28 Mar VA might add more ‘presumptive’ illnesses for Vietnam veterans

http://www.stripes.com/va-might-add-more-presumptive-illnesses-for-vietnam-veterans-1.399750

August this year many more thousands of Vietnam War veterans, those suffering from bladder cancer, hypothyroidism, Parkinson’s-like symptoms and even high blood pressure, could learn they will be eligible for Department of Veterans Affairs health benefits and disability compensation. Or perhaps not.

Difficult months of study lie ahead for a working group of senior scientists and health experts that VA Secretary Bob McDonald convened last week, following release of a 10th and final biennial review of evidence of health problems linked to Agent Orange and other herbicide exposures.

Every review in the series, going back two decades, has been conducted, as Congress mandated, by the Institute of Medicine (IOM), a division of the National Academies of Sciences. Its latest review, Veterans and Agent Orange: Update 2014, takes into account medical and scientific literature published from Oct. 1, 2012, through Sept. 30, 2014.

The IOM concludes that the research supports changing the strength of association to herbicide exposure for several ailments. For bladder cancer and hypothyroidism, it found “limited or suggestive” evidence of an association, an upgrade from previous “inadequate or insufficient” evidence.

This latest review looked again at scientific literature on cardiovascular conditions and herbicides. The IOM didn’t upgrade but it did affirm limited and suggestive evidence that hypertension may be linked to herbicides.

This review also considered whether conditions resulting in Parkinson’s-like symptoms, apart from Parkinson’s disease itself, should fall into the same limited or suggestive category of evidence. Yes it should, the IOM concluded, finding “no rational basis” for the current exclusion.

For only the second time, the IOM withdrew an earlier finding of that herbicide exposure may have caused an ailment, in this case spina bifida in children born to Vietnam veterans. For 20 years VA has used a preliminary finding of an association to grant children benefits. The IOM says it no longer believes the evidence merits retaining spina bifida in that category.

On March 9, the same day the IOM briefed senior VA officials on its report, McDonald ordered the VA working group convened to review not only the 1,100-page IOM report but original studies IOM refers to as well as any peer reviews on ailments and herbicides completed since October 2014, which would be research the IOM had considered in its final review.

Dr. Ralph Loren Erickson, chief consultant of post deployment health services for the Veterans Health Administration, is co-chair of the working group. He said the plan is to review carefully all of the studies and the IOM recommendations and then prepare “a response document” to be distributed “throughout our senior leadership, with suggestions and recommendations for action,” before presenting to McDonald for final decisions.

“No question when the [IOM] moves something to a higher category you can bet we will look even more closely at those particular diseases,” Erickson said. “It certainly is not within my purview to make any statement at this point as to how the secretary will decide. In the past there have been things in this (limited or suggestive evidence) category that have become presumptions, and there are things in this category that have not.”

The IOM says “llimited or suggestive” means the epidemiological evidence indicates there could be a link between herbicide exposure and increased risk for a health effect. For some ailments, including ischemic heart disease, past VA secretaries used “limited or suggestive evidence” to add diseases to the presumptive list. And yet for others, including hypertension, that same category hasn’t been viewed as enough.

Among provisions of the Agent Orange law Congress allowed to sunset last year was a requirement that the VA secretary take action on IOM recommendations within 60 days. Erickson said the working group hopes to give McDonald what he needs to make decisions on the IOM by late July.

“We feel that if we can move at a pace that gets this all taken care of within about four months, we’re be doing well,” he said.

It would be far longer before any veterans or survivors see more or higher disability pay, however. VA rulemaking following a decision to add diseases to the presumptive list involve writing and publishing proposed regulations, collecting and reacting to public comments, and then publishing final regulations, a process that could take more than a year with added delay possible from the change in administrations to occur in January.

Whatever decisions McDonald makes on the IOM recommendations will be “rooted in science” and “evidenced based,” said Erickson.

But doesn’t VA also take account of size of the population affected? For example, hypertension afflicts two-thirds of Americans age 65 and older.

It is true, Erickson said, that Vietnam veterans have moved into their 60s, 70s and 80s and many have chronic diseases of older age.

“Hypertension is one of them,” he said. “And so teasing those things out — [to decide] is it related to this veteran’s age [or] to their being in Vietnam where they were exposed to Agent Orange — sometimes can be difficult.”

Does it finally come down to a judgment call?

“Well, a judgment call based on the evidence,” Erickson said. “The secretary has made it very clear, certainly to me and to others who work on these types of technical working groups, he wants to know what does the science show? What does the evidence show?”

The final decision will be based on “whether the preponderance of the evidence will support a proposal of the new presumption,” Erickson said.

If McDonald does accept IOM recommendations, this review would be the first in six years to result in one or more diseases being added to list of ailments VA presumes are linked to herbicide exposure.

The eligible population would be any veteran who can show they stepped foot in Vietnam between Jan. 9, 1962 and May 7, 1975, including on ships in Vietnam’s inland waterways, also veterans who served in or near the Korean Demilitarized Zone any time from April 1, 1968, to Aug 31, 1971.

To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120 or email: milupdate@aol.com or Twitter: @Military_Update

11 Feb Once Again, the VA Turns Down Navy Vets for Agent Orange Benefits

Once Again, the VA Turns Down Navy Vets for Agent Orange Benefits

The U.S. Department of Veterans Affairs has once again turned down an effort by Navy veterans to get compensation for possible exposure to Agent Orange during the Vietnam War.

In a document released Friday, the VA said it would continue to limit benefits related to Agent Orange exposure to only those veterans who set foot in Vietnam, where the herbicide was sprayed, and to those who were on boats in inland rivers. The VA compensates these veterans for a litany of associated illnesses, including diabetes, various cancers, Parkinson’s Disease, peripheral neuropathy and a type of heart disease.

Advocates for some 90,000 so-called Blue Water Navy veterans who served off the coast of Vietnam have been asking the VA for more than a decade to broaden the policy to include them. They say that they were exposed to Agent Orange because their ships sucked in potentially contaminated water and distilled it for showering, drinking, laundry and cooking. Experts have said the distillation process could have actually concentrated the Agent Orange, which contained the toxic chemical dioxin and was used to kill vegetation and deny enemy cover.

ProPublica and the Virginian-Pilot profiled their effort to gain coverage in September as part of an ongoing project to chronicle the impact of Agent Orange on vets and their families.

The U.S. Court of Appeals for Veterans Claims last April struck down VA rules that denied compensation for sailors whose ships docked at certain harbors in South Vietnam, including Da Nang. Those ports, the court determined, may have been in the Agent Orange spraying area. The court ordered the VA to review its policy.

But on Friday, the VA largely stood by its old policy and once again asserted that there’s no scientific justification or legal requirement for covering veterans who served off the coast.

“Environmental health experts in VA’s Veterans Health Administration have reviewed the available scientific information and concluded that it is not sufficient to support a presumption that Blue Water Navy Veterans were exposed to Agent Orange,” the VA said in a fact sheet.

U.S. Sen. Richard Blumenthal, D-Conn., the ranking member of the Senate Veterans’ Affairs Committee, criticized the VA’s decision.

“Rather than siding with veterans, VA is doubling down on an irrational and inconsistent policy,” he said in a statement. “Young sailors risked their lives during the Vietnam War, unaware that decades later, they and their children and grandchildren would still feel the toxic effects of exposure. Veterans who served offshore and in the harbors of Vietnam were exposed and deserve the presumption of service connection for Agent Orange-related diseases.”

Blumenthal and others are seeking adoption of the Blue Water Navy Vietnam Veterans Act, which would ensure that all vets exposed to Agent Orange are compensated.

The VA opposes the legislation, as it has several previous iterations dating back to 2008.

The VA’s new review rejecting benefits relied on a 2011 report by the respected Institute of Medicine, as well as other published research, according to the agency’s fact sheet.

Jim Smith served in the Navy from 1972–1979. “My feeling is the VA is thumbing their nose and sending the middle finger back to the Blue Water people,” he said. (Courtesy of Jim Smith)

The Institute of Medicine report said there was no way to prove Blue Water vets were exposed to the chemicals, but it identified plausible routes that Agent Orange could have traveled out to sea and into a ship’s distillation system. Although military policy at the time recommended against distilling water closer than 10 miles to shore — where the chemical concentration would have been highest — veterans said doing so was often unavoidable, and their commanding officers routinely ordered it.

The VA said it is working with veterans groups to “initiate a groundbreaking study of Blue Water Navy Veterans health outcomes. We hope to have data gathered and analyses published in 2017.”

Veterans called the VA’s decision a betrayal. John Wells, a Louisiana lawyer who has spent more than a decade advocating for Blue Water veterans, said his group would continue challenging the VA and push for legislation that would mandate coverage for the Blue Water veterans.

“It wasn’t completely unexpected. We’re used to being betrayed by the VA,” Wells said. “We’re going to fight this thing until we’re done or dead.”

Jim Smith, who served aboard the ammunition ship Butte, has been diagnosed with prostate cancer and believes that Agent Orange exposure may have played a role. “My feeling is the VA is thumbing their nose and sending the middle finger back to the Blue Water people,” he said. “It’s like nobody at the VA has any kind of science background whatsoever.”

Blue Water vets — so named to set the sailors apart from their Brown Water Navy counterparts, who patrolled the murky rivers of South Vietnam — were initially deemed eligible for compensation under the Agent Orange Act of 1991, only to have the VA change its interpretation a decade later.

Correction, Feb. 9, 2016: A photo caption in this story originally misstated Jim Smith’s years of service in the Navy as 1972 to 1973. He served in the Navy from 1972 to 1979. He served aboard the U.S.S. Butte from 1972 to 1973.

ProPublica and the Virginian-Pilot are interested in hearing from veterans and family members for our ongoing investigation into the effects of Agent Orange on veterans and their children. Share your story.

05 Jan VA: Automatic benefits for Camp Lejeune vets will take a year

http://www.tampabay.com/news/military/veterans/va-automatic-benefits-for-camp-lejeune-vets-will-take-a-year/2258346 The Department of Veterans Affairs says it will take at least a year to formulate regulations enabling Camp Lejeune veterans to receive automatic benefits for any of eight diseases linked to contaminated drinking water at the base.

The VA announced Thursday that it would grant sick veterans benefits without their having to go through the protracted and arduous claims process for receiving disability and health benefits if they had one of the illnesses and served on the base between Aug. 1, 1953, and Dec. 31, 1987.

Those illnesses are liver and kidney cancer, leukemia, non-Hodgkins lymphoma, multiple myeloma, scleroderma, Parkinson’s disease and aplastic anemia (myelodysplastic syndromes).

“The notice and comment rulemaking process is lengthy, so even though this rule is a VA priority, we anticipate it will take 12 months or more to publish a final rule,” VA spokeswoman Walinda West said in a written statement.

The statement was released in response to questions submitted by the Tampa Bay Times. The VA response came too late to include in an earlier Times story on Thursday’s announcement.

“The devil is always in the details,” said Michael Partain, who was born on the base in 1968 and later was diagnosed with breast cancer, which is rare in men. Partain sits on a panel that consults with federal scientists studying Lejeune water contamination and has been active in battling the VA to extend benefits.

“This is another year for these veterans and their families to wait while the VA squanders precious time.”

The agency noted that veterans can still apply for benefits while the VA promulgates regulations. In an important concession for veterans, the VA said it would stay any claim denials for veterans diagnosed with the eight illnesses so they do not have to reapply for benefits once it finishes drafting rules.

The VA said it did not yet have an estimate of the number of veterans who would be affected by the decision to extend benefits.

Scientists believe up to 1 million people may have been exposed to a toxic brew of chemicals, including several carcinogens, that make the Lejeune contamination perhaps the worst-ever mass exposure to polluted drinking water in the United States. The contamination stretched more than 50 years, ending in 1987, and involved residents now scattered across the nation.

About 14,000 Lejeune veterans and their family members live in Florida, the second-highest total in the nation behind North Carolina, according to Marine Corps figures.

The base’s water was tainted with industrial solvents and components of fuel from a variety of sources, including underground fuel tanks that leaked.

While Thursday’s decision is an important victory for veterans, critics of the agency note there are still numerous diseases that may be linked to the water pollution that are not covered, including breast and bladder cancer. Veterans with these conditions can still apply for benefits through the normal claims process.

17 Oct Overview of the VA adjudication process

The process used by the Department of Veterans Affairs (VA) to adjudicate claims for veterans’ benefits consists of two levels. Claims are filed and adjudicated at the first level, which is considered the “agency of original jurisdiction” (AOJ) (38 U.S.C.S. 7105 (b) (1)).  The agencies of original jurisdiction are the fifty-eight VA regional offices located around the county. If the veteran is dissatisfied with the decision received from one of the fifty-eight regional offices they have one year from the date of that decision to appeal to the Board of Veterans’ Appeals (BVA). If the decision is not appealed to BVA within the one year time frame, the regional office decision becomes final. The BVA is the second level of appeal and makes the final agency decision.

Agency Process

• Claim is filed- The claimant may file an original claim, reopened claim, or claim for revision on a previous final decision based upon a clear and unmistakable error.
• VA makes decision on claim and mails decision to the claimant.
• Claimant files a Notice of Disagreement (NOD)- this must be filed within one year of the mailing from the AOJ.
• Claimant has the option to request a Decision Review Officer (DRO) review within 60 days of the AOJ’s letter offering them a DRO review.
• If the claimant chooses the DRO review, the AOJ mails the claimant the DRO decision.  If a DRO review is not selected the AOJ will mail the claimant a Statement of the Case (SOC).
• Claimant files a substantive appeal (VA Form 9). This form has to be filed within 60 days of the SOC or 1 year from the mailing of the NOD, whichever is later. This perfects the claimant’s appeal. If the VAF 9 is NOT filed the appeal dies and the AOJ’s decision on the SOC becomes final.
• The AOJ certifies the case to the BVA.
• BVA decides the case and mails out a decision to the claimant.