Planes spray Agent Orange over a forest in North Vietnam. Agent Orange was a blend of herbicides used to defoliate forests where Viet Cong forces were based. Photo from Wikipedia

Details Won’t Be Announced Until After Federal Rulemaking Process

WASHINGTON — VA Secretary David Shulkin, MD, said he has made a decision on the expansion of the list of presumptive conditions for Agent Orange compensation and has passed it on to the next step in the process.

“I spent a great deal of time personally looking at all of the data on the presumptives, and I have made a decision,” Shulkin said last month. The comments were made during a speech on VA benefits, where he explained he could not announce the details of the decision since it still needs to go through federal rulemaking procedures.

“My intention is to do what is right for veterans, and if I were to not honor the process that is used, my fear is that I would hurt the ultimate outcome of getting veterans the benefits they deserve,” he said.

Shulkin’s comments came just days after he wrote in a Nov. 1 statement—a deadline he had established earlier this year—that he had “made a decision to further explore new presumptive conditions for service connection that may ultimately qualify for disability compensation,” adding, that VA would “now begin work with the [Trump] Administration to concurrently conduct a legal and regulatory review of these potential presumptive conditions for awarding disability compensation to eligible veterans.”

Currently, VA recognizes 14 presumptive conditions associated with exposure to Agent Orange or other herbicides. Veterans’ groups have been pushing, however, for VA to act on the National Academy of Medicine’s report “Veterans and Agent Orange: Update 2014,” released in March 2016.

That report changed, for certain health effects, the categories of association with exposure to the herbicides sprayed in Vietnam. In the report, bladder cancer and hypothyroidism were moved from “inadequate or insufficient” evidence of association up to “limited or suggestive” evidence of association. The committee also “clarified” that Vietnam veterans with “Parkinson-like symptoms,” but without a formal diagnosis of Parkinson disease, should be considered eligible under the presumption that Parkinson’s disease and the veterans’ service are connected.

‘Delay No Further’

“We call upon Secretary Shulkin to delay no further and to act on the National Academy of Science’s findings by adding bladder cancer, hypothyroidism, Parkinson’s-like symptoms, hypertension, and stroke to the service-connected, presumptive list for those who served in Vietnam and elsewhere in the Southeast Asia Theater of operations,” Vietnam Veterans of America National President John Rowan stated in response to the Nov. 1 announcement.

Rowan pointed out that it has been “more than a year and a half since the March 10, 2016, release of the National Academy of Medicine’s Veterans and Agent Orange Update 2014,” noting, “Our Vietnam veterans have been very patient, but as each day passes, they are growing rapidly less so. We are losing over 500 a day, many of them from conditions associated with exposure to dioxin. We must take care of our Vietnam veterans.”

On Capitol Hill, Sens. Jon Tester (D-MT), Patty Murray (D-WA), Sherrod Brown (D-OH), Joe Manchin III (D-WV), and Bernie Sanders (I-VT) co-authored a letter to Shulkin in September, also calling on the agency to provide a response to the NAM’s recommendations.

“The care owed to our servicemembers should not be delayed and denied any longer,” the senators wrote. “They fought for our country, were exposed to a toxic chemical while carrying out their daily duty, and in return, we are failing to provide medical care and disability compensation.”

They further urged the administration to “act on these recommendations and extend presumption for service connection for bladder cancer, hyperthyroidism, and Parkinson-like conditions, in keeping with the recommendations made by NAM.”

Shulkin acknowledged in that his agency should have responded last year within 60 days of the NAM report.
“This is an example where VA is not performing at an acceptable level,” he conceded. “That decision has been delayed and delayed and delayed. I made a commitment that I wouldn’t delay that any further as secretary and that I would make a decision by Nov 1, 2017.”

Meanwhile, Agent Orange benefits for Blue Water veterans were also being considered by lawmakers. Shortly after Shulkin’s Nov 1 announcement, veterans’ organizations expressed their disappointment that the House Committee on Veterans’ Affairs tabled legislation that would have extended the presumption of exposure for Agent Orange to include veterans who served in open sea ships off the shore of Vietnam, as opposed to Brown Water veterans who served on inland waterways.

“As president, you have the authority to end this injustice. You have stated time and time again that you would take care of our nation’s veterans,” wrote Veterans of Foreign Wars Commander in Chief Keith Harman in a Nov. 2 letter to President Donald Trump.

Current Agent Orange Presumptive Diseases

VA has recognized certain cancers and other health problems as presumptive diseases associated with exposure to Agent Orange or other herbicides during military service. Veterans and their survivors may be eligible for benefits for these diseases:

  • AL Amyloidosis

    A rare disease caused when an abnormal protein, amyloid, enters tissues or organs

  • Chronic B-cell Leukemias

    A type of cancer which affects white blood cells

  • Chloracne (or similar acneform disease)

    A skin condition that occurs soon after exposure to chemicals and looks like common forms of acne seen in teenagers. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

  • Diabetes Mellitus Type 2

    A disease characterized by high blood sugar levels resulting from the body’s inability to respond properly to the hormone insulin

  • Hodgkin’s Disease

    A malignant lymphoma (cancer) characterized by progressive enlargement of the lymph nodes, liver, and spleen, and by progressive anemia

  • Ischemic Heart Disease

    A disease characterized by a reduced supply of blood to the heart, that leads to chest pain

  • Multiple Myeloma

    A cancer of plasma cells, a type of white blood cell in bone marrow

  • Non-Hodgkin’s Lymphoma

    A group of cancers that affect the lymph glands and other lymphatic tissue

  • Parkinson’s Disease

    A progressive disorder of the nervous system that affects muscle movement

  • Peripheral Neuropathy, Early-Onset

    A nervous system condition that causes numbness, tingling, and motor weakness. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of herbicide exposure.

  • Porphyria Cutanea Tarda

    A disorder characterized by liver dysfunction and by thinning and blistering of the skin in sun-exposed areas. Under VA’s rating regulations, it must be at least 10 percent disabling within one year of exposure to herbicides.

  • Prostate Cancer

    Cancer of the prostate; one of the most common cancers among men

  • Respiratory Cancers (includes lung cancer)

    Cancers of the lung, larynx, trachea, and bronchus

  • Soft Tissue Sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)

    A group of different types of cancers in body tissues such as muscle, fat, blood and lymph vessels, and connective tissues