietnam veterans exposed to herbicides.
The Veterans’ Health Care, Training and Small Business Loan Act (P.L. 97-72)
elevated Vietnam veterans’ priority status for health care at Department of Veterans
Affairs facilities by recognizing a veteran’s own report of exposure as sufficient
proof to receive medical care unless there was evidence to the contrary. The
Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262) completely
restructured VA medical care eligibility requirements for all veterans. Under P.L.
104-262, a veteran does not have to demonstrate a link between a certain health
condition and exposure to Agent Orange; instead, medical care is provided unless the
VA has determined that the condition did not result from exposure to Agent Orange
or the condition has been identified by the Institute of Medicine (IOM) as having
“limited/suggestive” evidence of no association between the occurrence of the
disease and exposure to a herbicide.
The Veterans’ Dioxin and Radiation Exposure Compensation Standards Act of
1984 (P.L. 98-542) required the VA to develop regulations for disability
compensation to Vietnam veterans exposed to Agent Orange. In 1991, the Agent
Orange Act (P.L. 102-4) established for the first time a presumption of service
connection for diseases associated with herbicide exposure. P.L. 102-4 authorized
the VA to contract with the IOM to conduct a scientific review of the evidence
linking certain medical conditions to herbicide exposure. Under this law, the VA is
required to review the reports of the IOM and issue regulations, establishing a
presumption of service connection for any disease for which there is scientific
evidence of a positive association with herbicide exposure.
Navy veterans of the Vietnam Era (those who served in Vietnam between
January 9, 1962, and May 7, 1975), who served offshore and were never physically
present on Vietnamese soil, have been contesting the presumption of service-
connection for Agent Orange disability benefits. In 2006, the U.S. Court of Appeals
for Veterans Claims (CAVC) ruled in Haas v. Nicholson that navy veterans who
served offshore during the Vietnam Era were entitled to a presumption of exposure
to Agent Orange. However, in May 2008, the U.S. Court of Appeals for the Federal
Circuit reversed the prior CAVC ruling. The Agent Orange Equity Act of 2008 (H.R.
6562), which has seen no legislative action, would clarify service in Vietnam to
include inland waterways, waters offshore, and, airspace above Vietnam.
This report will be updated as events warrant.
Contents
Background ..................................................1
Health Care..................................................1
Disability Compensation........................................2
The Agent Orange Registry......................................4
Non-Vietnam Veterans Exposed to Agent Orange....................4
Haas v. Peake (Previously Haas v. Nicholson) ......................5
Haas v. Nicholson.........................................5
Subsequent Actions........................................6
Haas v. Peake.............................................7
Subsequent Actions........................................7
Proposed Legislation to Clarify Service in Vietnam...............7
Epidemiologic Research on Vietnam Veterans.......................8
Centers for Disease Control and Prevention.....................8
Air Force Health Study (AFHS)..............................8
Veterans Affairs: Health Care and Benefits
for Veterans Exposed to Agent Orange
Background
Between 1962 and 1971, the U.S. Air Force sprayed approximately 107 million
pounds of herbicides in South Vietnam for the purpose of defoliation and crop
destruction. The herbicides sprayed during the Vietnam era contained mixtures of
picloram, and cacodylic acid. The most extensively used defoliant compound, a
because of the orange-colored band placed on each chemical storage container. One
of the chemicals used in Agent Orange, 2,4,5-T, contained small amounts of dioxin.
Other herbicides employed in Vietnam such as “Agent Purple”and “Agent Green”
also were contaminated with dioxin. Collectively, these compounds were referred
to as the “rainbow defoliants.” The late 1960s saw a decline in the use of these
herbicides when dioxin, already well known to be highly toxic in animals, was
implicated in birth defects seen in mice. By 1969, spraying was restricted to remote
areas, and by 1971, the Air Force ceased all spraying of Agent Orange.
Since the 1970s, Vietnam-era veterans have voiced concerns about how
exposure to Agent Orange may have affected their health and caused certain
disabilities, including birth defects in their children. Initially, the Department of
Defense (DOD) maintained that only a limited number of U.S. military personnel,
such as those operating aircraft or troops engaged in herbicide spraying, could be
positively linked to Agent Orange exposure. However, in 1979, the General
Accounting Office, now the Government Accountability Office (GAO), reported that
ground troops had also been exposed to Agent Orange, and DOD was forced to1
reconsider its prior statements. In response to these concerns, Congress passed
legislation to research the long-term health effects on Vietnam veterans, and to
provide benefits and services to those who may have been exposed to Agent Orange.
Health Care
Prior to the 1981 Veterans’ Health Care, Training and Small Business Loan Act
(P.L. 97-72), veterans who complained of Agent Orange-related illnesses were at the
lowest priority for treatment at Department of Veterans Affairs (VA) medical
1 U.S. General Accounting Office, Ground Troops in South Vietnam were in Areas Sprayed
with Herbicide Orange, GAO 80-23, November 1979, p. 1.
facilities because these conditions were not considered “service-connected.”2 P.L.
97-72 elevated Vietnam veterans’ priority status for health care at VA facilities by
recognizing a veteran’s own report of exposure as sufficient proof to receive medical
care unless there was evidence to the contrary. The Veterans’ Health Care Eligibility
Reform Act of 1996 (P.L. 104-262) completely restructured VA medical care
eligibility requirements for all veterans. Under P.L. 104-262, a veteran does not have
to demonstrate a link between a certain health condition and exposure to Agent
Orange; instead, medical care is provided unless the VA has determined that the
condition did not result from exposure to Agent Orange or the condition has been
identified by the Institute of Medicine (IOM) as having “limited/suggestive” evidence
of no association between the occurrence of the disease and exposure to a herbicide.3
The research by the IOM (part of the National Academies) and its significance is
addressed below.4
Disability Compensation
The Veterans’ Dioxin and Radiation Exposure Compensation Standards Act of
1984 (P.L. 98-542) required the VA to develop regulations for disability
compensation to Vietnam veterans who may have been exposed to Agent Orange.
Veterans seeking compensation for a condition they thought to be related to herbicide
exposure had to provide proof of a service-connection that established the link
between herbicide exposure and disease onset. P.L. 98-542 authorized disability
compensation payments to Vietnam veterans for the skin condition chloracne, which
is associated with herbicide exposure. In 1991, the Agent Orange Act (P.L. 102-4)
established for the first time a presumption of service connection for diseases
associated with herbicide exposure. Under the Agent Orange Act, veterans seeking
disability compensation for diseases they thought to be associated with herbicides no
longer were required to provide proof of exposure. P.L. 102-4 authorized the VA to
contract with the IOM to review and summarize the scientific evidence concerning
the association between exposure to herbicides used in support of military operations
in Vietnam during the Vietnam Era and each disease suspected to be associated with
such exposure. P.L. 102-4 mandated that IOM determine, to the extent possible (1)
whether there is a statistical association between the suspect diseases and herbicide
exposure, taking into account the strength of the scientific evidence and the
appropriateness of the methods used to detect the association; (2) the increased risk
of disease among individuals exposed to herbicides during service in Vietnam during
the Vietnam Era; and (3) whether there is a plausible biological mechanism or other
2 The term “service-connected” means, with respect to disability, that such disability was
incurred or aggravated in the line of duty in the active military, naval, or air service. VA
determines whether veterans have service-connected disabilities, and for those with such
disabilities, assigns ratings from 0% to 100% based on the severity of the disability.
Percentages are assigned in increments of 10%.
3 “Limited/suggestive” evidence of no association is when several adequate studies, covering
the full range of levels of exposure that human beings are known to encounter, are consistent
in not showing a positive association between any magnitude of exposure to herbicides and
the outcome of disease.
4 For detailed information on eligibility for VA health care, see CRS Report RL34598,
Veterans’ Medical Care: FY2009 Appropriations, by Sidath Viranga Panangala.
evidence of a causal relationship between herbicide exposure and the health
outcome.5 VA is then required to review the reports of the IOM and issue
regulations, establishing a presumption of service connection for any disease for
which there is scientific evidence of a positive association with herbicide exposure.
Once the VA has established presumption of service connection for a certain disease
or medical condition, a Vietnam veteran with that disease is eligible for disability
compensation. The amount of compensation is based on the degree of disability and,
again, veterans are compensated only for approved conditions that have demonstrated
sufficient evidence of an association with herbicide exposure.
Currently, the conditions that are presumptively recognized for service-
connection for Vietnam veterans are chloracne (must occur within one year of
exposure to Agent Orange); non-Hodgkin’s lymphoma; soft tissue sarcoma (other
than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma);
Hodgkin’s disease; porphyria cutanea tarda (must occur within one year of exposure);
multiple myeloma; respiratory cancers, including cancers of the lung, larynx, trachea,
and bronchus; prostate cancer; acute and subacute transient peripheral neuropathy
(must appear within one year of exposure and resolve within two years of date of
onset); type II diabetes; and chronic lymphocytic leukemia.6 In addition, Vietnam
veterans’ children with the birth defect spina bifida are eligible to receive a monthly
monetary allowance in addition to certain health care services. The Veterans
Benefits and Health Care Improvement Act of 2000 (P.L. 106-419) authorized
similar benefits and services for children with certain birth defects who were born to
female Vietnam veterans.7
The Agent Orange Act of 1991 (P.L. 102-4) also mandated the VA to publish
a notice when the VA determines that a presumption of service-connection is not
5 This comprehensive review by the IOM has been repeated at least every two years since
1994 and is authorized to continue until October 2014. Veterans and Agent Orange weighs
the strengths and limitations of the complete body of epidemiologic evidence on herbicide
exposure and manifestation of certain health outcomes. This review then assigns the
investigated medical conditions to one of four categories ranging from “sufficient evidence
of an association” to “limited or suggestive evidence of no association.” For example, in
the 2006 Veterans and Agent Orange update, this information is available in Table S-1. The
latest update was compiled in 2006 and released in July 2007, at [http://www.nap.edu/].
6 38.C.F.R. §3.309(e). In 2003, based on 2002 update of the IOM report Veterans and Agent
Orange, the VA issued regulation designating chronic lymphocytic leukemia (“CLL”) and
other medical conditions as diseases associated with dioxin. CLL was therefore to be
considered “service connected.” However, the VA did not re-adjudicate prior claims for
CLL, nor did it pay retroactive benefits, arguing that compensation was not applicable to
diseases determined to be service-connected after September 20, 2002, the original sunset
date of the Agent Orange Act of 1991. Following extensive litigation, the U.S. Court ofth
Appeals for the Ninth Circuit (Nehmer v. VA, 494 F.3d 846 (9 Cir. Cal. 2007)) affirmed the
district court decision (Nehmer v. VA, 32 F.Supp. 2d 1175 (N.D. Cal. 1999)) and, in effect,
confirmed that the VA was obligated to pay disability benefits to all “Agent Orange”
veterans with CLL, including those diagnosed after September 20, 2002.
7 38 C.F.R. §3.815. For detailed information on eligibility for disability compensation, see
CRS Report RL33113, Veterans Affairs: Basic Eligibility for Disability Benefit Programs,
by Douglas Reid Weimer.
warranted. On June 12, 2007, based on the 2004 IOM report on Agent Orange, the
VA issued a notice that a presumption of service-connection is not warranted based
on exposure to herbicides used in Vietnam during the Vietnam Era for the following
medical conditions: Hepatobiliary cancers; oral, nasal, and pharyngeal cancer; bone
and joint cancer; skin cancers (melanoma, basal, and squamous cell); breast cancer;
female reproductive cancer (cervix, uterus, and ovary); testicular cancer; urinary
bladder cancer; renal cancer; leukemia (other than chronic lymphocytic leukemia
[CLL]); abnormal sperm characteristics and infertility; spontaneous abortion;
neonatal or infant death and stillbirth in offspring of exposed individuals; low
birthweight in offspring of exposed individuals; neurobehavioral disorders (cognitive
and neuropsychiatric); movement disorders, including Parkinson’s disease and
amyotrophic lateral sclerosis (ALS); chronic peripheral nervous system disorders;
respiratory disorders; gastrointestinal, metabolic, and digestive disorders (changes in
liver enzymes, lipid abnormalities, ulcers); immune system disorders (immune
suppression, autoimmunity); circulatory disorders; amyloid light-chain (AL)
amyloidosis; endometriosis; effects on thyroid homeostasis; gastrointestinal tumors
(esophagus, stomach, pancreas, colon, rectum); brain tumors; and any other condition
for which the VA has not specifically determined a presumption of service-
connection.8
The Agent Orange Registry
The Agent Orange Registry was established in 1978 by the VA for Vietnam
veterans concerned about the health effects of exposure to Agent Orange. A veteran
choosing to register is eligible for an examination consisting of a medical history, a
physical examination, and a series of laboratory tests. Each veteran is also required
to answer a set of questions relevant to exposure. In September 2000, the Agent
Orange Registry was expanded to include veterans who served in Korea in 1968 and
1969. Since August 2001, the registry is accessible to all U.S. veterans potentially
exposed to dioxin or other toxic substances used in herbicides while engaged in
military activity. Participating in the registry does not give exposed military
personnel automatic access to health and disability compensation benefits. As of
September 2007, more than 490,000 veterans have participated in the registry.9
Non-Vietnam Veterans Exposed to Agent Orange
Under current law, only Vietnam veterans who served in-country are eligible to10
receive health care benefits and compensation for service “in Vietnam.” However,
under certain circumstances, veterans are eligible for health care and compensation
benefits for service outside of Vietnam. A non-Vietnam veteran who claims that an
8 U.S. Department of Veterans Affairs, “Health Outcomes Not Associated With Exposure
to Certain Herbicide Agents.” Federal Register, vol. 72, no.112 (June 12, 2007), pp
9 There were a total of 439,849 initial examinations, and 50,487 follow-up examinations.
10 Service in the Republic of Vietnam includes service in the waters offshore and services
in other locations if conditions of service involved duty or visitation in the Republic of
Vietnam. 38 C.F.R. §3.313(a); 38 C.F.R. 3.307(a)(6)(iii).
injury or illness resulted from exposure to Agent Orange while serving in the military
can apply for service-connected benefits. But unlike Vietnam veterans, they are
required to prove they were exposed to Agent Orange. VA requires the following
information in the veteran’s benefit application: a medical diagnosis of a disease or
condition the VA recognizes as associated with Agent Orange; evidence of exposure
to a chemical contained in the herbicides used in Vietnam; and medical evidence that
the disease began or manifested within the designated time frame, if any, for that
disease.11 Those veterans who served in areas such as the Korean Demilitarized Zone
(DMZ) may be eligible to apply for disability benefits. The DOD has also published
a list of areas outside of Vietnam where Agent Orange was used.12
In 2003, Congress passed the Veterans Benefits Act of 2003 (P.L. 108-183).13
Among other things, the Act expanded health care and other benefits to natural
children of Korea service veterans born with spina bifida.14 To be eligible for
benefits, the veteran must have served in the active military, naval, or air service in
or near the Korean Demilitarized Zone (DMZ) between September 1, 1967, and
August 31, 1971, and must have been exposed to certain herbicides during such
service.15 Furthermore, under P.L. 108-183, the determination of service in the
Korean DMZ is to performed by the VA in consultation with DOD.
Haas v. Peake 16 (Previously Haas v. Nicholson)17
Haas v. Nicholson. On August 16, 2006, the U.S. Court of Appeals for
Veterans Claims (CAVC) determined that the veterans who had served in the waters
off Vietnam (this class of veterans is generally known as “blue water” veterans) were
11 If a veteran did not serve in the Republic of Vietnam, but was exposed to an herbicide
agent defined in 38 CFR 3.307(a)(6) during active military service, has a disease on the list
of diseases subject to presumptive service-connection, VA will presume that the disease is
due to the exposure to herbicides. Additional information on benefits and compensation for
veterans exposed to Agent Orange is available at the U.S. Department of Veterans Affairs,
“VA’s Guide on Agent Orange Claims, Compensation and Pension Service,” updated April
12 [http://www1.va.gov/agentorange/docs/Report_on_DoD_Herbicides_Outside_of_
Vietnam.pdf].
13 P.L. 108-183, among other the bills, contained provisions from H.R. 2297 (H.Rept.
14 This applies to all forms and manifestations of spina bifida, except spina bifida occulta.
15 38 U.S.C. §1821.
16 525 F.3d 1168 (Fed. Cir. 2008).
17 20 Vet. App. 257 (2006). Jonathan L. Haas was a member of the U.S. Navy Reserve
components that served in the waters off Vietnam and received the Vietnam Service Medal
(VSM). He claimed that his diabetes mellitus and resulting medical complications were
related to his exposure to Agent Orange that drifted offshore, and filed a disability claim
with the VA. VA denied the claim on the grounds that servicemembers had to have actually
set foot on Vietnamese soil in order to be eligible for benefits.
entitled to a presumption of exposure to Agent Orange.18 Prior to this CAVC
decision,19 VA’s interpretation of 38 CFR 3.307(a)(6)(iii) was that a service member
had to have actually set foot on Vietnamese soil or served on a craft in its rivers (also
known as “brown water” veterans) in order to be entitled to the presumption of
exposure to Agent Orange. The CAVC specifically held the following: (1) the
reference to service “in Vietnam” as used in the statute was ambiguous because there
are many definitions of the territory of a nation, and (2) VA’s regulation defining
Vietnam service for purposes of granting the presumption of exposure to herbicides,
which also defines service in Vietnam. Because CAVC determined that ambiguity
was present, it also examined VA’s Adjudication Procedure Manual M21-1 (the
M21-1 manual)20 provision from 1991, which stated that the receipt of a Vietnam
Service Medal (VSM) would be considered proof of Vietnam service in the absence
of “contradictory evidence.” In 2002, VA issued a new M21-1 provision advising
VA benefit adjudicators that the receipt of the VSM could indicate service on land
in Vietnam but, by itself, was not proof of service in Vietnam because a veteran may
have received this medal for service in locations other than Vietnam.21 The CAVC
determined the M21-1 provision to be a substantive rule establishing entitlement to
the presumption of exposure to herbicides, and held that VA’s “attempted
rescissions” of that M21-1 provision were void because they failed to comply with
the notice and comment requirements of the Administrative Procedures Act (APA).22
Subsequent Actions. On September 21, 2006, Secretary Nicholson issued
a memorandum directing the Board of Veterans Appeals (BVA) to withhold
adjudicating all service-connected claims based on exposure to herbicides in which
the only evidence of exposure is the receipt of the Vietnam Service Medal or service
on a vessel off the shore of Vietnam. On December 11, 2006, VA issued a
memorandum to its regional offices, instructing them that claims related to Haas v.
Nicholson decision should not be adjudicated until the litigation is resolved. As a
result, at this time, BVA has suspended action on Haas v. Nicholson claims.23
VA appealed the CAVC decision to the U.S. Court of Appeals for the Federal
Circuit in Washington, D.C. Oral argument was held on November 7, 2007.
18 For further information on the CAVC, see CRS Report RS22561, Veterans Affairs: The
U.S. Court of Appeals for Veterans Claims — Judicial Review of VA Decision Making, by
Douglas Reid Weimer.
19 U.S. Court of Appeals for Veterans Claims (CAVC), 20 Vet. App. 257 (2006).
20 The M21-1 is an internal manual used to provide guidance to VA benefit adjudicators on
procedures for adjudicating claims for compensation, pension, dependency and indemnity
compensation, accrued benefits, and burial allowance.
21 The VSM was awarded to all members of the Armed Forces who served between July 3,
1965, and March 28, 1973, either (1) in Vietnam and contiguous waters and airspace
thereover, or (2) in Thailand, Laos, or Cambodia, or airspace thereover, in direct support of
operations in Vietnam.
22 5 U.S.C. §706(2)(A).
23 For further details on the BVA, see CRS Report RL33704, Veterans Affairs: The Appeal
Process for Veterans’ Claims, by Douglas Reid Weimer.
On November 27, 2007, VA published a Federal Register notice proposing to
rescind provisions of its Adjudication Procedures Manual, M21-1 (M21-1), that were
found by the CAVC not to have been properly rescinded under the APA.24 This
action was taken by the VA as a preemptive measure in the event the Department did
not prevail on appeal in Haas v. Nicholson.
Haas v. Peake. Haas v. Peake is the case name on appeal of the previously
discussed Haas v. Nicholson. On May 8, 2008, the U.S. Court of Appeals for the
Federal Circuit (the “court”) issued a decision reversing the prior CAVC ruling. The
court concluded that the VA’s interpretation of “service in Vietnam” as requiring the
servicemember’s presence at some point on the landmass or the inland waters of
Vietnam was based on a permissible construction of the statute.25 The court also
stated in its opinion that “Mr. Haas is free to pursue his claim that he was actually
exposed to herbicides while on board his ship as it traveled near the Vietnamese
coast.” However, according to the court’s opinion, he is not entitled to the benefit
of a presumption related to Agent Orange exposure.
Subsequent Actions. On June 23, 2008, the attorneys for Haas filed a
petition with the U.S. Court of Appeals for the Federal Circuit (the “court”) for a
Panel Rehearing or a Rehearing En Banc (that is, the whole panel of judges of the
court).26 The court may grant or deny the petition. If granted, the court may have a
rehearing of the case. If denied, the court will not rehear the case.
Following a final decision of the court,27 either the veteran or the VA may
petition the U.S. Supreme Court for certiorari within 90 days of the court’s final
action.28 In the present case, there does not appear to be an immediate judicial
resolution of the issues, and a decision of the court may be appealed to the U.S.
Supreme Court. However, it is possible that congressional legislative activity, in the
meantime, may render moot the judicial issues; that is, congressional legislative
actions may resolve the legal issues in controversy.
Proposed Legislation to Clarify Service in Vietnam. Representative
Filner, the Chairman of the House Veterans’ Affairs Committee, has introduced the29
Agent Orange Equity Act of 2008 (H.R. 6562). This legislation, if enacted, would
24 Department of Veterans Affairs, “Rescission of Manual M21-1 Provisions Related To
Exposure to Herbicides Based on Receipt of the Vietnam Service Medal,” Federal Register,
vol. 72, no 227 (November 27, 2007), pp. 66218-66219.
25 Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008).
26 No. 2007-7037.
27 In this case, the final decision may be a decision based upon the merits of the case
following the grant of a motion for rehearing or the denial of the petition for rehearing.
28 38 U.S.C. § 7292(c)). A petition for certiorari is a request for the Supreme Court to
review the decision of the lower court. If the petition is granted, the Supreme Court will
review the case.
29 The bill was introduced on July 22, 2008, and was referred to the House Committee on
Veterans’ Affairs on that date.
clarify service in Vietnam to include inland waterways, waters offshore, and airspace
above Vietnam.
In addition, Senator Akaka, the Chairman of the Senate Veterans’ Affairs
Committee, introduced the Agent Orange Compensation Act (S. 2026) for
consideration at the request of the Administration.30 If enacted, this legislation would
clarify that the presumption of herbicide exposure applies only to veterans who
served in Vietnam on land or on Vietnam’s inland waterways and not to those who
served only in waters offshore or in airspace above.
Epidemiologic Research on Vietnam Veterans
Because of the controversy surrounding the use of herbicides in Vietnam,
significant research on the health effects of Agent Orange and dioxin exposure has
occurred over the last 30 years. The majority of studies have focused on morbidity
and mortality of Vietnam veterans and are conducted by the VA, the Centers for
Disease Control and Prevention (CDC), the U.S. Air Force, and the various veteran
service organizations (VSOs). Despite the abundance of research completed,
epidemiologic studies on Agent Orange are historically burdened by the lack of
reliable exposure data. The lack of accurate data remains a continued source of
frustration for researchers, government officials, and Vietnam-era veterans seeking
conclusive information on the health risks of exposure to Agent Orange. Below is
a brief description of epidemiologic research conducted by the various agencies.
Centers for Disease Control and Prevention. In 1979, the VA was
authorized to conduct an epidemiologic study to determine the association between
Agent Orange and the medical concerns of Vietnam-era veterans. In carrying out the
congressional mandate, the VA was faced with substantial challenges in determining
study design and research protocol, and in 1982, responsibility for the research was
transferred from the VA to the CDC. The CDC also faced its own obstacles in
research design and were delayed by the lack of exposure data. In response to the
difficulty in obtaining exposure data, the CDC attempted an Agent Orange Validation
Study to see if indirect estimates of exposure from military records and self-reports
could be compared to dioxin serum levels in veterans as a method of determining true
exposure. After investigation, the CDC reported that military records and self-reports
obtained from the Agent Orange Validation Study were inadequate for identifying the
exposed individuals necessary for a large epidemiologic study of dioxin effects.
Secondary to the problems faced by the VA and the CDC, a group of government
panels and advisory boards determined that the congressionally mandated Agent31
Orange Study was improbable, and the CDC investigation ended.
Air Force Health Study (AFHS). Operation Ranch Hand was responsible
for spraying herbicides in Vietnam between 1962 and 1971. In 1982, Air Force
30 The bill was introduced on September 6, 2007, and was referred to the Committee on
Veterans’ affairs on that date.
31 The government panel and advisory groups included the CDC advisory group, the Science
Panel of the Domestic Policy Council’s Agent Orange Working Group, and the Agent
Orange Advisory Panel of the Congressional Office of Technology Assessment.
investigators began a study investigating the long-term health problems of pilots and
ground crews engaged in spraying herbicides in Vietnam. The study cohort consisted
of more than 1,200 Ranch Hand veterans and more than 19,000 comparison Air
Force veterans who did not spray herbicides. AFHS data collected between 1979 and
1993 revealed no statistically significant differences between the Ranch Hand
personnel and the comparison cohort both for all-cause mortality and for cause-
specific mortality. The exception was an increased mortality rate for circulatory
diseases seen in enlisted ground crew personnel, a group at higher risk for skin
exposure to herbicides. In 2005, an AFHS update reviewing 20 years of
epidemiologic data on mortality rates reported a small, but significant, increase in all-
cause death rates for Ranch Hand veterans. This was the first published research to
find a statistically significant increase in the relative risk for all-cause mortality
among Ranch Hand veterans.32 After 20 years of analysis, data collection, and
review, a recent IOM publication indicated that diabetes presented as the most
serious health problem observed in the AFHS. Type II diabetes was added to the list
of service-connected diseases for Vietnam veterans exposed to Agent Orange in
Section 714 of the John Warner National Defense Authorization Act, 2007 (P.L.
109-364), requires the Secretary of the Air Force to transfer custody of the AFHS
data to the IOM. This decision to retain the AFHS materials was based on the
scientific merit of maintaining herbicide exposure records as a valuable source of
medical and epidemiologic data as recommended by the IOM study.34 Furthermore,
P.L. 109-364 required the Secretary of Defense to make $850,000 available to the Air
Force in preparation for the transfer of study data to the IOM. An additional
$200,000 was to be reimbursed from the DOD to the IOM for costs related to the
transfer of study materials from the Air Force.35 Under this provision, the Air Force
is required to submit a report on the transfer to the Armed Services Committees of
Congress.
32 Norma Ketchum and Joel Michalek, “Postservice Mortality of Air Force Veterans
Occupationally Exposed to Herbicides During the Vietnam War: 20-year follow-up results,”
Military Medicine, vol. 170, no. 5 (May 2005), pp. 406-413.
33 National Academies, Institute of Medicine, Disposition of the Air Force Health Study,
34 Ibid., p. 4.
35 U.S. Congress, Conference Committees, National Defense Authorization Act for Fiscal
Year 2007, a report to accompany H.R. 5122, 109th Congress, 2nd sess., H.Rept. 109-702.
Congressional Record, daily edition, vol. 152 (September 29, 2006), pp. H8061-H8536.