NEWS

4 problems the VA secretary wants associated with Agent Orange

VA Secretary David Shulkin suggests he favors expansion of Agent Orange-related health care and disability compensation to new categories of ailing veterans but that factors, like cost, medical science, and politics, still stand in the way.


Shulkin told the Senate Veterans Affairs Committee on March 21, 2018, that he made recommendations to White House budget officials in 2017 on whether to add up to four more conditions — bladder cancer, hypothyroidism, Parkinson-like tremors, and hypertension (high blood pressure) — to the VA list of 14 illnesses presumed caused by exposure to herbicides used during the Vietnam War.

Also read: VA begins awarding compensation for C-123 agent orange claims

"I have transmitted my recommendations to the [White House's] Office of Management and Budget. I did that by Nov. 1, 2017, Shulkin said. "And we are in the process right now of going through this data. In fact, we met with [OMB officials] on March 26, 2018. They asked for some additional data to be able to work through the process and be able to get financial estimates for this. So, we are committed to working with OMB to get this resolved in the very near future."

Shulkin didn't say which of the four conditions, if any, he wants added to the presumptive list, if and when cleared by the White House.

At the same hearing, the VA chief was asked his position on Blue Water Navy veterans of the Vietnam War who also suffer from illnesses on the VA presumptive list but aren't eligible to use it to facilitate claims for care and compensation.

They "have waited too long for this," Shulkin agreed, but then suggested the solution for these veterans is blocked by medical evidence or swings on the will of the Congress.

Barrels of Agent Orange being stored at Johnston Atoll.

"I would like to try to find a way where we can resolve that issue for them, rather than make them continue to wait," Shulkin said. "I do not believe there will be scientific data [to] give us a clear answer like we do have on the Agent Orange presumptive" list for veterans who had served in-country. "For the Blue Water Navy… epidemiologic studies just aren't available from everything I can see. So, we're going to have to sit down and do what we think is right for these veterans."

Vietnam veterans who served even a day in-country who have illnesses on the presumptive list can qualify for VA medical care and disability compensation without having to show other evidence that their ailments are service-connected.

Shulkin said VA "recently" received the last report of the National Academy of Medicine, which found a stronger scientific association than earlier studies between certain ailments and herbicide exposure. In fact, however, the VA has had the report, Veterans and Agent Orange: Update 2014, for two years.

More: 5 life lessons today's troops could learn from Vietnam vets

It was written by a committee of medical experts that reviewed medical and scientific literature on select ailments and herbicide exposure published from Oct. 1, 2012, through Sept. 30, 2014. Released in March 2016, the report found evidence to support raising the strength of association between herbicide exposure and bladder cancer and hypothyroidism. The report upgrades the link from "inadequate or insufficient" evidence to "limited or suggestive" evidence of an association.

In years past, VA decided that for some ailments, such as Parkinson's and ischemic heart disease, "limited or suggestive evidence" was enough to add these illnesses to the Agent Orange presumptive list. For others, including hypertension, a more common disease of aging, VA deemed it wasn't enough.

This last NAM report, however, looked again at cardiovascular conditions and herbicide exposure. It didn't upgrade the link to heart ailments but it did affirm limited or suggestive evidence that hypertension is linked to herbicide exposure.

U.S. Army Huey helicopter spraying Agent Orange over agricultural land during the Vietnam War.

It also studied whether Parkinson's-like symptoms should fall into the same limited or suggestive category as Parkinson's disease itself. The 2016 report found "no rational basis" to continue to exclude Parkinson-like symptoms from the same risk category. Parkinson's disease itself was added to presumptive list in 2010.

VA secretaries under both the Obama and Trump administration reacted more slowly on the last NAM perhaps, by law, they could. Congress in 2015 let a portion of the Agent Orange law expire, language that required the VA Secretary to decide on new presumptive conditions within 180 days of accepting a NAM report.

The impact was immediate. Though a senior VA official tasked with reviewing this last NAM report said then-VA Secretary Bob McDonald would make his decisions within three months, it didn't happen. McDonald left it to his successor. Shulkin waited more months and, in July 2017, vowed to decide by Nov. 1, 2017 OMB blocked an announcement, however, presumably over projected costs.

Related: A Vietnam veteran is returning to thank the doctors who saved his life

Cost has been a factor, too, in Congress not passing legislation to extend VA benefits to Blue Water Navy veterans diagnosed with illnesses on the presumptive list. Budget analysts a few years ago estimated a cost of $1.1 billion over 10 years.

Also, NAM did conduct a review of medical and scientific evidence regarding Blue Water Veterans' possible exposure to herbicides and concluded in a May 2011 report that "there was not enough information… to determine whether Blue Water Navy personnel were or were not exposed to Agent Orange."

Blue Water Veterans remain ineligible to use the Agent Orange presumptive list. A lone exception is granted for veterans with non-Hodgkin's lymphoma. Vietnam veterans with this ailment may be granted service-connection without showing inland waterway service or that they set foot in-country.

In every session of Congress, going back years, Blue Water Navy bills have been introduced. They would, if passed, "include as part of the Republic of Vietnam its territorial seas for purposes of the presumption of service connection for diseases associated with exposure [to] herbicide agents while in Vietnam."

The current House version of the Blue Water Navy Vietnam Veterans Act (HR 299), introduced in January 2017 by Rep. David Valado (R-Ga.), has 327 co-sponsors. Yet prospects of passage remain dim. Valado reminded Shulkin at a mid-March 2018 hearing of the House Veterans Affairs Committee that, six months ago, Shulkin said he was seeking more recommendations from "subject matter experts" on the issue and would be ready to update Congress in the coming months.

"Have you come to a decision on Blue Water Navy veterans?"

Also read: This is what the average 'doc' carried on patrol in Vietnam

"I am aligned with you that these veterans have waited too long," Shulkin said, "and this is a responsibility that this country has. And, as our veterans get older, it's unfair.…I believe it is imperative upon us to resolve this issue.

"I also believe," Shulkin continued, "that there will not be strong scientific data to help resolve this," in other words to justify benefit expansion. "This is going to be an obligation that we feel as a country, that these veterans shouldn't be waiting any longer. And I am on the side of trying to find a way to resolve this for the Blue Water Navy veterans."

Shulkin said his staff is "working hard to look at offsets" which means cuts to other parts of the VA budget to pay for Blue Water Navy benefits, or to find "other ways to be able to do that. And it is a high priority for us."

Reminded by Valado that "with these types of cancers, time is of the essence," Shulkin replied, "Absolutely."

The Senate version of Blue Water legislation, S 422, was introduced by Sen. Kirsten Gillibrand (D-N.Y.), has 49 co-sponsors and, so far, equally dim prospects of passage.

4 critical components to the success of the first total penis transplant

The procedure was performed on an Afghanistan war veteran wounded by an IED

Doctors at the Johns Hopkins University School of Medicine in Maryland announced the first-ever successful total penis and scrotum transplant was performed on an Afghanistan veteran recently. The recipient was wounded in an IED attack that left him without sexual or urinary function but left his internal organs unharmed.

The procedure was performed on March 26th and the unidentified "sergeant" will have urinary function by the end of the week.

Keep reading... Show less
Articles

How R. Lee Ermey's Hollywood break is an inspiration to us all

While there have been many outstanding actors and celebrities who have raised their right hand, there has never been a veteran who could finger point his way to the top of Hollywood stardom quite like the late great Gunnery Sergeant R. Lee Ermey.

Keep reading... Show less
GEAR & TECH

Marines used a 3D printed F-35 replacement part for the first time

Marines with Combat Logistic Battalion 31, 31st Marine Expeditionary Unit, are now capable of "additive manufacturing," also known as 3-D printing.

This innovative process uses 3-D printing software to break down a digital model into layers that can be reproduced by the printer. The printer then builds the model from the ground up, layer by layer, creating a tangible object.

Keep reading... Show less
History

The 'indomitable determination' of John Paul Jones lives on in the Navy

April is a great month to remember the namesake of one of our Pearl Harbor guided-missile destroyers, USS John Paul Jones, named for a founding hero of our Navy and proudly known by the crew and their families and friends as "JPJ."

On April 19, 1775, the Battles of Lexington and Concord lit the match of Revolution against British tyranny. At the time Great Britain had more than 250 warships with nearly half having 50 or more guns – cannons. Our tiny naval force consisted of a few ragtag privateers and some humble sailing vessels. Even before our nation began, the founders commissioned 13 frigates and recruited warfighters, including immigrants like John Paul Jones.

Keep reading... Show less
Articles

This is how the 'missing man formation' honors fallen pilots

The first time I witnessed a 'missing man formation' was at the funeral of my grandfather, who flew the B-25 Mitchell during World War II. After his service in the Army Air Corps, he became a commercial pilot for TWA and then ventured into private flight. He died in an airplane crash at the age of 74 and my family gathered with his aviation community at Santa Paula Airport for his memorial.

At the ceremony, we looked to the sky as a group of planes from the Condor Squadron flew overhead. One of the planes banked away, leaving an empty space in the formation.

The symbolism was not lost on me.

Keep reading... Show less
Veterans

This Army vet started a supplement company dedicated to education

Before John Klipstein joined the Army, he smoked a pack a day and his PT test run time was roughly 23 minutes — which accounts for the time spent throwing up on the side of the track. The military turned that around. The newly-minted 13B found a love for fitness and pushing his body to the limit. After leaving the military, he developed a line of supplements to help others do the same — safely.

Keep reading... Show less

Taiwan is ready to push back against China's aggression

Tensions between the Peoples Republic of China and Taiwan have recently flared up as China held the largest show of naval force in its history in April 2018, and made new threats directed towards Taipei.

"We would like to reaffirm that we have strong determination, confidence and capability to destroy any type of 'Taiwan independence' scheme in order to safeguard the country's sovereignty and territorial integrity," Ma Xiaoguang, a spokeswoman for the State Council's Taiwan Affairs Office, recently said.

Keep reading... Show less
GEAR & TECH

The president is getting a new Marine One after almost 60 years

Marine One is an icon of the presidency and for the most part, one helicopter has carried that load for almost 60 years: The VH-3, which first carried President Eisenhower in 1961. The current D model of the VH-3 entered service in 1978 and was later backed up with the introduction of the VH-60N in 1987. But, the fact remains that both of these helicopters are getting older by the day.

Keep reading... Show less