Waiting for an Army to Die (29 page)

A. Every veteran who alleges defoliant exposure must receive prompt, courteous, compassionate consideration.

B. If the veteran has no objective symptoms or signs, simple reassurance should be offered. The veteran should be told that a record of the medical examination will be kept for future reference, but that if the veteran does not now have symptoms and did not previously experience any, the likelihood of herbicide poisoning is virtually zero.

C. If the veteran presents with symptoms and signs which are not clearly explicable in terms of definable disease, a detailed history should be recorded on the VA form 10-10m, including such details the veteran may remember concerning his exposure to defoliant agents. This information can be checked against military data, if indicated.

D. In view of the remaining uncertainties on the long-term effects of the defoliants, all VA personnel should avoid premature commitment to
any diagnosis of defoliant poisoning. Similarly, entries in medical records should not contain statements about the relationship between a veteran’s illnesses and defoliant exposure unless unequivocal confirmation of such a connection has been established. Accordingly, veterans in whom defoliant poisoning is suspected should be admitted to a VA hospital for appropriate work-up.

E. If there is evidence suggestive of defoliant agent poisoning, pertinent data must be forwarded to the ADCMD for operations (II), VACO.

F. No veterans other than those referred by DVE should be called in for the express purposes of having them examined for possible defoliant poisoning.

G. All VA forms 10-10m indicating that the veteran or the physician has material concern about the possibility of defoliant poisoning, should be preserved until further notification.

H. A 3×5 locator card should be developed by MAS so that VA forms 10-10m can be swiftly retrieved if the need develops. MAS staff have received instructions on how to develop these cards. Significant administrative problems may be reported to VACO MAS (136D).

I. If a patient who already is hospitalized intimates that he or she may have been exposed to defoliants, a statement to this effect should be entered in the medical record. If there are symptoms or signs which cannot be explained in terms of well-known medical entities, these should be appropriately investigated.

J. Many agricultural and horticultural agents contain the same herbicidal chemicals as were incorporated in the Vietnam defoliants. Whenever there is suspicion of chemical poisoning, therefore, inquiry should be directed to other sources of intoxication as well as the allegations concerning the Vietnam episodes. There also are many industrial sources of chemical intoxication whose manifestations are similar to the syndromes ascribed to the defoliants. A careful occupational history therefore is necessary.

K. Staff of field HFC’s who may be called upon to make public statements concerning the defoliants should not do so before reviewing their proposed expositions with the ADCMD for professional services, whose staff will provide the needed technical guidance.

8. We trust that the foregoing guidance will be sufficient. If new information indicated a change of policy, additional directives will be issued. Should any problem arise which is not covered by this policy statement additional clarification may be sought by calling VACO Medical Service
(Dr. Gerrit Schepers, ext. 389-2550). Any freedom of information request should be coordinated with VACO.

Symptoms in Vietnam Veterans Exposed to Agent Orange

To the Editor.—Agent Orange is an herbicide containing equal parts of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid. It was used extensively in Vietnam as a defoliant. A toxic contaminant is dioxin, 2,3,7,8-tetrachlorodibenzo-
p
-dioxin.

A ten-month study of 78 Vietnam veterans who claimed exposure to Agent Orange yielded many findings: 85% of the men experienced a rash that was resistant to treatment. Using immunofluorenscence in one patient, a skin biopsy specimen showed intraepithelial and intercellular IgA, IgG, and IgM. In 53% of the patients, the rash was aggravated by sunlight.

Joint pain occurred in 71%, stiffness in 59%, and swelling in 45%. Hypersomnolence occurred in 44% of the men and extreme fatigue in 80%. Sinus bradycardia and premature ventricular contractions were not infrequent.

Persistent neurological complains were tingling (55%), numbness (60%), dizziness (69%), headaches (35%), and autonomic dyscontrol (18%). Severe psychiatric manifestations were depression (73%), suicidal attempts (8%), and violent rages (45%). An inability to concentrate occurred in 17% and bouts of sudden lapses of memory were seen in 21%. Patients have described fearful episodes of suddenly not knowing where they were going; it was as if their thoughts had left them. There was also a loss of libido in 47%. Three patients died of cancer. Another 10% have been treated for cancer.

The Vietnam veterans demonstrated a large number of gastrointestinal ulcerations. Complaints related to the gastrointestinal tract included anorexia (41%), nausea (59%), vomiting (13%), hematemesis (8%), diarrhea (51%), constipation (31%), and abdominal pain (24%). Hepatitis was reported in 10% and jaundice in 5%.

Nineteen percent of our group had children with gross birth defects. One or more miscarriages were experienced in 13% of the wives. There were reports of sterility; semen analysis showed low sperm counts and abnormal forms.

The two most frequent genitourinary findings were brown urine (23%) and hematuria (9%). A kidney biopsy specimen in one patient was pathological, with an unknown etiology. Other as yet unexplained symptoms were blurred vision (54%), dyspnea (8%), gynecomastia (4%), and galactorrhea (5%).

This group of veterans has in general been chronically ill. Patients complained of frequent infections and allergies. The mean age of the group was 31.7 years. Both upper and lower socioeconomic levels were represented.

The aforementioned information is intended to create an awareness of a substance known as dioxin. This chemical may cause a variety of symptoms, and physicians should be aware of its potential.

RESOLUTION: No. 410 (Iowa)

COMMITTEE: Veterans Affairs and Rehabilitation

SUBJECT: The American Legion Policy on Agent Orange

WHEREAS, the chemical herbicide commonly known as Agent Orange was sprayed throughout Vietnam during the years 1962–1971 to defoliate jungle and rice paddies; and

WHEREAS, the total long-range toxic effects of the defoliant, of which in excess of 10.6 million gallons were reportedly expended by American military forces, remain virtually unknown; and

WHEREAS, the chemical mixture of 2,4-D and 2,4,5-T, which contains a certain amount of the chemical dioxin, has been subjected to partial bans by the Environmental Protection Agency following reports of spontaneous abortions and stillbirths in areas where heavily used in the United States; and

WHEREAS, a significant number of service personnel serving in Vietnam were exposed to these toxic chemicals and have subsequently developed cancer, neurological disorders, liver dysfunction. Severe depression, and other life-threatening diseases; and

WHEREAS, these veterans are now seeking benefits from the VA, to which they believe they are justly entitled, by reason of disease and disability incurred through exposure to Agent Orange; and

WHEREAS, the American Legion is seriously concerned about the effect of Agent Orange on those veterans who served in Vietnam during the time it was used as a defoliant; and

WHEREAS, the American Legion is strongly supportive of the studies and research being conducted by the Air Force, the Center for Disease Control, the Armed Forces Institute of Pathology, the Veterans Administration, etc., on Agent Orange, and has urged the administrator
of veterans affairs, the VA Advisory Committee on Health-Related Effects of Herbicides, and the VA Central Office Ad Hoc Committee on the Toxic Effects of Herbicides to proceed without delay using all resources available, to ascertain with scientific validity the effects of Agent Orange on veterans who were exposed to it during their active military service; and

WHEREAS, section 307 of the Veterans Health Programs Extension and Improvement Act of 1979 (Public Law 96-151) mandated the Veterans Administration to undertake a scientific study of the effect of dioxin exposure on veterans; and

WHEREAS, the Veterans Administration negotiated a contract with the UCLA School of Public Health on May 1, 1981, for the design of the protocol of the Agent Orange study mandated by Public Law 96-151; and

WHEREAS, the protocol has been designed, has undergone peer review and was revised as a result thereof, and preliminary steps are being taken to proceed with a pilot study; and

WHEREAS, the American Legion feels strongly that the study itself should be conducted by an independent scientific entity rather than by the Veterans Administration as the results would be more readily acceptable by the Vietnam veterans who were exposed, their families, and the scientific community; and

WHEREAS, the American Legion is aggressively assisting and counseling veterans in the filing and development of claims for benefits provided under title 38, United States Code, and referring those individuals claiming exposure to the persons responsible for the Agent Orange examination program at the nearest VA medical center or outpatient clinic for an appropriate examination; and

WHEREAS, because of the fact that very few claims for service connection have been granted, the American Legion has continually called upon the administrator of veterans affairs and the Department of Veterans Benefits to take a more objective approach in the adjudication of claims for benefits for disease and disabilities resulting from exposure to Agent Orange, until such time that conclusive scientific evidence is available, and to resolve all reasonable doubt in favor of veterans, their dependents and survivors, in claims for benefits based on exposure to Agent Orange, but such urging has been to little or no avail; and

WHEREAS, a significant number of Vietnam veterans have expressed displeasure with the manner in which they were attended to during their Agent Orange examination at a VA medical facility; now therefore, be it

RESOLVED, by the American Legion in National Convention assembled in Chicago, Illinois, August 24, 25, 26, 1982, that the American Legion sponsor and support legislation in the Congress of the United States to amend section 307 of Public Law 96-151 by assigning the responsibility of conducting the epidemiological study of Vietnam veterans who were exposed to any of the class of chemicals known as “the dioxins” produced during the manufacture of the various phenoxy herbicides, including Agent Orange, to an independent scientific agency; and, be it further

RESOLVED, that the American Legion support legislation to amend title 38, United States Code, to establish a mechanism for presumption of service connection for certain disabilities traced to Agent Orange exposure once such presumption is justified by conclusive scientific evidence; and, be it further

RESOLVED, that the American Legion disseminate the most current responsible information on Agent Orange to Legionnaires, Vietnam veterans and their families, and the public through all resources available to transmit such information; and, be it finally

RESOLVED, that the American Legion continue to make careful observation of the Veterans Administration’s Agent Orange examination program to determine whether or not Vietnam veterans reporting to VA medical care facilities claiming exposure are being appropriately examined, and that the examining physicians demonstrate both compassion and thoroughness in the way they receive, examine and treat all Vietnam veterans who present themselves alleging dioxin exposure.

APPROVED

Brown, Michael.
Laying Waste: The Poisoning of America by Toxic Chemicals
. New York: Pantheon, 1980.

Carson, Rachel.
Silent Spring
. New York: Fawcett, 1962.

Dux, John, and P.J. Young.
Agent Orange: The Bitter Harvest
. Sydney: Hodder and Stoughton, 1980.

Ensign, Tod, and Michael Uhl.
GI Guinea Pigs: How the Pentagon Exposed Our Troops to Dangers More Deadly Than War
. New York: Playboy Press, 1980.

Fuller, John G.
The Poison That Fell from the Sky
. New York: Random House, 1977.

Hersh, Seymour M.
Chemical and Biological Warfare: America’s Hidden Arsenal
. Indianapolis: Bobbs-Merrill, 1968.

Linedecker, Clifford.
Kerry: Agent Orange and an American Family
. New York: St. Martin’s Press, 1982.

Pfeiffer, E. W., Arthur H. Westing et al.
Harvest of Death: Chemical Warfare in Vietnam and Cambodia
. New York: Free Press, 1971.

Whiteside, Thomas.
The Pendulum and the Toxic Cloud: The Course of Dioxin Contamination
. New Haven and London: Yale University Press, 1979.

___. The Withering Rain: America’s Herbicidal Folly
. New York: Dutton, 1971.

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