Agent Orange: Veterans' Complaints Concerning Exposure to Herbicides in South Vietnam

A G E N T ORANGE:

VETERANS' C O M P L A I N T S C O N C E R N I N G E X P O S U R E

T O H E R B I C I D E S IN S O U T H VIETNAM

ISSUE BRIEF NUMBER IB80040

AUTHOR:

P a m e l a W.

Smith

Science Policy,Research Division

THE LIBRARY OF CONGRESS

CONGRESSIONAL RESEARCH SERVICE

MAJOR I S S U E S S Y S T E M

D A T E O R I G I N A T E D 09/06/79

D A T E U P D A T E D 06/25/82

FOR ADDITIONAL INFORMATION CALL 287-5700

0625

CRS- 1

ISSUE DEFINITION

From 1962 to 1971, the United States Air Force

(USAF) sprayed various

herbicide mixtures (chemicals that kill plants)

in South Vietnam.

The

purpose of the spraying was to defoliate jungle growth to deprive the

Communist forces o f ground cover, and to destroy enemy crops to restrict food

supplies. The most extensively used of these herbicide mixtures was known a s

Agent Orange, a 50:50 mix of two common herbicides called 2,4,5-T and 2,4-D

( 2 , 4 , 5 - t r i c h l o r o p h e n o x y a c e t i c acid and 2 , 4 - d i c h l o r o p h e n o x y a c e t i c acid).

A

third chemical present

in the mixture in small amounts was TCDD, a n

inevitable by-product of the manufacture of 2,4,5-T. This chemical, called

tetrachlorodibenzo-para-dioxin or simply "dioxin," i s highly toxic

to

laboratory animals when administered in its pure form.

Acute

(short-term)

toxicity values in humans have not been established, although Gosselin e t

al., in the 1976 edition of 9

puts

TCDD in a class of chemicals for which the "probable lethal dose1' for humans

would be less than 5 mg/kg, o r about 7 drops for a 1 5 0 ~b (70 kg) person.

CRS has been unable to locate any report 0 6 a human death from exposure to

pure TCDD.

The human health

effect that has been most consistently

documented following exposure to small amounts of TCDD a s a contaminant i n

There i s other, less

other compounds is a skin condition known as chloracne.

consistent, evidence of damage to the liver and the nervous system in humans.

Extensive testing on laboratory animals has been done to determine possible

long-term effects of exposure to TCDD.

It can induce cancer i n some strains

of rats and mice (carcinogenicity) cause fetal death in several species

(fetotoxicity)

and

birth

defects

in

developing

mouse

fetuses

(teratogenicity), but has been found not to cause genetic changes i n

mammalian cells (mutagenicity). The American Medical Association's

Council

on Scientific Affairs concluded that "there i s no scientific evidence that

2,4-0, 2,4,5-T or TCDD has caused reproductive difficulties o r hazards in the

human.

Congressional intRrest was triggered by receipt of reports from Vietnam

veterans who believed they had been harmed by exposure to herbicides,

particularly Agent Orange. The 96th Congress held numerous hearings on the

use of herbicides in South Vietnam, and various initiatives to deal with the

problem were introduced. P.L. 96-151 was enacted to direct the Veterans

Administration (VA) to conduct a n epidemiological study on Vietnam veterans

to determine whether there may be adverse human health

effects associated

with exposure to phenoxy herbicides and/or

dioxin.

This study and other

studies planned will help elicit answers to the scientific questions posed by

the Veterans Administration i n determining whether or not the veterans1

medical problems, allegedly due to exposure to Agent orange an&

associated

herbicides used i n Vietnam, ar@ cornpensable.

Pollowing recommendations made

by the Interagency Work Group on Phensxy Herbicides

(now the Agent Orange

Working Group), legislation was introduced in the 97th Congress to expand the

scope of the V A 1 s epidemiological study of the health effects of Agent Orange

to include other factors related to military

service in Vietnam;

The

legislation also allows veterans with medically certifiable conditions that

might possibly have been caused by exposure to Agent Orange t o receive

medical care in VA facilities. The bill (H.R. 3499) was considered by the

House and Senate i n June 1981, put into final form in October, and signed by

3 , 1981.

Its title i s the Veterans1 Health Care,

the President Nov.

Training, and Small Business Loan Act of 1981 (P.L. 97-72).

CRS- 2

BACKGROUND AND POLICY ANALYSIS

History

During the summer of 1969, the first reports of human birth defects

allegedly attributed to Agent Orange appeared in Vietnamese newspapers.

Based on these allegations and the results of a study sponsored by the

National Cancer Institute that showed that 2,4,5-T contaminated with TCDD

caused birth defects in laboratory animals, the USAF stopped spraying 2,4,5-T

in South Vietnam by early 1971.

Although the Department of Defense maintains that only a limited number of

U.S. military personnel can be positively identified a s having been exposed

to 2,4,5-T in South Vietnam (i.e., crews of aircraft that were used to spray

herbicides), it is theoretically possible that large numbers of both military

personnel (from the United States, South Vietnam, North Vietnam, Australia,

and New Zealand) and civilians (especially South Vietnamese peasants) were

exposed to 2,4,5-T through the USAF spraying program.

A growing number of

U.S. veterans who served in South Vietnam have begun to attribute the cause

of various chronic ailments which they are now experiencing

(especially

nervous disorders, cancers, and birth defects in their offspring) to exposure

to 2r4,5-T in South Vietnam, and many have filed claims with the VA for

compensation. The VA has not yet awarded compensation to veterans for any

claims related to 2,4,5-T exposure because of the lack of valid human data to

prove a cause and effect relationship between exposure to 2,4,5-T and/or TCDD

and specific health effects (except for chloracne).

TCDD Contamination

The industrial production of 2,4,5-T always results i n some

TCDD

contamination although TCDD levels can be reduced to about 0.01 parts per

Because it was not widely recognized

million (ppm) with current technology.

until the late 1960s that 2,4,5-T could contain hazardous amounts of TCDD,

manufacturers did not start reducing the level of TCDD in 2,4,5-T until the

USAF was already winding down its herbicide spraying program.

The average

TCDD levels in the 2,4,5-T

containing herbtcide mixtures used in South

Vietnam were approximately 2 ppm i n Agent Orange

(which accounted for

approximately 32.8

approximately 96% of the 2,4,5-T used in South Vietnam),

ppm in Agent Purple, and 65.6 ppm i n Agents Pink and Green

(Agents Purple,

Pink, and Green contained the remaining 2,4,5-T used in South Vietnam).

h he

herbicides procured by the USAF were code named after the colored band that

was placed around each 55 gallon drum in order to identify the contents.]

-

Health Effects

-- Animal Data

Although TCDD is well established a s one of the most toxic chemicals known

for acute (short-term) effects, there i s no consensus in the scientific

community over the chronic (long-term) effects on humans of exposure to l o w

levels of TCDD (such a s those levels found in the herbicides used in South

Vietnam).

Statistically

significant

animal

experiments

have

demonstrated

that

CRS- 3

IB80040

UPDATE-06/25/82

2,4,5-T con-ining

low levels of TCDD and/or TCDD alone have caused various

tumors in mice and rats. A recently-released National Toxicology Program

bioassay of TCDD confirms these earlier reports that TCDD is carcinogenic in

some laboratory animals.

Thymic atrophy (without a corresponding loss in

immune function) and severe weight loss have been observed i n many species

after TCDD exposure.

In some species, acute exposure to TCDD can cause liver

damage. Birth defects such a s cleft palate and kidney abnormalities have

A

been reported in baby mice when the mothers were exposed during pregnancy.

National Toxicology Program animal study of male reproductive effects of

exposure to TCDD, however, has failed to reveal a statistically significant

increase in reproductive abnormalities in TCDD-exposed animals o r birth

defects in the TCDD-exposed male animals1 offspring. Although there is some

experimental evidence that TCDD may cause mutations (changes i n the c e l l l s

genetic material that may produce birth defects in as-yet-unconceived

offspring), these experiments have been few, they have been done mainly on

non-mammalian species o r in vitro (in test tubes), and they have basically

been inconclusive.

Some investigators feel that humans are less sensitive than animals to the

toxic effects of TCDD. There is wide variation of responses to TCDD among

different species, and the mechanisms of its toxicity and metabolism are not

understood. More work needs to be done to clarify whether human exposure to

TCDD can produce the same health effects with the same potency as those

observed in animal studies.

Health Effects

-- Human Data

If a cause and effect relationship is to be scientifically established

between human exposure to a chemical and chronic health effects, a study

which meets the following minimum criteria must be conducted to prove that

a group of people (the "study groupw) must be

such a relationship exists:

identified that has already been exposed to the chemical under study

(it

would help to know the level of exposure); this study group must be large

enough to detect chronic effects with statistical significance

(to find a n

effect that occurred in 1 out of 1 0 0 people, one would need to examine a t

least 100 people); a control group must be fOUnCl that ideally would differ

from the study group only by never having been exposed to the chemical under

study (thus, any differences in chronic health effects between the study and

control groups could be attributed Only to exposure to the chemical under

study); a n d , due to the long latency period for many chronic effects, the

study and control groups must be followed for as many years after exposure as

it takes for the chronic effects to show up

(i..,

in carcinogenicity

studies, subjects must be followed for a minimum of 1 0 to 20 years after

exposure to the suspect carcinogen).

These exacting criteria a r e not met by

most of the studies that have explored the relationship between human

Only for

exposure to TCDD and/or 2,4,5,-T and subsequent health effects.

chloracne has such a cause and effect relationship been well established.

Workers who have been exposed to TCDD and/or

2,4@5-T i n industrial

explosions or who have had other occupational exposure are frequently found

to have a skin condition known a s chloracne

which resembles normal acne

except that it is caused by chemical exposure.

Chloracne can appear from

weeks to months after initial exposure and while mild cases (blackheads) may

clear in a matter of months, severe cases (inflammatory lesions and scars)

may last up to 3 0 years after exposure has ceased.

While the severity of

chloracne is not thought to correlate precisely with the intensity or

2,4,5-TI chloracne i s associated so

duration of exposure to TCDD and/or

--

CRS- 4

IB80040

UPDATE-06/25/82

closely with exposure that some scientists argue that patients who have not

exhibited chloracne are unlikely to have suffered other toxic effects of TCDD

and/or 2,4,5-T exposure.

Studies of these exposed workers have also indicated a variety of other

health problems. For example, the United States Air Force Technical Report

on the Toxicology, Environmental Fate, and Human Risk of Herbicide Orange and

its Associated Dioxin (1978) listed a number of symptoms, signs, or disorders

(trichlorophenol,

that had been reported after occupational exposure to TCP

2,4,5-T's precursor), 2,4,5-TI or TCDD

(see Appendix).

As noted, these

studies, which reported symptoms associated with human exposure to dioxin,

were not conducted in such a way as to prove a cause-and-effect

relationship

between exposure to TCDD and/or 2,4,5-T and any of these effects, but they

may be indicative of such a relationship.

Several of the above studies have focused on investigating cancer rates

among exposed workers.

These studies do not show a clear cause/effect

relationship between carcinogenicity associated with exposure to TCDD and/or

2,4,5-T because very few exposed workers (with the exception of those in

Nitro, West Virginia) have been followed for more than ten years (the latency

period for most cancers being 1 5 to 4 0 years after exposure) and the results

have been equivocal.

However, they support a continuing suspicion and

indicate a need for further study.

When the scientific panel of the

Interagency Work Group on Phenoxy Herbicides reviewed five research papers by

European scientists, it concluded that despite the studiesf limitations, they

do "show a correlation between exposure to phenoxy acid herbicides and an.

increased risk of some forms of cancer."

A soft-tissue sarcoma study Bas

been proposed that will be conducted jointly by the Armed Forces Institute of

Pathology and the National Cancer Institute.

Studies that have been conducted in non-industrial settings have not been

able to prove a cause and effect relationship between exposure to TCDD and/or

2,4,5-T and specific health effects. The National Academy of Sciences

(NAS)

was directed by congress [P.L. 91-441, sec. 506(c)] to conduct a study on the

effects of herbicides in South Vietnam, including health effects.

This NAS

study, as well as a t least three other similar studies that were conducted in

~

unable to find adequate data upon

South Vietnam during the early 1 9 7 0 ~were

which to reach any conclusions concerning a Causal effect between exposure to

herbicides and any health effects, including birth defects.

An explosion in a Hoffman-LaRoche chemical plant in Seveso, Italy in July

1976 caused thousands of people to be exposed to varying doses of TCDD as a

toxic cloud drifted across the Italian countryside in a cone-shaped pattern

about a mile long and half a mile wide.

Some 5400 people lived in the two

zones most directly affected, with an additional 40,000 people potentially

exposed. Animals began to die 2 to 3 days after the incident with over 1,100

animals killed by direct exposure to TCDD. Over 700 people were evacuated

from their homes.

Chloracne was reported in 187 people, mostly children, and

it tended to heal rapidly. Long-term human health effects of exposure to

Preliminary findings reported in

TCDD at Seveso are still being studied.

1979 by Hoffman-LaRoche revealed that SeVeSO residents had suffered liver

damage but that there was no permanent breakdown in liver function.

They

also reported that rates of spontaneous abortions, fetal malformations,

congenital defects, chromosome aberrations, reactions to infectious disease,

and morbidity and mortality were not affected by TCDD exposure. As reported

by the American Medical Association's Council on Scientific Affairs, "The

most recent progress report on the long-term epidemiologic survey of the

residents of the Seveso area emphasizes the preliminary nature of their

CRS- 5

IB80040

UPDATE-06/25/82

findings and reiterates the conclusions of prior investigators.

Except for

the skin, no organs or body functions were impaired.

No derangement of

gestation, no fetal lethality and loss, no gross malformations, no growth

retardation at term and no cytogenetic abnormalities have yet occurred."

Health effects of domestic use of 2,4,5-T have been

kept

under

surveillance by various Government agencies for some years.

In April

1970,

the Departments of Agriculture, Interior, and Health, Education and Welfare

jointly announced the suspension of cer$ain uses of 2,4,5-T following studies

indicating that it was a teratogen.

On Apr.

21, 1978, the Environmental

Protection Agency (EPA) issued a Rebuttable Presumption Against Registration

(RPAR) on 2,4,5-T, finding that the herbicide had exceeded

certain risk

criteria and inviting comments from interested parties.

The RPAR was based

on toxicological data from animal studies showing a correlation between

2,4,5-T exposure and cancer and birth defects.

One of the comments received

was from Alsea, Oregon, claiming that there was a high incidence of

miscarriage among area women following spraying of the local forests with

2,4,5-T.

EPA investigated this claim and reported its conclusion that the

incidence of spontaneous abortion over a 6-year period in Alsea was higher

than the rates i n two other regions of Oregon that had lower rates of 2,4,5-T

usage.

Based on the combination of evidence from the animal studies and the

Alsea study, EPA announced the emergency suspension of the domestic use sf

2,4,5-T on forests, pastures, and rights-of-way on Feb. 28, 1979. The Alsea

study has been criticized on methodological grounds by various groups, and

EPA hearings

on

its results are rejected by a number of writers.

cancellation of 2,4,5-T began in June 1979. On Mar. 24, 1981, EPA and Dow

Chemical requested a recess in the hearing to discuss the possiblity of

The recess has b@en

extended

while

the

negotiating a settlement.

negotiations continue.

Herbicide Spraying i n Vietnam

Approximately 1 0 7 million pounds of herbicides were aerially disseminated

on 6 million acres o f South Vietnam (an area about the size of Connecticut)

from January 1 9 6 2 to February 1971. Approximately 276,000 gallons of Agents

Green, Pink, and Purple were sprayed in South Vietnam prior to 1965 when they

were replaced by Agent Orange.

Approximately 1 1 million gallons of Agent

making it the most widely used

Orange were then sprayed in South Vietnam

herbicide of the war.

Ninety percent of Agent Orange was sprayed on 2.9

million acres of inland forests and mangrove forests for defoliation, 8% was

sprayed on enemy crops for crop destruction, and the remaining 2% was sprayed

around base perimeters, cache sites, waterways, and communications lines.

--

The Air Force continued to operate its herbicide spraying program in South

Vietnam until the late 1960s when the National Cancer Institute released

results of an animal bioassay that showed 2,4,5-T to be tesatogenic and/or

fetotoxic i n rodents, and newspapers in South Vietnam

started reporting

health problems among the rural popuPations who had been exposed

to such

herbicides.

The Air Force first restricted the use of Agent Orange to areas

remote from populations in October of 1969, then stopped a11 airplane

spraying of Agent Orange in early 1 9 7 0 ' a n d all helicopter spraying of Agent

Orange by 1971.

All remaining herbicide stocks were gathered and stored a t

either Gulfport, Mississippi or Johnston Island in the Pacific until they

were incinerated at sea i n 1977.

The following table outlines major military projects

involving

handling of Agents Orange, Purple, Pink, or Green in South Vietnam.

the

CRS-

6

CRS- 7

IB80040

U~~~T~-06/25/82

MILITARY PROJECTS INVOLVING AGENTS ORANGE, PURPLE, PINK, OR GREEN

PROJECT

DATES

AGILE

1960-68

Selection of herbicides, and development

and evaluation of defoliation techniques.

RANCH HAND

1962-71

Aerial spraying of herbicides in South

Vietaam.

Various USAF

Projects

1962-70

Development and testing of aerial spray

equipment.

PACER IVY

1971

Redrumming and movement of surplus

herbicide from South Vietnam to

Johnston Island.

Air Force

Logistics

Command Project

1972-77

Maintenance of herbicide inventory

and research on options for disposal.

PACER HO

DESCRIPTION

Dedrumming of herbicide inventory and

at-sea incineration of Agent Orange.

Each of these projects involved some human exposure to the herbicide

2,4,5-T and its contaminant, TCDD. The difficulty lies i n

determining who may have been exposed and at what level.

CRS- 8

P e r s o n n e l Exposed

The e a r l y t r i a l s t h a t w e r e c o n d u c t e d i n S o u t h V i e t n a m t o i m p r o v e a i r c r a f t

s p r a y s y s t e m s ( 1 9 6 0 t o e a r l y 1 9 6 2 ) w e r e c o n d u c t e d b y USAF p e r s o n n e l

assigned

t o t h e S p e c i a l A e r i a l S p r a y F l i g h t D i v i s i o n , L a n g l e y AFB, V a . (USAF p e r s o n n e l

engaged i n t h e h e r b i c i d e program d i d n o t r e c e i v e permanent change of

station

t h u s making i t more d i f f i c u l t t o

a s s i g n m e n t s t o South Vietnam u n t i l 1964

t r a c k p e r s o n n e l who may h a v e b e e n e x p o s e d t o h e r b i c i d e s ) .

During l a t e 1962

a n d e a r l y 1 9 6 3 , t h e C r o p s D i v i s i o n a t F o r t D e t r i c k a n d t h e USAF Armament

Laboratory a t Eglin A i r Force Base,

F l o r i d a were i n v o l v e d i n e f f o r t s t o

p r o v i d e i m p r o v e m e n t s i n s p r a y s y s t e m c o m p o n e n t s i n s u p p o r t o f O p e r a t i o n RANCH

--

HAND.

Most o f t h e p e r s o n n e l i n v o l v e d i n t h e a c t u a l h a n d l i n g o f

h e r b i c i d e drums

was

were Vietnamese.

However,

a USAF f l i g h t m e c h a n i c o r c r e w c h i e f

r e s p o n s i b l e f o r e n s u r i n g t h a t t h e a i r c r a f t were p r o p e r l y l o a d e d a n d t h a t

the

s p r a y systems were f u n c t i o n a l .

Each h e r b i c i d e a i r c r e w C o n s i s t e d o f

a pilot

and a c o p i l o t (both u s u a l l y o f f i c e r s )

and a f l i g h t mechanic/spray

unit

operator (usually enlisted).

The a i r c r e w s were f r e q u e n t l y j o i n e d b y S o u t h

V i e t n a m e s e a n d U.S. o b s e r v e r s .

As

n o t e d i n a USAF r e p o r t ,

"within

the

a i r c r a f t , i t was n o t uncommon t o h a v e h e r b i c i d e l e a k a g e f r o m a r o u n d t h e

n u m e r o u s h o s e c o n n e c t i o n s j o i n i n g t h e s p r a y t a n k a n d pumps w i t h t h e w i n g a n d

a f t s p r a y booms.

In hot weather, the odor of herbicide within t h e a i r c r a f t

was d e c i d e d l y n o t i c e a b l e . n

that

took place

T h e USAF h a s d a t a o n 6 , 5 4 2 h e r b i c i d e s p r a y i n g m i s s i o n s

b e t w e e n A u g u s t 1 9 6 5 a n d F e b r u a r y 1 9 7 1 o n i t s "HERBSw c o m p u t e r t a p e .

These

d a t a w e r e c o m p i l e d on a m i s s i o n - b y - m i s s i o n basis f r o m r e p o r t s a n d f i l e s i n

v a r i o u s commands a n d o f f i c e s i n S o u t h V i e t n a m a n d t h e U n i t e d S t a t e s .

The

HERBS t a p e c o n t a i n s t h e f o l l o w i n g

data f o r each mission:

date;

mission

n u m b e r ; l o c a t i o n ; p r o v i n c e a n d UTM c o o r d i n a t e s ; t y p e o f h e r b i c i d e ( b a s i c a l l y ,

Agents Orange, White, o r Blue); q u a n t i t y of h e r b i c i d e ; a r e a covered;

purpose

of mission ( d e f o l i a t i o n , crop d e s t r u c t i o n , e t c . ) ; and t y p e of a i r c r a f t (plane

or helicopter).

T h e NAS u s e d t h e HERBS t a p e i n i t s e v a l u a t i o n o f t h e e f f e c t s

of h e r b i c i d e s on S o u t h Vietnam.

A f t e r e v a l u a t i n g t h e HERBS d a t a ,

t h e NAS

concluded t h a t

t h e HERBS t a p e a c c o u n t e d f o r a p p r o x i m a t e l y 8 6 % o f

all

h e r b i c i d e o p e r a t i o n s i n South Vietnam and t h a t

"despite certain recognized

d e f i c i e n c i e s , " t h e HERBS t a p e i s " a r e l i a b l e s o u r c e f o r a n a s s e s s m e n t o f

the

major p a r t of t h e h e r b i c i d e o p e r a t i o n i n S o u t h Vietnam" a n d " i s t h e best a n d

i n f a c t t h e only a v a i l a b l e comprehensive computation of t h e major p a r t of t h e

h e r b i c i d e o p e r a t i o n s conducted i n t h e Vietnam war."

When t h e D O D s u s p e n d e d a l l u s e o f 2 , 4 , 5 - T i n S o u t h V i e t n a m , t h e USAF was

l e f t w i t h a n i n v e n t o r y o f 2.22 m i l l i o n g a l l o n s o f u n u s e d Agent Orange

(1.37

million

m i l l i o n g a l l o n s which had been s h i p p e d t o S o u t h Vietnam a n d 0.85

g a l l o n s w h i c h were w a i t i n g t o b e s h i p p e d a t t h e N a v a l C o n s t r u c t i o n B a t t a l i o n

Center a t Gulfport, Mississippi).

I n A p r i l 1972, t h e 1.37 m i l l i o n g a l l o n s of

A g e n t O r a n g e w e r e moved f r o m S o u t h V i e t n a m t o J o h n s t o n I s l a n d i n t h e P a c i f i c

Ocean f o r s t o r a g e .

T h e t o t a l a m o u n t o f TCDD i n t h e r e m a i n i n g A g e n t O r a n g e

s t o c k was a p p r o x i m a t e l y 44.1

pounds.

Problems began t o a r i s e i n both

l o c a t i o n s a s d r u m s r e p o r t e d l y b e g a n t o l e a k a n d t h e USAF e x p r e s s e d c o n c e r n

over f u r t h e r leakage problems t h a t could occur i f

a tornado h i t

the

~ i s s i s s i p p is i t e o r i f a t y p h o o n h i t t h e P a c i f i c s i t e .

After exploring a

n u m b e r o f o p t i o n s , t h e USAF d e c i d e d t o d i s p o s e o f t h e A g e n t O r a n g e b y b u r n i n g

i t a t high temperatures a t s e a on t h e

D u t c h i n c i n e r a t o r s h i p named t h e

f l V u l c a n u s . w The A g e n t O r a n g e was d r a i n e d f r o m t h e d r u m s a t e a c h s i t e a n d

CRS- 9

transferred to the Vulcanus.

The empty drums were then rinsed with diesel

fuel and crushed.

The rinse fluid was combined with the Agent Orange for

incineration at sea. A total of 15,480 drums of Agent Orange were processed

at the Mississippi

site between May 24, 1977, and June 1 0 , 1977, by

from the five Air Logistics

approximately 1 1 0 USAF officers/technicians

Centers of the Air Force Logistics Command (located at Kelly AFB Texas; Hill

AFB, Utah; Warner Robbins AFB, Georgia; Tinker AFB, Oklahoma; and McCellan

A total of 24,795 drums of Agent Orange were processed

at

AFB, California).

the Johnston Island site between July 27, 1977, and Aug.

23, 1977.

Approximately 100 civilian employees hired by a contractor performed the

dedrumming process.

At both the Johnston Island and Mississippi sites,

workers were provided with daily changes of work

clothes and some with

protective clothing.

The Agent Orange was incinerated at sea in the period

from July to September 1977. Results of industrial hygiene studies conducted

at the time of the disposal operation by the U.S. Air Force

(Gulfport) and

the Battelle Memorial

Institute

(Johnston Island) revealed no immediate

adverse health effects among the personnel involved in the operation.

Department of Defense Efforts

The USAF has stated that i t can now identify 1,264 servicemen who were

containers and

directly exposed to Agent Orange as they handlea herbicide

flew spraying missions in South Vietnam.

The Air Force has initiated a

health effects study of Air Force personnel involved in operation "Ranch

Hand," who sprayea Agent Orange in Vietnam.

The Department of Defense

(DOD)

believes that these individuals had at least 1000 times more exposure to

Agent Orange than the average ground troops.

The epidemiological study will

try to determine whether a causal relationship can be established between

exposure to the 2,4-D/2,4,5-T mixture and long-term health effects.

Althcugh

the study was originally scheduled to begin in October 1979, peer review of

its protocols forced delays.

The University of Texas School of Public

Health, the U.S. Air Force Scientific Advisory Board and the Armed Forces

Epidemiological Board reviewed the

study

protocols

and

recommended

modifications.

Then the Air Force asked the National Academy

of Sciences

(NAS) to review the protocols.

On May 6, 1980, the N A S

announced

recommendations that the scope and duration of the study be expanded to

increase the likelihood of obtaining definitive data.

NAS also expressed

concern about the public perception of credibility and impartiality of a

study conducted internally by the Air Force. The Interagency Work

Group's

Scientific Panel, however, has recommended that the study, a s designed by the

Air Force, be conducted because, despite its limitations, it provides "a

focus as to the type of health effects that may possibly occur in other

(ground troop) personnel."

The Ranch Hand study is proceeding in several phases and will continue for

medical

history

20 years.

The first phase consists of a detailed

questionnaire, which has been administered to the Ranch Handers in their

homes by trained interviewers from Louis Harris and Associates.

A carefully

matched control group, selected from military records held by the Air Force,

has also been interviewed.

The first data from the questionnaire should be

available by mid-summer 1982. Also underway is the second phase of the

of

study, a 3-day series of physical examinations, including a battery

psychological tests, which Will be given to both the study group and the

controls.

The contractor for this phase is Kelsey-Sea.bold of Houston.

The

exams are scheduled to be completed by September 1982, with preliminary

findings available 2 to 3 months later. Follow-up exams will be conductea at

A mortality analysis on the Ranch Hand group is

1 , 3, 5, 1 0 , and 2 0 years.

in progress at the Air Force School of Aerospace Medicine, with data

anticipated around August 1982, and a mortality

tracking program will be

continued throughout the study. Information on the health status of the

veterans, as shown by the questionnaires and the physical examinations, will

provide data for a morbidity analysis.

Many of the veterans who have filed claims with the VA for compensation

for health effects caused by exposure to TCDD in South Vietnam did not hold

jobs that caused direct exposure to 2,4,5-T. They claim that their exposure

occurred indirectly either by being s ~ r a y e dwith overhead planes

(although

substances other than herbicides were also sprayed from planes) or by being

exposed to 2,4,5-T in the environment.

According to the DOD, military

personnel did not usually enter areas sprayed with Agent Orange until 4 to 6

weeks after treatment.

However, a recent General

Accounting

Off ice

investigation concluded that a large number of Marines in the I Corps section

of Vietnam from 1966-1969 were in, or close to, areas sprayed with Agent

Some Army

Orange on both the day of spraying and within 4 weeks afterward.

units were also close to Agent Orange spraying.

The Department of Defense has recently made progress in identifying ground

troops that may have been exposed to Agent Orange. Two Army and one Marine

31st Engineer Battalion, 2050 troops; 1st Squadron, 9th Calvary

battalion

(Air Mobil), 2300 troops and 3rd Battalion, 1st Marines, have been identified

as being in areas of Agent Orange operations. Exact numbers, locations, and

identities of individuals who may have been sprayed are impossible to

determine.

-

Veterans' Problems and Veterans Administration Efforts

The.first reports of veterans' concerns over health effects of exposure to

2,4,5-T began to appear in late 1977 and early 1978, following media coverage

of several veterans' claims. Veterans have associated a number of illnesses

with exposure to 2,4,5-T, including skin conditions, fatague, nervousness,

numbness in extremities, vision and/or hearing impairments, birth defects in

offspring, reduced libido, miscarriages, impotency, respiratory problems,

gastro-intestinal tract disturbances, and various cancers, as well as a

variety of other illnesses.

As of Apr. 1 , 1982, the VA had received 13064 claims for damage reportedly

related to in-service exposure to herbicides; 2986 claims have been made due

only to exposure to the herbicides and not for any specific condition; 10078

claims have been filed for specific conditions related to herbicide exposure,

but 3469 of these have not had the diagnosis confirmed by medical authority.

Of the 6609 claims with a confirmed diagnosis, 923 (13.7%) have been allowed

for reasons other than Agent Orange exposures and 5686 (86.3%)

have been

denied.

Approximately 93% or 858 of the total 923 claims allowed were for

service-connected skin conditions, and the remaining 7% or 6 5 claims were

allowed for cancer, psychiatric and neurological conditions, and various

other miscellaneous disabilities.

The 5686 claims denied fall into the

following categories (many claims have more than one claimed diagnosis): 3055

for various skin conditions; 2335 for nervousness, headache, or fatigue; 886

for paralysis or numbness; 751 for gastro-intestinal or genito-urinary

conditions; 399 for various malignancies; 356 for impaired sexual activity;

394 for eye, ear, nose, and throat conditions; 274 for lung conditions; 227

for cardiovascular conditions; and 137 for miscellaneous conditions. The VA

has not awarded compensation for the claims of chronic illnesses related to

Agent Orange exposure because of the lack of valid human data to prove a

cause and effect relationship between exposure to a 2,4,5-T/2,4-D

mixture

and/or TCDD and specific chronic health effects.

Previously, the difficulty

of determining which veterans were or were not exposed to Agent Orange was

also a factor in denying compensation, but more recently the VA has conceded

exposure for all veterans who were in Vietnam.

The VA is maintaining a registry of all Vietnam veterans who have come to

V A hospitals and health care facilities expressing concern about possible

herbicide-related health problems.

Each such veteran, whether experiencing

any health problems or not, is given a physical examination; currently, some

2700-2800 exams a r e being conducted each month.

Data from all the exams is

being computerized into a central Agent Orange Registry in addition to the

individual records being maintained a t the local VA facilities.

As of Mas.

25, 1982, 81,670 veterans had received the initial exam, and about 61,000 of

the records had been coded into the computer.

Information from the registry

is being analyzed to determine if the veterans have a n increased rate of any

particular diseases.

Thus far, nothing unusual or unexpected has turned up.

Treatment of any health problems uncovered by the exams i s handled under

normal VA procedures regarding service-connection, ability to pay for medical

care, etc., with the exception that special guidelines have been issued for

the handling of conditions possibly related to Agent Orange.

In the Federal

Register of Dec. 2, 1981, pursuant to Public Law 97-72, the VA issued

guidelines for use by its physicians to "assist them in making determinations

in individual cases a s to whether a disability may have been causedw by

exposure to Agent Orange.

Even though treatment may be given for some

conditions, the VA specified that "In accordance with congressional intent, a

determination to furnish care under this authority does not establish that

the condition for which medical care is provided is service-conneetec3"

for

purposes of compensation or vocational rehabilitation eligibility.

Three additional VA activities on Agent Orange include participation

in

the tissue registry, the Chloracne Task Force, and investigations into TCDD

surgery

residues in body fat tissue of veterans.

When V A facilities perform

or autopsies on Vietnam veterans, tissue samples are taken and sent to the

Armed Forces Institute of Pathology where a special tissue registry i s being

maintained.

Examination of approximately 800 specimens has so far shown no

significant clustering of tumors or other particular

disease features.

The

Chloracne Task Force was established in response to a congressional request

to sift out those cases of skin conditions that either resemble or are truly

chloracne.

Those veterans whose medical records show a definite possibility

of chloracne will be invited to come to non-VA clinics for re-examination

by

dermatologists who have an expert knowledge of the disease.

The VA has

conducted a study to determine if TCDD can be detected in the body f a t

tissues of Vietnam veterans a t any higher levels than in veterans who were

not in Vietnam.

Dioxin in body fat is measured in parts per trillion, levels

which are at the technological limits of available detection methods.

The

test requires surgical removal of tissue from the abdomen and chemical

analysis sf the sample ow

gas

chromatography/high

resolution

mass

spectrometry instruments. The results of the study were inconclusive, and

the VA has decided that the reliability of the procedure is not sufficient to

warrant its use i n attempting to verify dioxin exposure.

An additional

problem

is that dioxin contamination is so ubiquitous

(from domestic

herbicide use and from its formation in municipal incinerators) that it may

likely be found in everyone's fat tissue.

is

As mandated i n P.L. 96-151, the Veterans' Affairs Amendments, the VA

currently preparing to perform a n epidemiological study of Vietnam veterans

exposed to Agent Orange.

Although the study's protocol has been developed

and validated by an independent group, the VA will perform

the testing and

scientific

committee.

collect the data, with oversight by a non-VA

Procurement of a n independent contractor for the study's protocol was delayed

(NVLC).

for 14 months by a protest filed by the National Veterans L a w Center

The NVLC alleged that not only was the V A violating procurement law, but also

the study a s currently contemplated did not comply with the requirements of

P.L. 96-151.

On Feb. 2, 1981, the General Accounting

Office concluded its

investigation and denied the NVLC protest.

O n Kay 5 , 1981, the VA announced

the awarding of a contract to the University of California a t Los Angeles

(UCLA) School of Public Health for the design of the epidemiological study.

UCLA submitted its first draft of the protocol to the VA in August 1981; it

was peer-reviewed by the VA Advisory Committee on Health-Related

Effects of

Herbicides, by the Office of Technology Assessment, and by the Science Panel

of the Agent Orange Working Group. All the review groups judged the draft

protocol to be inadequate and not in compliance with the contract.

UCLA has

since modified the protocol, expanding o n problem areas and incorporating the

suggestions of the review groups; its final submission to the VA is due April

29, 1982. As with the Ranch Hand study, this epidemiological study will have

two main parts:

a questionnaire on health status and

medical

and

The study

occupational history, and a physical exam with laboratory workup.

Two of

group will be 18,000 veterans, divided into 3 cohorts of 6000 each.

the cohorts will have had Vietnam

service, and will be distinguished as

T h e third cohort

having a high or a low likelihood of herbicide exposure.

will be veterans with non-Vietnam military service.

Inclusion of the third

group will generate data about the health effects of Vietnam

service in

addition to the information expected about herbicide-related health

effects.

The study will commence with a pilot project to field test its procedures and

the questionnaire.

P.L. 96-151 also mandated the VA to conduct a comprehensive review and

scientific analysis of the worldwide literature on Agent Orange and other

JRB Associates prepared the review under contract, and

phenoxy herbicides.

the VA published the 2-volume study in October 1981.

The VA i s now preparing

to contract for an update to the literature review, to reflect new reports

and data that have appeared.

The Interagency Work Group on Phenoxy Herbicides and Contaminants,

established i n December 1979, recommended that the Centers for Disease

Control (CDC) perform a case-control study to see if there is a n increased

incidence of specific malformations in children of Vietnam veterans.

The

population to be studied is a group of 7500 children who have birth defects

and who are registered in CDC's Birth Defects Program (in operation since the

late 1960s).

Information on the families of these children, gained by

extensive interviews and questionnaires, will be compared with that for 300

normal controls.

The data will be analyzed to see what risk factors i n the

parentsg lives, including military service in Vietnam, may be related

to

increased incidence of malformations in their children.

CDC has completed a

pilot study o n a representative sample of the two groups to test the

questionnaire and the procedures for finding the families.

The main

study

will be started in late April 1982, and a preliminary report on the issue of

Vietnam service is expected in the fall of 1983. Detailed analysis of the

data on all risk factors will take several years to complete.

On Sept. 22, 1980, the Work Group held its first public meeting to discuss

problems and proposals related t o exposure to herbicides.

On Jan. 1 9 , 1981,

the Secretary of Health and Human Services established the "Advisory

Committee on Special Studies Relating t o the Possible Long-Term Health

Effects of Phenoxy Herbicides and Contaminantsw to advise the Secretary and

the Chair of the Interagency Work Group on Herbicides concerning the Advisory

Committee's oversight of the conduct of the Ranch Hand Study being conducted

by the Air Force.

In its seventh report to the White House, the Work Group's

Scientific Panel concluded that:

While i t is difficult to accept logically that a

could be

single causative factor -- Herbicide Orange

responsible for such a diverse set of health effects [as

alleged by Vietnam veteran claims to the VA], there is no

definitive evidence that permits selective exclusion of

some of these illnesses. Further, it is possible that

some of these health effects are occurring as a consequence

of Vietnam service but not due to exposure to Herbicide

Orange. The Science Panel is not aware of any data that

suggest a modification of its previous recommendation that

the focus of a study of Vietnam veterans should be

broadened to consider Vietnam service as the exposure

factor rather than focus solely on Herbicide Orange

exposure....

The Science Panei is in receipt of data

which indicate that there is a t best a remote chance of

accurate identification of specific ground troops who were

exposed to Hetbicide Orange....

The Panel is therefore of

the opinion that design of a scientifically valid Herbicide

Orange study of ground troops may not be possible.

If

the focus of a study o f Vietnam veterans is broadened to

consider Vietnam service as the exposure factor, a study

of ground troops is necessary and a scientifically valid

study can be designed.

--

On July 1 7 , 1981, the Interagency Work Group was renamed and its

membership expanded.

Now called the Agent Orange Working Group, it is part

of the Cabinet Council on Human Resources.

The Department of Health and

Human Services is the lead agency.

Because the VA currently recognizes only chloracne as a human health

effect that can be proven to be caused by exposure to 2,4,5-T, veterans mag

have difficulty being compensated for even those effects for which there i s

strong animal evidence (i.e., cancer and birth defects caused in utero which

are those birth defects that cannot be caused by the father and require the

mother and fetus to be exposed during the actual pregnancy).

Veterans who

claim compensation f o r health effects which are not supported by strong

which could cause genetic defects in the

animal data (i.e., mutations

father's sperm that would affect children conceived after exposure) may have

a n even tougher case to argue.

--

The veteran's question then becomes:

How much evidence is required to

prove the right to compensation? On whom does the burden of proof lie

(the

veteran or the VA)?

If more eviaence is needed, who will generate it? And

finally, what constitutes fair treatment of veterans while the necessary data

are being gathered?

Congressional Action of the 96th Congress

The 96th Congress responded to the problems of establishing a cause and

effect relationship between veterans' exposure to herbicides in South Vietnam

and the various health problems they are now experiencing by holding hearings

and enacting legislation.

The Subcommittee on Oversight and Investigations of the House Committee on

Interstate and Foreign Commerce held hearings on June 24 and 25, 1979, to

hear testimony from veterans who allegedly have been affected by herbicide

exposure and from the Veterans Administration regarding its efforts to

unequivocally determine the relationship between herbicide exposure and

health effects. The Subcommittee on Medical Benefits and Facilities of the

House Committee on Veterans' Affairs held two sets of hearings on the hazards

associated with TCDD, veterans' complaints of health effects associated with

Agent Orange exposure, and Veterans Administration's efforts to resolve the

Agent Orange problem.

The Senate Veterans' Affairs Committee also held hearings to

Agent Orange problem.

examine

the

As a step to gain access to records to locate veterans who may have been

2282, the Veterans'

exposed to herbicides in-service, Title V of H.R.

Disability Compensation and Survivors' Benefits Amendments of 1979, requires

the Director of the National Institute for Occupational Safety and Health,

upon request by the V A (or other appropriate agency) to request the current

mailing address from the Internal Revenue Service of persons whom the VA

certifies may have been exposed to occupational hazards.

H.R.

2282 was

passed in lieu of its companion bill, S. 689, and became Public Law 96-128 on

Nov. 28, 1979.

Title I11 of H.R. 3892, the Veterans' Affairs amendments, directs the

Veterans Administration to conduct an epidemiological study of the long-term

health effects on individuals from exposure to dioxins in Vietnam, upon the

Office of Technology ~ s s e s s m e n t ' s (OTA) approval of its protocol.

Its

companion bill, S. 1039, was incorporated in H.R. 3892 as an amendment, and

the measure was enacted by Congress and signed by the President .on Dec. 20,

1979 (P.L. 96-151).

If enacted, S. 2096 would have directed the Secretary of Health,

Education, and Welfare (now, Health and Human Services) to undertake an

epidemiological study to determine the long-term adverse human health effects

associated with exposure to dioxins produced during the manufacture of

phenoxy herbicides. This bill proposed to investigate the long-term health

effects of exposure to dioxins, in general, not just to Agent Orange.

As

similarly incorporated in H.R. 3892, S. 2096 would have required that the

study's protocol be approved by the Congressional Office of Technology

Assessment.

This bill was presented to the President on Dec. 21, 1979, and

vetoed by him on Jan. 2, 1980. President Carter vetoed the bill because the

White House counsel believed that such a procedure violated the separation of

power between the legislative branch and the executive branch.

He did not

feel that the Department of Health and Human Services' study protocol should

be subject to approval by a congressional agency.

Title X of H.R. 5288, the Veterans' Rehabilitation Program and Veterans'

Educational Assistance Program would have directed the Secretary of Health

and Human Services to conduct a study of veterans and other groups exposed to

the herbicide known a s "Agent Orangen to determine if there may be adverse

health effects associated with such exposure.

Like H.R. 3892 (P.L.

96-151)

and S. 2096, the bill called for OTA approval of the study's protocol.

The

bill also would have required the Secretary of Health and Human Services to

coordinate its efforts with other studies in the Federal Government.

During

the debate on S. 1188, its companion bill, the

Disabled

Veterans'

Rehabilitation Act, the Senate adopted an amendment offered by Senator

Cranston to expand the study on health effects of exposure to Agent Orange t o

include other factors related to service in Vietnam.

The Senate also adopted

a n amendment offered by Senator Heinz requiring the VA to promulgat@

regulations regarding guidelines to resolve veterans' disability claims based

on exposure to Agent Orange.

The amendments were striken by the ~ o u s e

because they were considered to be "non-germane" to the primary focus of the

bill.

S. 1872 (the Vietnam Veterans' Act);

H.R.

6050 (the Vietnam Veterans'

Act); H.R. 6 3 7 7 (the Vietnam Era Veterans Agent Orange Act); each would have

established a presumption of service-connected disability for health effects

i n Vietnam veterans (and birth defects i n their children) exposed to Agent

Orange. H.R. 8 2 3 8 (Independent Agent Orange Study) would have directed the

Veterans Administrator to request the National Academy of Sciences to conduct

a study o n veterans exposed to Agent Orange. H.R. 8300 would have expanded

the scope of the Agent Orange study currently being coordinated by the VA and

would have established deadlines for promulgating regulations related to

Agent Orange exposure claims. These bills received n o action.

LEGISLATION

P.L.

97-72, H.R.

3499

Veterans' Health Care, Training and Small Business Loan Act of 1981.

Amends title 38, U.S. Code, to extend the Vietnam-era veterans' readjustment

counseling program, to provide medical care for Vietnam veterans exposed to

herbicide defoliants (including Agent Orange), to recover the cost of certain

health care provided by the VA, and authorizes the VA to expand the scope of

its epidemiological study on the health effects of Agent Orange, and other

purposes.

Introduced May 7, 1981; referred to Committee on Veterans1

Affairs.

Committee consideration and mark-up session held May 12.

Reported

to House (amended) by Committee on Veterans' Affairs (H.Rept. 97-79) May 19.

Passed House (amended) June 2 , 1981. Received in the Senate June 3.

Senate

struck all after the Enacting Clause and substituted the language of S. 9 2 1 ,

June 16. Passed Senate in lieu of S. 9 2 1 with amendments, June 1 6 , $981.

House concurred i n Senate amendments with amendments Oct.

2, 1981.

Senate

agreed to House amendments Oct. 1 6 , 1981. Signed into law Nov. 3 , 1981.

H.R.

523 (Roe)

Amends Title 3 8 , U.S. Code, to waive the 1-year limitation on claims for

compensation from the Veterans Administration for disabilities and diseases

incurred in or aggravated by military service in the case of claims by

veterans who served i n Southeast Asia during the Vietnam era for compensation

for disabilities resulting from exposure to the phenoxy herbicides known a s

Agent Orange or other phenoxy herbicides.

Introduced Jan. 5 , 1981; referred

to Committee on Veterans1 Affairs.

H.R.

1173 (Montgomery, by request)

Amends section 307 of P.L. 96-151, by assigning the responsibility of

designating a protocol for, and conducting a n epidemiological study o f ,

veterans who were exposed to Agent Orange, to an independent scientific

agency.

Introduced Jan.

22, 1981; referred to Committee o n Veterans'

Affairs.

H.R.

1 9 6 2 (Gilman)

Amends the Veterans Health Programs Extension and Improvement Act of 1979

to require the Veterans Administration and the National Academy of Sciences

to enter into an agreement under which the Academy Will conduct a n

epidemiological study of veterans exposed to Agent Orange.

Introduced Feb.

1 9 , 1981; referred to Committee on Veterans' Affairs.

H.R.

2157 (Mottl)

Expands the scope of a study required to be conducted by the Administrator

of Veterans' Affairs concerning the effect on humans of exposure to the

chemical known as Agent Orange.

Introduced Feb. 2 5 , 1981:

referred to

Committee on Veterans' Affairs.

VA requested Executive comment Mar. 2 , 1981.

Referred to Subcommittee on Hospitals and Health Care Apr. 28. Hearings held

Apr. 30. Subcommittee consideration and mark-up session held.

Clean bill

forwarded to full committee.

H.R. 2297 (Downey)

Amends Title 38, United States Code, to waive the 1-year limitation o n

claims for compensation from the Veterans Administration for disabilities and

disease incurred in o r aggravated by military service in the case of claims

by veterans who served in Southeast Asia during the Vietnam era for

phenoxy

compensation for disabilities resulting from exposure to the

herbicides known a s "Agent Orange" or other phenoxy herbicides.

Introduced

Mar. 4 , 1981; referred to Committee on Veterans' Affairs.

H.R.

2493 (Daschle)

Amends Title 38, United States Code, to provide a presumption of service

connection for the occurrence of certain diseases in veterans who were

exposed to herbicides i n Southeast Asia during the Vietnam era.

Introduced

Mar. 1 2 , 1981; referred to Committee on Veterans' Affairs.

H.R.

2953 (Daschle)

Entitles veterans exposed to Agent Orange during the Vietnam era to

specified medical benefits.

Extends the period during Which veterans of such

era may initially request psychological readjustment counseling.

Extends

specified educational assistance without delimiting periods for vocational

training for specified veterans determined to be in need of such assistance.

I , 1981; referred to Committee on Veterans' Affairs.

Introduced Apr.

Referred to Subcommittee on Hospitals and Health Care Apr. 28. Hearings held

Apr. 28.

Subcommittee consideration and mark-up session held Apr. 30, 1981.

H.R.

3163

(Railsback)

Requires the Secretary of Health and Human Services to arrange for a n

independent epidemiological study of persons exposed to Agent Orange.

Introduced Apr. 8, 1981; referred to Committee o n Energy and Commerce.

Referred to Subcommittee on Health and the Environment Apr.

9, 1981.

S. 636 (Cranston et al.)

EntitLes the United States to recover the costs of certain medical care

disability

and services furnished to a veteran for a non-service-connected

when disability is covered by another form o f insurance or compensation.

Permits the expansion of the scope of the epidemiological and literature

study of the long term adverse health effects of exposure to Agent Orange

during the Vietnamese conflict to include the effects of other factors.

Introduced Mar. 5, 1981; referred to Committee on Veteransq Affairs.

S. 689 (Heinz)

Amends section 307 of the Veterans Health Programs Extension

and

Improvement Act of 1979 to require the promulgation of regulations containing

guidelines for resolving claims for veterans benefits based on exposure to

Agent Orange, and for other purposes.

Introduced Mar. 1 2 , 1981; referred to

Committee o n Veterans1 Affairs.

Hearings held Apr. 30, 1981.

S. 9 2 1 (simpson)

Extends the authority of the Administrator of Veteransq Affairs to

contract for hospital care or medical services in Puerto Rico and the Virgin

Islands without reference to patient loads or incidence of provision of

medical services for veterans treated by the Veteransq Administration in the

contiguous 4 8 States.

Introduced Apr. 8 , 1981; referred to Committee o n

97-89);

Veterans1 Affairs. Reported with amendment May 15, 1981 (S.Rept.

H.R. 3499 passed in lieu (see P.E.

97-72 above) June 1 6 , 1981.

S. 1345 (Heinz)

Authorizes the Administrator of the Veterans1 Administration to provide

hospital or nursing home care to a veteran for treatment of a condition

associated with exposure to Agent Orange during service in Vietnam.

Extends

the Vietnam-era

veterans1 readjustment counseling program.

Directs the

Administrator to expand the scope of the epidemiological study of long term

adverse health effects of other factors involved in such service.

Introduced

June 8, 1981; referred to Committee on Veterans1 Affairs.

Amends title 38, United States Code to provide a presumption of service

connection for the occurrence of certain diseases in veterans who were

exposed to phenoxy herbicides while serving in Southeast Asia during the

Vietnam era.

Introduced Dec. 15, 1981; referred to Committee on Veterans

Affairs.

HEARINGS

U.S.

Congress. House. Committee on Interstate and Foreign

Commerce.

Subcommittee on Oversight and Investigations.

Agent Orange: exposure of Vietnam veterans. Hearing, 96th Congress,

26 session. Sept. 25, 1980. 249 p.

----- Involuntary exposure to Agent Orange and other toxic

spraying. Hearings, 96th Congress,

1st session. June 26 and 2 7 , 1979.

256 p.

U.S.

Congress. House. Committee on Veterans1 Affairs.

Ad Hoc

Status of Vietnam veterans in the Bay area.

Subcommittee.

Hearing, 96th Congress, 2d session. Apr. 10, 1980. 64 p.

U.S.

Congress. House.

Committee on Veterans1 Affairs.

Subcommittee on Hospitals and Health Care.

Legislation to improve medical programs administered by

the Veterans Administration (H.R. 2157, H.R. 2953, and H.R. 2999).

Hearings, 97th Congress, 1st session. Apr. 28, 1981. 5 4 p.

U.S.

Congress. House.

Committee on Veterans1 Affairs.

Subcommittee on Medical Facilities and Benefits. Herbicide

"Agent Orangen. Hearing, 95th Congress, 2d session. Oct. 1 1 ,

1978. 6 2 p.

----- Oversight hearing to receive testimony on Agent Orange.

Hearing, 96th Congress, 2d session.

Feb. 25, 1980.

121 p.

----- Oversight hearing to receive testimony on Agent Orange.

Hearing, 96th Congress, 2d session.

July 22, 1980.

----- Scientific community report on Agent Orange.

Congress, 26 session.

Sept. 16, 1980.

459 p.

Hearing, 96th

145 p.

U.S.

Congress. House. Committee on Veteransf Affairs.

Subcommittee on Oversight and Investigations. Current

status of Agent Orange studies. Hearing, 97th

Congress, 1st session. May 6 , 1981. 385 p.

U.S.

Agent

Congress. Senate. Committee on Veterans1 Affairs.

Orange update and appendix: Agent Orange activities (part 11).

Hearing, 96th Congress, 26 session. Sept. 10, 1980. 1368 p.

----- Oversight on issues related to Agent Orange and other

herbicides. Hearing, 97th Congress, 1st session.

1981.

(not yet printed)

Nov. 18,

----- VA health resources and program extensions and appendix:

Agent Orange activities. Hearing, 96th Congress, 1st session,

on S. 741 and S. 196. Apr. 10, 1979. 462 p.

----- Veterans' Programs Extension and Improvement Act of 1981.

Hearing, 97th Congress, 1st session, on S. 26 (titles

I1 and 111, only), S. 380, S. 458, S. 636, S. 689, S. 872, S. 914,

S. 921, and related bills.

Apr. 30, 1981. 685 p.

----- Vietnam veterans1 readjustment.

Hearings, 96th Congress, 2d

session. Feb. 21, Mar. 4 , and May 21, 1980. Part 2.

595-2082 p.

ADDITIONAL REFERENCE SOURCES

American Medical Association.

Council on Scientific

Affairs.

Health effects of HAgent Orangeg1and

1981.

dioxin contaminants (Executive Summary)

6 P-

.

Behrens, Richard, et al. Comments from CAST (Council on

Agricultural Science and Technology):

Dioxin.

1978.

9 PBuck, Craig. The Death of a nation.

AUg. 28, 1978: 49-50, 52-55.

New west, v. 3 ,

Cookson, Clive.

"Emergencygvban on 2,4,5-T herbicide

in U.S.

Nature, v - 278, Mar. 8 , 1979:

108-110.

Davis, Donald E. et al. Comments from CAST (Council

on Agricultural Science and Technology):

Agent

orange.

1978. 5 p.

a mixed blessing..

Galston, Arthur W.

Herbicides:

v. 29, February 1979: 85-90.

Bioscience,

International Agency for Research on Cancer.

IARC monographs on

the evaluation of the carcinogenic risk of chemicals to

man:

2,5,5-TI vol. 15, August 1977.

JRB Associates.

Review of literature on herbicides,

including phenoxy herbicides and associated

dioxins. Washington, Veterans Administration,

1981.

2V.

Laporte, Joan-Ramon.

Multinationals and health:

reflections on

the SeVes0 catastrophe.

International journal of health

services, v. 8 , no. 4, 1978: 619-632.

National Research Council.

The effects of herbicides in South

Vietnam:

Part A.

Summary and conclusions. Washington,

National Academy of Sciences, 1974. AD-774-749.

398 p.

Peterson, Jeannie. Seveso:

1978:

232-239.

the event.

Ambio, v.

7, no. 5-6,

-

Seveso, Missouri, and

Reggiani, G. Localized contamination with TCDD

other areas.

In: Halogenated biphenyls, terphenyls,

naphthalenes, dibenzodioxins and related products, ed. Renate

D. Kimbrough.

Amsterdam, New York, Oxford, Elsevier/North-Holland

Biomedical Press, 1980.

Severo, Richard.

Seveso:

lessons from an escape.

June 17, '1978: 101-102, 104-106, 108.

U.S.

Economist, v. 267,

General Accounting Office.

Health effects of exposure to

herbicide orange in South Vietnam should be resolved,

Apr. 6 , 1979. CED-79-22.

----- U.S. ground troops in South Vietnam were in areas sprayed

with herbicide orange.

Nov. 16, 1979.

FPCD-80-23.

Young, Alvin et al. The toxicology, environmental fate and human

risk of herbicide orange and its associated dioxin. The

October 1978.

Surgeon General, U.S, Air Force, Washington, D.C.

Walsh, John.

Seveso: the questions persist where dioxin created a

wasteland.

Science, v. 197, Sept. 9 , 1977:

1064-1067.

Whiteside, Thomas.

Defoliation.

New York, Ballantine, 1970.

----- The pendulum and the toxic cloud.

New Haven, Yale

U n i v e r s i t y P r e s s , 1979.

Z i m m e r m a n , D a v i d R.

A g e n t Orange: V i e t n a m ' s l i n g e r i n g

poison.

A m e r i c a n h e a l t h , v. 1, no. I, M a r . / ~ p r .

1982:

68-72.

Source

17

Signs, Symptoms, and Disorders Reported A f t e r Occupational Exoosure t o TCP, 2,4,5-T o r 1

. (9)

(14)

Baader and Bauer (6)

Bauer , e t a l

Bleiberg e t a l .

(24)

Poland e t a l . (62)

(33)

Dugois e t a l .

Hardel 1

Kimmig and Schulz

Kramer (49)

(37)

(61)

. (38)

J i rasek e t a l .

J i rasek e.t a1

(54)

Pazderova e t a l .

Miura e t a l .

O l i v e r (57)

Ter Beek e t a l . (79)

Ze 1 i kov and Dan i l o v (88)

T o t a l number o f cases

r e ~ otedC

r

.

a ~ u m b e re n t r i e s i n t a b l e r e f l e c t the number o f cases i n which s i g n , symptom o r d i s o r d e r was

b+ = Sign, symptom o r d i s o r d e r r e p o r t e d b u t number o f cases n o t given.

reported

due t o the o v e r l a p t o s t u d i e s by J i r a s e k e t a l . and Pazderova e t a l .

u umbers do n o t i n c l u d e cases represented by "+I1and t o t a l s may represent some double counting

SOURCE:

Young, Alvin et al. The Toxicology, Environmental Fate, and Human Risk of Herbicide

(Numbers in parentheses identify sources

Orange and Its Associated Dioxin, p. VI-14.

in Young's bibliography.)