Scientific, Social and Administrative Challenges of Identifying and Compensating for Medical Conditions presumptively related to exposure to Agent Orange

Military service can be a patriotic gesture, a civic duty, a vocational choice, a time of excitement, an opportunity to see new places, build intense emotional relationships, develop new skills, and overcome great challenges – but it can also be a time in which service men and women are exposed to great risks and dangers, leading to illness, disability and death. Unlike other occupations in which industrial hygienists can engineer a safe work place and minimize risk of occupational injuries, military service is intrinsically dangerous. Despite efforts to mitigate risk by physical training, body armor, hearing protection, immunization and utilization of technical innovation, injuries inevitably occur. By the “Law of unintended consequences” even measures employed to protect troops can have unexpected adverse consequences. Agent Orange was a defoliant used in Southeast Asia during the Vietnam War by allied forces to reduce the cover of vegetation used by North Vietnamese snipers and troops infiltrating South Vietnam territory. In subsequent decades we have learned that Agent Orange has caused a wide variety of metabolic and genetic medical problems in veterans and other people exposed to it. In response to the recognition of the unintended and unexpected adverse effects of Agent Orange, the Department of Veterans Affairs set up the Agent Orange Database Screening Program to see just what sorts of problems Vietnam veterans were actually having and an external advisory mechanism to identify any scientific evidence that could be used to establish presumptive connections between dioxin exposure and medical problems decades later. Recognized Agent Orange-associated adverse medical conditions have mushroomed over the period since Agent Orange spraying ceased in 1971. The accepted list of conditions presumptively associated with Agent Orange exposure has grown from chloracne, peripheral neuropathy, and soft tissue sarcoma to encompass an ever increasing group of cancers including lung cancer, lymphoma, prostate cancer and multiple myeloma. As the Vietnam veteran population has aged, dioxin has also been associated with pervasive metabolic and neurologic problems including accelerated development of diabetes, atherosclerotic cardiovascular disease and Parkinson's Disease. It is important to appreciate the enormous challenges of using the best available scientific evidence to identify valid connections between Agent Orange exposure 4 decades ago with medical conditions developing in veterans who have had 40 years of exposure to other possible etiologic factors plus the inevitable effects of aging. The administrative challenge is immense and continues to grow, but increased personnel resources and efforts at computerization of the claims process are being utilized to reduce the backlog of Vietnam veterans' claims.