For a long time now, the VA has suspected that Agent Orange, along with all the other health catastrophes trailing in its wake, is a root of respiratory disorders for many veterans who were exposed to Agent Orange. The Institute of Medicine (IOM) has been hedging around this possibility since 1994. Due to the apparent lack of definitive research on this topic, non-malignant respiratory disorders have yet to be included in the list of presumptive conditions caused by exposure to Agent Orange.
In 1994, based upon the IOM’s findings, the VA officially recognized respiratory cancers (including laryngeal cancer, and cancer of the lung, bronchus and trachea) as a presumptive condition caused by exposure to Agent Orange. The IOM ruled that “positive associations were found consistently only in those studies in which TCDD or herbicide exposures were probably high and prolonged, especially the largest, most heavily exposed cohorts of chemical production workers exposed to TCDD.” And while studies on Vietnam veterans remained inconclusive, the IOM felt that there was enough cumulative data to find a limited/suggested association between lung cancers and Agent Orange.
However, in this same report of 1994, the IOM determined that there were too many discrepancies among studies on non-malignant (non-cancerous) respiratory disorders for it to make a definitive—or even a limited/suggestive—ruling on an association between respiratory disorders and exposure to Agent Orange.
PROBLEMS WITH THE INSTITUTE OF MEDICINE RESEARCH
The IOM depends upon medical research in order to make a proper determination on whether or not a condition is related to Agent Orange. What it boils down to is this: most of these medical studies base their conclusions on mortality rates, not occurrence rates. They study how many people died of “x” condition who were exposed to “y” for a certain duration. There are several problems with this:
- It is not uncommon for cause of death to be inaccurate (especially if the deceased individual had multiple health conditions);
- Respiratory conditions (for purposes of this topic) are not always a cause of death;
- These studies tended to target Vietnam populations who were too young (at the time of the studies) to provide an accurate idea of how many veterans would pass away due to respiratory conditions. Studies conducted within the last 5 years to the present may provide more accurate results.
So, instead of basing their research on how many veterans have acquired a respiratory disorder, they look at how many veterans have died from a respiratory disorder. As mentioned above, there could be multiple factors in cause of death (such as heart failure or a cancerous condition), so the likelihood of the cause of death being a respiratory condition is small. But just because a veteran did not die of a respiratory condition does not mean that he did not suffer from it throughout his life or that it did not significantly impact his quality of life.
Another big reason that the IOM has been so reluctant to link respiratory mortalities to exposure to Agent Orange is all the other factors that can cause a respiratory disorder, such as smoking, post-service exposures, etc. As the IOM states in its 2012 Update to the “Veterans and Agent Orange” publication:
The most important risk factor for many noncancerous respiratory disorders is inhalation of cigarette smoke. […] Cigarette-smoking also makes almost every respiratory disorder more severe and symptomatic than it would otherwise be. The frequency of habitual cigarette-smoking varies with occupation, socioeconomic status, and generation. For those reasons, cigarette-smoking can be a major confounding factor in interpreting the literature on risk factors for respiratory disease. Vietnam veterans are reported to smoke more heavily than do non-Vietnam veterans.
You see the problem. While cigarette smoking is a valid risk factor, however, there have been numerous cases in which non-smokers still suffer from respiratory problems that can only have a logical origin in exposure to Agent Orange. In particular, the IOM cited studies conducted in 2006 and 2010 which gave affirmative evidence of respiratory problems due to Agent Orange exposure.
FIRST VA STUDY – 2006
In 2006, Han Kang and Nancy Dalager, both from the Department of Veterans Affairs, along with five other researchers, published a study, Health Study of Army Chemical Corps Vietnam, Veterans Who Sprayed Defoliant in Vietnam. This article followed a 1997 study by the same authors in following the Vietnam veterans who served in the Army Chemical Corps. The purpose of this 2006 health survey study was to determine the long-term health consequences of Agent Orange exposure among Army Vietnam veterans who were occupationally exposed to herbicides.
According to this study, Vietnam veterans who had sprayed Agent Orange showed a significantly increased risk for diabetes, heart conditions, chronic respiratory conditions, hypertension requiring medication, and self-reported poor health status, than those who did not spray Agent Orange. And while there was no statistically significant impact of Vietnam service in general on these conditions, chronic respiratory disease was a condition found to be significantly associated with a history of spraying herbicides. The authors note that these associations are consistent with date from the Air Force Ranch Hand Study of 1997.
The study concluded with an assertion that, compared with other veterans with no history of exposure to herbicides, “US Army veterans who were occupationally exposed to phenoxyherbicides in Vietnam experienced significantly higher risks of diabetes, heart disease, hypertension, and non-malignant lung diseases.”
SECOND VA STUDY – 2010
In a 2010 follow-up to the article outlined above, Han Kang and Yasim Cypel (both from the Department of Veterans Affairs) published a study, Mortality Patterns of Army Chemical Corps Veterans Who were Occupationally Exposed to Herbicides in Vietnam. They studied Vietnam veterans who had been a part of the Army Chemical Corps (ACC), whose job had been handling and spraying herbicides around the perimeters of military base camps in Vietnam. Admittedly, this study observed a class of veterans with a very specific MOS and set of duties; however, the IOM stated that “the ACC veterans represent our best opportunity to understand the health effects of exposure to TCDD and herbicides used in Vietnam and recommended further follow-up of these veterans”. The purpose of the study was to determine the long-term mortality rates of ACC Vietnam veterans.
This study found that ACC Vietnam veterans who had reported spraying herbicides in Vietnam were found to have “significantly increased serum TCDD (a contaminant of Agent Orange) concentrations and a significantly increased risk for diabetes, heart disease, hypertension, and nonmalignant respiratory disease associated with the exposure.” The study also noted patterns of elevated risk for digestive and respiratory diseases, when compared to those of U.S. men.
While the study in question was one on mortality rates, the researchers referred to a previous health study conducted in 1999/2000 among ACC Vietnam-era veterans—a study which supports their current findings (as of 2010). Among the 2927 veterans who participated in this 1999/2000 health study, “there was a statistically significant association between a history of spraying herbicide in Vietnam and physician-diagnosed diabetes, heart disease, hypertension, and chronic respiratory diseases while controlling for Vietnam-service status, race, BMI, military rank, cigarette smoking, and age at time of interview.”
Moreover, the current study showed that respiratory cancer and nonmalignant respiratory disease mortality were significantly greater in the Vietnam study group compared with U.S. men. This indicates that “service in Vietnam, or some aspect of this such as herbicide spray activity, [was] a possible factor.” And while researchers included the usual caveats of smoking as a significant cause of respiratory disorders, they noted that a sub-analysis of about one-half of the original ACC Vietnam veteran study group showed a greater risk of death caused by respiratory cancer and non-malignant respiratory diseases, even after adjusting for smoking. Even though this finding is not statistically significant (due to the low number of participants in that group), the researchers were of the opinion that “a similar pattern of elevated risk of respiratory diseases among Vietnam veterans with greater opportunity for herbicide exposure after controlling for smoking history lends support to the findings from the entire cohort of ACC Vietnam veterans.”
WHAT DO THESE STUDIES MEAN FOR YOU?
This 2010 study was meant to record findings of deaths caused by respiratory disorders in Army Chemical Corps Vietnam veterans who had been exposed to Agent Orange, and how these veterans were more likely to have a higher risk of death due to these conditions than men who had not been to Vietnam or had contact with Agent Orange. This study was focused on mortality rates; however, in a broader sense, this study showed that veterans who were exposed to Agent Orange had an increased risk of manifesting both cancerous and non-cancerous respiratory disorders. And while this study was applicable only to Army Chemical Corps Vietnam veterans (and not Vietnam veterans as a whole), it can be argued that this study still demonstrates the respiratory effects of exposure to Agent Orange, in whatever form or fashion the exposure may have taken place.
The Institute of Medicine continues its discussion on respiratory conditions. In its 2012 Update, the IOM baldly points out that “causes of death from respiratory diseases, especially chronic diseases, are often misclassified on death certificates.” It goes on to explain that the diagnoses of the primary cause of death from respiratory and cardiovascular diseases are often inconsistent. In cases in which the person had both conditions simultaneously, it is poses a difficulty for the coroner to determine which was the predominant cause of death (if both contributed to the death), or which condition caused or aggravated the other (for example, COPD leading to congestive heart failure and then to respiratory failure). This causes a huge issues in mortality studies—the very studies upon which the IOM bases its determinations.
In its 2012 update, the IOM stated that “results of the studies of mortality from noncancerous respiratory diseases reported in Update 2008 and earlier VAO reports […] did not support the hypothesis that exposures to herbicides or TCDD are associated with the general category of noncancerous respiratory diseases.
WHAT DOES THIS MEAN IN THE WORLD OF VA CLAIMS FOR BENEFITS?
While the IOM needs more proof than all the research it has amassed can produce thus far, there is still plenty of research out there which supports the possibility that exposure to Agent Orange has damaging effects on the respiratory system. It may be years before the IOM finally caves and concedes the causation of respiratory disorders by Agent Orange. However, the VA laws are still in the veteran’s favor. While these kinds of cases are certainly not simple, a medical expert’s opinion, stating that it is at least as likely as not (50/50 chance) that the veteran’s condition is caused by exposure to Agent Orange, can be that golden ticket to obtaining the VA compensation that the veteran so richly deserves.