BLUE WATER NAVY VIETNAM VETERANS AND AGENT ORANGE EXPOSURE
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract V101 (93) P-2136 (Task Order 21) between the National Academy of Sciences and the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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IOM (Institute of Medicine). 2011. Blue Water Navy Vietnam Veterans and Agent Orange Exposure. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
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COMMITTEE ON BLUE WATER NAVY VIETNAM VETERANS AND AGENT ORANGE EXPOSURE
ROBERTA B. NESS, M.D. (Chair), Dean,
School of Public Health, University of Texas
PATRICK N. BREYSSE, Ph.D., Professor,
Department of Environmental Sciences, Johns Hopkins University Bloomberg School of Public Health
RICHARD CLAPP, D.Sc., Professor,
Department of Environmental Health, Boston University
MIRIAM DIAMOND, Ph.D., Professor,
Department of Geography and Program in Planning and Department of Chemical Engineering and Applied Chemistry, Dalla Lana School of Public Health, University of Toronto
MENACHEM ELIMELECH, Ph.D., Chair,
Department of Chemical Engineering, Yale University
KIMBERLY L. JONES, Ph.D., Professor and Chair,
Department of Civil Engineering, Howard University
SAMUEL KACEW, Ph.D., Professor of Pharmacology,
McLaughlin Centre for Population Health and Risk Assessment, University of Ottawa
DAVID KALMAN, Ph.D., Chairman and Professor,
Department of Environmental and Occupational Health Sciences, University of Washington
JUDY LAKIND, Ph.D., President,
Department of Epidemiology and Public Health, University of Maryland School of Medicine, and
Adjunct Associate Professor,
Department of Pediatrics, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center
JOSE SERICANO, Ph.D., Research Scientist,
Geochemical and Environmental Research Group, Texas A&M University
KENNETH R. STILL, Ph.D., Director and Toxicology Consultant,
Occupational Toxicology Associates Inc., and
Environmental Health, School of Community Health, Portland State University
ROBERTA WEDGE, Study Director
MARGOT IVERSON, Program Officer
DOMINIC BROSE, Associate Program Officer
CARY HAVER, Associate Program Officer
JOSEPH GOODMAN, Senior Project Assistant
JONATHAN SCHMELZER, Senior Project Assistant
NORMAN GROSSBLATT, Senior Editor
CHRISTIE BELL, Financial Officer
RICK ERDTMANN, Director,
Board on the Health of Select Populations
This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of the report:
YORAM COHEN, Ph.D., University of California, Los Angeles
SEYMOUR DEITCHMAN, Independent Consultant
MICHAEL GALLO, M.D., UMDNJ–Robert Wood Johnson Medical School
DAVID H. GARABRANT, M.D., University of Michigan
ROBERT HERRICK, S.D., Harvard School of Public Health
WILLIAM LUTTRELL, Ph.D., Oklahoma Christian University
JOEL MICHALEK, Ph.D., University of Texas Health Science Center
CLAUDIA S. MILLER, M.D., University of Texas Health Science Center at San Antonio
DAVID RICHARDSON, Ph.D., University of North Carolina
THOMAS J. SMITH, Ph.D., Harvard University
RICHARD WANG, D.O., Centers for Disease Control and Prevention
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Rogene Henderson, Ph.D., Lovelace Respiratory Research Institute, and Kristine M. Gebbie, Dr.P.H., R.N., Flinders University of South Australia. Appointed by the NRC and the Institute of Medicine, they were responsible for making certain that an independent examination of
The committee has been asked to consider whether Blue Water Navy veterans might have been exposed to herbicides used in Vietnam, specifically Agent Orange and its contaminant, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), and whether this exposure could lead to an increased risk of long-term adverse health outcomes.
When Congress passed the Agent Orange Act of 1991 (Public Law 102-4), which provided for presumption of service connections for diseases associated with exposure to certain herbicide agents, initially the law was interpreted to apply to all service men and women deployed to Vietnam including members of the Blue Water Navy. But in 2002, the Department of Veterans Affairs (VA) took the position that for a Vietnam veteran to be presumed to have been exposed to Agent Orange, the veteran must demonstrate that he or she actually set foot in Vietnam, and in 2008, that VA position was upheld by the US Court of Appeals for the Federal Circuit. This position effectively excluded most Blue Water Navy veterans from receiving a presumption of service connection for diseases associated with exposure to herbicides.
Nevertheless, Blue Water Navy Vietnam veterans continue to have concerns that they were exposed to Agent Orange and TCDD during their wartime service. A 2002 Australian study showing that TCDD could be enriched in a simulation of the distillation process used on the US Navy and Royal Australian Navy ships during the Vietnam War era to produce potable water raised awareness among Blue Water Navy veterans that a unique mechanism might exist by which they might have been exposed to TCDD. These concerns and a 2009 Institute of Medicine (IOM) Veterans and Agent Orange report that supported the findings of the Australian study prompted VA to ask the IOM to establish a committee to specifically study whether the Vietnam veterans in the Blue Water Navy experienced exposures to herbicides and their contaminants comparable with those of veterans who served on the inland waters of Vietnam (the Brown Water Navy) and those who served on the ground in Vietnam.
In approaching its task, the committee attempted to collect as much scientific and historical information as possible to shed light on the question of possible herbicide exposure by Blue Water Navy veterans. The committee was surprised and disheartened to find a dearth of
information on environmental concentrations of TCDD during the Vietnam War, in spite of the large volumes of Agent Orange sprayed throughout South Vietnam. Such information is vital to determining possible exposures not only of Navy veterans but also veterans who served on the ground and on the inland waterways of Vietnam.
The committee struggled with how to deal with the lack of scientific data on which to base its conclusions. Because of the paucity of data available, the committee decided that it would be necessary to approach its task by evaluating whether Blue Water Navy personnel were or were not exposed to Agent Orange and its associated TCDD, and whether it is possible to state with certainty that exposure of Blue Water Navy personnel, taken as a group, was qualitatively different from that of their Brown Water Navy and ground counterparts.
Despite this limited framework for asking the question, the committee could not find enough data to determine whether or not Blue Water Navy personnel were exposed to Agent Orange–associated TCDD. At the same time, the committee could not clearly delineate whether there were overlapping exposures between personnel categories. Indeed the committee believes that given the lack of measurements taken during the war and the almost 40 years since the war, this will never be a matter of science but instead a matter of policy.
The committee appreciates the importance of this issue for many Blue Water Navy Vietnam veterans, and the committee owes a tremendous thanks to the many individuals and groups who generously gave of their time and expertise to share with committee members their insight into particular issues, to provide copies of reports and research articles, and to answer queries about their work and experiences during the war. The committee is especially grateful to the many veterans who shared their personal stories and who provided historical documents. Among the many people who provided helpful information to the committee are David Barrans, Victoria Cassano, Michael Peterson, and James Sampsel of the Department of Veterans Affairs; Susan Belanger; Thomas Boivin, Hatfield Consultants; Joseph Carnevale, US Navy (retired); Michael Cassady, US Navy; William G. Jeff Davis and Michael Teaney, Veterans Association of Sailors of the Vietnam War; Frederick Gersh; Charles Gordon, Mac McLaughlin, and the docents of the USS Midway; Thomas Hamrick, US Navy (retired); Clint Hoffmann, US Department of Agriculture; Mary Ellen McCarthy, Committee on Veterans’ Affairs, US Senate; Paul McCarthy, US Navy (retired); John
Paul Rossie, Blue Water Navy Vietnam Veterans Association; Jeanne Stellman, Columbia University; and John Wells, US Navy (retired).
The committee is also very grateful to Roberta Wedge, who served as study director for this project, and to all of the IOM staff members who contributed to this project: Dominic Brose, Joseph Goodman, Cary Haver, Margot Iverson, and Jonathan Schmelzer. A thank you is also extended to William McLeod who conducted database and literature searches.
Roberta B. Ness, Chair
Committee on Blue Water Navy Vietnam Veterans and Agent Orange Exposure
Tables, Figures, and Box
Major Herbicides Used in Operation Ranch Hand, 1962–1971,
Examples of Adverse Health Effects Associated with Chemical Exposure,
Summary of Seventh Biennial Update of Findings of Occupational, Environmental, and Veteran Studies Regarding Associations Between Exposure to Herbicides and Specific Health Outcomes,
Association of Selected Characteristics of Military Service in Vietnam with NHL in the Selected Cancers Study, 1984–1988,
Association of Selected Characteristics of Military Service in Vietnam with Hodgkin’s Disease in the Selected Cancers Study, 1984–1988,
Aerial herbicide spraying missions in southern Vietnam, 1965–1971,
Environmental fate and transport processes for Agent Orange and TCDD,
Exposure pathways for Agent Orange–associated TCDD,
Veterans’ Diseases Associated with Agent Orange Exposure,