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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
×

POST-VIETNAM DIOXIN EXPOSURE
IN AGENT ORANGE–CONTAMINATED
C-123 AIRCRAFT

Committee to Evaluate the Potential Exposure to
Agent Orange/TCDD Residue and
Level of Risk of Adverse Health Effects for
Aircrew of Post-Vietnam C-123 Aircraft

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
×

THE NATIONAL ACADEMIES PRESS      500 Fifth Street, NW      Washington, DC 20001

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/Grant No. VA241-P-2024 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 author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-30890-8
International Standard Book Number-10: 0-309-30890-9

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Copyright 2015 by the National Academy of Sciences. All rights reserved.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2015. Post-Vietnam Dioxin Exposure in Agent Orange–Contaminated C-123 Aircraft. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
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INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr. is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
×

COMMITTEE TO EVALUATE THE POTENTIAL EXPOSURE TO AGENT ORANGE/TCDD RESIDUE AND LEVEL OF RISK OF ADVERSE HEALTH EFFECTS FOR AIRCREW OF POST-VIETNAM C-123 AIRCRAFT

ROBERT F. HERRICK (Chair), Harvard School of Public Health

ROBERT CANALES, University of Arizona

KENNY S. CRUMP, Independent Consultant

MELISSA GONZALES, University of New Mexico

JOHN C. KISSEL, University of Washington

LINDA A. MCCAULEY, Emory University

CLIFFORD P. WEISEL, Rutgers University

IOM Staff

MARY BURR PAXTON, Co-study Director, Senior Program Officer

JENNIFER A. COHEN, Co-study Director, Program Officer

HEATHER L. CHIARELLO, Research Associate

FREDERICK J. ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’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 for 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 this report:

Richard A. Fenske, University of Washington

Michael A. Gallo, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School

Melissa J. Perry, George Washington University

Martin A. Philbert, University of Michigan

Dale Sandler, National Institute of Environmental Health Sciences

Lauren Zeise, California Environmental Protection Agency

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 this report was overseen by Kristine M. Gebbie, Flinders University of South Australia. Appointed by the National Research and the

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Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
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Acknowledgments

This report was greatly enhanced by the participants of the workshop that was held as part of this study. The committee would like to acknowledge the efforts of those who gave presentations and who provided materials to the committee during the course of the study’s information-gathering period: Wesley Carter (C-123 Veterans Association), Jeffrey Driver (RiskScience.net), Patrick Finley (Sandia National Laboratories), Harry Heist II (Air Mobility Command Museum, Dover, Delaware), Peter Kahn (AESOP, Rutgers University), Peter Lurker (Germantown Consultants, LLC), Thomas McKone (University of California, Berkeley), William Nazaroff (University of California, Berkeley), Brian Nicklas (National Air and Space Museum Archives), Thomas Sinks (Agency for Toxic Substances and Disease Registry), Jeanne Stellman (Columbia University), and Alvin Young (A.L. Young Consulting, Inc.). The information that was provided helped to set the stage for fruitful discussions in the closed session that followed. The committee greatly appreciates the contribution of Roberta Wedge (Institute of Medicine) in providing experienced, but fresh eyes to the report. The committee would also like to acknowledge and thank Chensheng (Alex) Lu (Harvard School of Public Health) for his participation as a committee member before resigning in September 2014.

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Acronyms and Abbreviations

2,4-D

2,4-dichlorophenoxyacetic acid

2,4,5-T

2,4,5-trichlorophenoxyacetic acid

 

ADI

acceptable daily intake

AF (USAF)

US Air Force

AFB

Air Force Base

AFHS

Air Force Health Study

AHR

aryl hydrocarbon receptor

AMARC

Aerospace Maintenance and Regeneration Center

AMARG

Aerospace Maintenance and Regeneration Group

AME

aero-medical evacuation

AO

Agent Orange (general term for all herbicide formulations containing TCDD)

atm

atmosphere (measure for vapor pressure)

ATSDR

Agency for Toxic Substances and Disease Registry

 

CAG

Cancer Assessment Group (EPA)

CHPPM

US Army Center for Health Promotion and Preventive Medicine

CVA

C-123 Veterans Association

 

ECG

electrocardiogram

EPA

US Environmental Protection Agency

 

HO

Herbicide Orange (equivalent to Agent Orange)

 
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
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IOM

Institute of Medicine

 

LOAEL

lowest-observed-adverse-effect level

lpm

liters per minute

 

MAP

Military Assistance Program

MASDC

Military Aircraft Storage and Disposal Center

MDI

mean daily intake

mg/m3

milligrams per cubic meter

 

NAS

National Academy of Sciences

ng/m2

nanograms per square meter

NIEHS

National Institute of Environmental Health Sciences

NIOSH

National Institute for Occupational Safety and Health

NMDOH

New Mexico Department of Health

NOEL

no-observed-effect level

NRC

National Research Council

ORH

Operation Ranch Hand (military codename for operation that

 

sprayed herbicides during the Vietnam War)

ORH C-123

UC-123 aircraft formerly used in ORH

 

PCB

polychlorinated biphenyl

PCDD

polychlorinated dibenzo-p-dioxin

PCDF

polychlorinated dibenzofuran

ppm

parts per million

PUF

polyurethane foam (vapor phase collection method)

 

QA/QC

quality assurance/quality control

 

RfD

noncancer reference dose

RH

Ranch Hand (name for individuals who served in ORH)

 

SVOC

semi-volatile organic compound

SWSL

surface wipe screening level

 

TAG

Tactical Airlift Group

TAS

Tactical Airlift Squadron

TC

transfer coefficient

TCDD

2,3,7,8-tetrachlorodibenzo-p-dioxin

TDI

tolerable daily intake

TEF

Toxicity Equivalency Factor

TEQ

Toxicity Equivalency Quotient (weighted total of TEFs)

TG 312

Technical Guide 312 (CHPPM, 2009)

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft. Washington, DC: The National Academies Press. doi: 10.17226/18848.
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TSCA

Toxic Substances Control Act

 

µg/kg

microgram per kilogram

µg/kg-d

microgram per kilogram per day (format for “mass per

 

kilogram-body weight per time unit”)

µg/m2

microgram per square meter (= 0.01 µg/100 cm2)

USAF

US Air Force

USAFSAM

US Air Force School of Aerospace Medicine

 

VA

Department of Veterans Affairs

VAO

Veterans and Agent Orange (IOM report series)

 

WHO

World Health Organization

WTC

World Trade Center

 

y0

gas-phase concentration immediately above contaminated surface

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From 1972 to 1982, approximately 1,500-2,100 US Air Force Reserve personnel trained and worked on C-123 aircraft that had formerly been used to spray herbicides in Vietnam as part of Operation Ranch Hand. After becoming aware that some of the aircraft on which they had worked had previously served this purpose, some of these AF Reservists applied to the US Department of Veterans Affairs (VA) for compensatory coverage under the Agent Orange Act of 1991. The Act provides health care and disability coverage for health conditions that have been deemed presumptively service-related for herbicide exposure during the Vietnam War. The VA denied the applications on the basis that these veterans were ineligible because as non-Vietnam-era veterans or as Vietnam-era veterans without "boots on the ground" service in Vietnam, they were not covered. However, with the knowledge that some air and wipe samples taken between 1979 and 2009 from some of the C-123s used in Operation Ranch Hand showed the presence of agent orange residues, representatives of the C-123 Veterans Association began a concerted effort to reverse VA's position and obtain coverage.

At the request of the VA, Post-Vietnam Dioxin Exposure in Agent Orange-Contaminated C-123 Aircraft evaluates whether or not service in these C-123s could have plausibly resulted in exposures detrimental to the health of these Air Force Reservists. The Institute of Medicine assembled an expert committee to address this question qualitatively, but in a scientific and evidence-based fashion. This report evaluates the reliability of the available information for establishing exposure and addresses and places in context whether any documented residues represent potentially harmful exposure by characterizing the amounts available and the degree to which absorption might be expected. Post-Vietnam Dioxin Exposure rejects the idea that the dioxin residues detected on interior surfaces of the C-123s were immobile and effectively inaccessible to the Reservists as a source of exposure. Accordingly, this report states with confidence that the Air Force Reservists were exposed when working in the Operation Ranch Hand C-123s and so experienced some increase in their risk of a variety of adverse responses.

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