Diabetes now tops Vietnam vets' claims

[Posted by alaurie_97@yahoo.com]

Diabetes now tops Vietnam vets' claims
By MIKE BAKER, Associated Press Writer




RALEIGH, N.C. – By his own reckoning, a Navy electrician spent just
eight hours in Vietnam, during a layover on his flight back to the
U.S. in 1966. He bought some cigarettes and snapped a few photos.

The jaunt didn't make for much of a war story, and there is no record
it ever happened. But the man successfully argued that he may have
been exposed to Agent Orange during his stopover and that it might
have caused his diabetes — even though decades of research into the
defoliant have failed to find more than a possibility that it causes
the disease.

Because of worries about Agent Orange, about 270,000 Vietnam veterans
— more than one-quarter of the 1 million receiving disability checks —
are getting compensation for diabetes, according to Department of
Veterans Affairs records obtained by The Associated Press through the
Freedom of Information Act.

More Vietnam veterans are being compensated for diabetes than for any
other malady, including post-traumatic stress disorder, hearing loss
or general wounds.

Tens of thousands of other claims for common ailments of age —
erectile dysfunction among them — are getting paid as well because of
a possible link, direct or indirect, to Agent Orange.

And the taxpayers may soon be responsible for even more: The VA said
Monday that it will add heart disease, Parkinson's disease and certain
types of leukemia to the list of conditions that might be connected to
Agent Orange. The agency estimates that the new rules, which will go
into effect in two months unless Congress intervenes, will cost $42
billion over the next 10 years.

Lawmakers and federal officials who have reservations about the
spending are loath to criticize a program that helps servicemen. They
have largely ignored a 2008 report in which a group of scientists said
the decision to grant benefits to so many on such little evidence was
"quite extreme."

"There needs to be a discussion about the costs, about how to avoid
false positives while also trying to be sure the system bends over
backwards to be fair to the veterans," said Jonathan M. Samet, a
public health expert who led that study and now serves as director of
the Institute for Global Health at the University of Southern
California.

The VA uses a complex formula when awarding benefits and does not
track how much is spent for a specific ailment, but AP calculations
based on the records suggest that Vietnam veterans with diabetes
should receive at least $850 million each year. That does not include
the hefty costs of retroactive payments or additional costs for health
care. The agency spends $34 billion a year on disability benefits for
all wars.

Dr. Victoria Anne Cassano, director of radiation and physical
exposures at the Veterans Health Administration, part of the VA,
pointed to the wording of the 1991 federal law on Agent Orange that
said officials should find a positive link to diseases "if the
credible evidence for the association is equal to or outweighs the
credible evidence against the association."

It's a low bar. But Cassano said the law requires the VA to act
without consideration of cost. She also said it is the best way to
ensure that deserving veterans don't get lost in the shuffle.

"Does it make you take a deep breath? Does it give you pause? Yes,"
she said. "But you still do what you think is the right thing to do."

Agent Orange was a dioxin-laden defoliant that was sprayed over
jungles to strip the Viet Cong of cover. American forces often got a
soaking, too, and Agent Orange was later conclusively linked to
several horrific health ailments, including cancers. So Congress and
the VA set up a system to automatically award benefits to veterans who
needed only to prove that they were in Vietnam at any time during a 13-
year period and later got one of the illnesses connected to Agent
Orange.

The VA, interpreting that 1991 law and studies that indicated
potential associations, has over time added ailments that have no
strong scientific link to Agent Orange. The nonprofit Institute of
Medicine's biennial scientific analysis of available research, to
which the VA looks for guidance, has repeatedly found only the
possibility of a link between Agent Orange and diabetes, and that even
a chance of a correlation is outweighed by factors such as family
history, physical inactivity and obesity.

"Whatever the relationship between dioxin or Agent Orange and
diabetes, it's a very small piece of the puzzle," said Dr. David
Tollerud, an environmental health professor at the University of
Louisville. He led an Institute of Medicine committee that first
reported in 2000 on a possible link between diabetes and Agent Orange.

Tollerud's committee concluded that evidence was limited and that
chance or other factors could not be ruled out. Yet the VA in 2001 put
diabetes on the list of ailments that get automatic approval for
benefits.

One large study released since then, costing $143 million and
published in 2005 after 25 years of research, surveyed the airmen
responsible for loading and dumping Agent Orange during Operation
Ranch Hand, as the spraying missions were called. The final round of
testing actually showed the prevalence of diabetes among those
participants was slightly lower than among pilots who did not take
part — 18.2 percent versus 19.3 percent.

Some 23 percent of Americans 60 and older have diabetes, according to
the Centers for Disease Control and Prevention.

"It's nothing more than a bunch of BS," said Jack Spey, who flew
hundreds of Ranch Hand missions during more than three years in
Southeast Asia.

Spey, who lives in Hurricane, Utah, and organizes a Ranch Hands
reunion every year, said cockpits were constantly covered in Agent
Orange. Leaking nozzles dripped on workers who walked under the wings.
Punctured lines would spray solution on pilots as they flew. In a bit
of machismo, some like Spey said they took swigs of Agent Orange to
prove they could handle it.

Spey said he is not drawing any VA benefits and believes veterans face
little more than the ailments of age.

While Spey said policymakers have gone too far in granting benefits,
Navy veteran Jonathan Haas believes they have not gone far enough. He
petitioned the VA for years for recognition of a diabetes link to
Agent Orange, saying he saw large clouds of chemicals drift over the
waters off Vietnam and engulf his ship. He unsuccessfully challenged
the VA rule that provided automatic compensation for diabetes only for
those who set foot in Vietnam or worked on the country's inland
waterways.

The VA eventually granted him 100 percent disability — he is now
drawing $36,000 a year, according to VA records — in part for diabetes
after medical records from his service indicated that his condition
had developed before he left the military. Other Navy veterans, he
said, are not as lucky.

"They're getting screwed," said Haas, a 72-year-old who blames
diabetes for his blindness, kidney failure and difficulty standing.

Some members of Congress are pushing to include those veterans who
served off the coast of Vietnam — which would add an estimated 800,000
people to the 2.6 million who served there on land. Cassano, the VA
official, said the agency is looking at it.

The case of the Navy electrician who spent eight hours in Vietnam is
detailed in the documents reviewed by the AP. As with most public
portions of VA claims records, the man's name is omitted.

The government's benefit-of-the-doubt policy contrasts with its stand
toward Vietnam. The U.S. has approved several million dollars in
recent years to help Vietnam clean up Agent Orange. But it has
declined to provide health and financial support to Vietnamese people
affected by the herbicide, with the American ambassador in Hanoi
saying there is insufficient evidence that it causes health problems.

Disability benefits are a lot like workers' compensation, providing
income to veterans who incurred ailments from their active-duty
service. The benefits can last a lifetime even if the veteran holds a
full-time job. They often transfer to surviving family members when a
veteran dies of the disability. They are paid in addition to any
medical, education and pension coverage that veterans receive.

Many veterans have a combination of ailments that are crunched in a
formula to determine their benefits. This makes it difficult to
determine how much is being spent solely on diabetes.

Most veterans get a 20 percent disability rating for diabetes, which
amounts to about $3,000 per year if it is their only ailment. Others
get up to 100 percent. If each of the 270,000 Vietnam veterans got the
minimum compensation for their diabetes, it would add up to $850
million every year.

Congress gave the VA the ability to deem ailments "presumptive" —
automatically awarded — because of exposure to Agent Orange. The VA
did that for five illnesses for which the Institute of Medicine found
"sufficient evidence of an association," such as leukemia, non-
Hodgkin's lymphoma and soft-tissue cancers. Those illnesses have risen
dramatically in both Vietnam and the U.S. since the war.

The list of "presumptive" medical problems has grown to include seven
ailments with only a "limited or suggestive" link to Agent Orange — a
link that scientists said could be influenced by other factors, such
as chance or bias in scientific studies. Those include diabetes along
with prostate cancer and lung cancer.

Anthony Principi, a Vietnam veteran and former VA secretary who added
diabetes to the list, said he struggled with the decision.

"I did the best I could with the information that was given to me. I
wish there was more information that I could have had," he said.
Principi said he expected a surge of diabetes claims but is still
surprised by the numbers.

The evidence of a link between Agent Orange and heart disease or
Parkinson's is inconclusive, according to the Institute of Medicine.
But the VA is moving ahead with plans to add both illnesses to the
list of presumptive conditions.

The VA estimated earlier this year that heart disease compensation
alone will cost taxpayers more than $30 billion over the next decade.
About 17 percent of Americans ages 65 to 74 have heart disease,
according to the CDC.

Virginia Sen. Jim Webb, a Democrat and Vietnam combat veteran,
questioned the decision to spend billions for heart disease coverage.
In a letter to VA Secretary Eric Shinseki this year, the lawmaker said
Congress intended that benefits would be automatically granted "for
relatively rare conditions."

"Over time, however, presumptions have expanded to include common
diseases of aging," Webb wrote.

Compensation can also be awarded for ailments secondary to the covered
condition. Type 2 diabetes, for example, can bring a host of
complications, such as high blood pressure, erectile dysfunction or
cataracts.

Erectile dysfunction is now the seventh-most-compensated disability
for Vietnam veterans, with more than 80,000 getting benefits for it
last year, and an AP review of hundreds of case summaries found that
many of the claims stemmed from veterans with diabetes linked to Agent
Orange.

Spey, the Ranch Hand veteran, blames politicians who are unwilling to
reject the claims of aging veterans.

"We're all going to die some day," he said.

___

Online:

VA list of diseases associated with Agent Orange:
http://www.publichealth.va.gov/exposures/agentorange/diseases.asp

Institute of Medicine report on Agent Orange: http://books.nap.edu/catalog.php?record_id12662