By JAMES DAO
http://www.nytimes.com/2009/10/13/
us/politics/13vets.html?_r=1
Under rules to be
proposed this week, the
Department of Veterans Affairs plans to add
Parkinson’s disease,
ischemic heart disease and hairy-cell leukemia to the
growing list of illnesses presumed to have been caused by Agent
Orange, the toxic defoliant used widely in Vietnam.
The proposal will make it
substantially easier for thousands of veterans to claim that
those ailments were the direct result of their service in
Vietnam, thereby smoothing the way for them to receive monthly
disability checks and health care services from the department.
The new policy will apply to
some 2.1 million veterans who set foot in Vietnam during the
war, including those who came after the military stopped using
Agent Orange in 1970. It will not apply to sailors on deep-water
ships, though the department plans to study the effects of Agent
Orange on the Navy.
The shift underscores efforts
by the secretary of veterans affairs,
Eric Shinseki, a retired Army chief of staff and a Vietnam
veteran himself, to reduce obstacles to sick or disabled
veterans’ receiving benefits. The
department
has come under sharp criticism from Congress and veterans groups
for long delays in processing disability claims.
“Since my confirmation as
secretary, I’ve often asked why, 40 years after Agent Orange was
last used in Vietnam, we’re still trying to determine the health
consequences to our veterans who served in the combat theater,”
Mr. Shinseki said in a statement. “Veterans who endure a host of
health problems deserve timely decisions.”
The veterans department
already recognizes more than a dozen conditions as being
presumptively connected to Agent Orange exposure in Vietnam,
including
Hodgkin’s disease,
prostate cancer and
Type 2 diabetes.
But for diseases not on that
list, veterans are required to provide evidence directly
relating their service in Vietnam to their illness, a
requirement that often leads to application rejections and
prolonged appeals.
Veterans department officials
estimate that about 200,000 veterans might seek benefits under
the proposed change in policy. But they said they could not
estimate the cost of the change until the policy underwent
public review and was published in final form, which could take
several months.
Mr. Shinseki’s decision is a
victory for groups like Vietnam Veterans of America, which has
been pushing the department to add Parkinson’s disease, ischemic
heart conditions and
hypertension to the list of diseases presumptively linked to
Agent Orange.
But the new policy is also
likely to prompt debate over how much responsibility the federal
government should take in compensating and caring for aging
veterans who are exhibiting a growing list of physical and
psychological problems.
The most common of the three
illnesses, ischemic heart disease, restricts blood flow to the
heart, causing irregular heartbeats and deterioration of the
heart muscle.
Parkinson’s disease is
associated with a loss of cells that secrete
dopamine, a brain chemical essential for normal movement.
Patients develop tremors, rigid posture, impaired balance and an
inability to initiate movement.
Hairy-cell leukemia, a rarer
condition, is a slow-growing
cancer in which the bone marrow produces too many
infection-fighting cells, lymphocytes, that crowd out healthy
white blood cells, red blood cells and platelets.
Agent Orange, named after the
color-coded band on storage drums, was the most common herbicide
used in Vietnam to clear jungle canopy and destroy crops. It
contained one of the most toxic forms of dioxin, which has since
been linked to some cancers.
Aides said Mr. Shinseki’s
decision was influenced by a report released in July from the
Institute of Medicine that found “limited or suggestive
evidence” of an association between exposure to herbicides and
an increased chance of Parkinson’s disease and ischemic heart
disease in Vietnam veterans. The report also found “sufficient
evidence,” a stronger category, of an association between
herbicides and hairy-cell leukemia.
The report, written by a
14-member panel appointed by the institute, was based on a
review of scientific literature. The institute is required by
Congress to monitor the health effects of herbicides used in
Vietnam and produce updates every two years.
In its report, the panel
warned that there was a paucity of epidemiological data about
Vietnam veterans. As a result, the panel said, its findings did
not represent “a firm conclusion” about herbicides and
Parkinson’s and herbicides and ischemic heart disease. It said
it could not estimate the chances of veterans’ developing either
disease.
Despite those caveats, the
Institute of Medicine report has been cited by veterans
advocates as providing sufficient evidence to justify a rule
change. Under laws governing Agent Orange policies for veterans,
the department cannot make benefits decisions based on cost,
only on the scientific evidence. Aides to Mr. Shinseki said the
Institute of Medicine report provided that evidence.
Some doctors and researchers
say the expansion of Agent Orange benefits has been based on
weak or inconclusive science, given the lack of studies on
Vietnam veterans. Those skeptics argue that diseases like
prostate cancer or Type-2
diabetes are just as likely the result of aging, lifestyle
or genetic predisposition as exposure to Agent Orange.
