Appendix A
Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee
MAIN ISSUES RAISED BY THE PUBLIC
Following the delivery of the committee’s charge by a Department of Veterans Affairs representative at the first meeting, the open session continued with brief presentations by other members of the public. It has been the practice of Veterans and Agent Orange committees to conduct open sessions, not only to gather additional information from people who have particular expertise on points that arise during deliberations but also especially to hear from individual Vietnam veterans and others concerned about aspects of their health experience that may be service-related. Open sessions were held during the first three of the committee’s five meetings. Following the agendas for these public meeting is a complete list of written submissions to and considered by the committee, which are all available from this study’s Public Access File.
Having solicited input, the committee feels a responsibility to note the concerns raised, even if it is only to the extent of noting that a topic does not fall within the committee’s charge. The main issues raised by veterans or their advocates during the current updating period fell into four general categories. The following is a summary of the four main topics (in no particular order) that were raised at the open sessions and/or in submitted written statements.
- Veterans exposed to Agent Orange in places other than Vietnam: Veterans noted several locations or situations outside of Vietnam where they believe they were exposed to Agent Orange and so are entitled to coverage of those diseases recognized as service-related for veterans who had “boots on the ground” in Vietnam. Evaluating data on the basis of where
- veterans may have experienced herbicide exposure is not within the scope of this committee’s charge.
- Health problems in children and grandchildren of Vietnam veterans: Veterans noted numerous concerns about the general phenomenon of the transmission of adverse effects to offspring following paternal exposure to toxic agents. Chapter 10 addresses evidence related to the possibility that the herbicide exposure of Vietnam veterans has had adverse consequences for their progeny.
- Bladder cancer: Veterans brought the issue of bladder cancer to the committee’s attention on multiple occasions during this update, drawing particular attention to decisions from regulatory bodies concerning organic arsenic compounds, including dimethyl arsenic acid, also known as DMA or cacodylic, one of the four herbicides sprayed by the US military in Vietnam. With addition of some new findings, the relevant epidemiologic evidence (although not specifically related to exposures to cacodylic acid) now shows that there is limited or suggestive evidence of an association between the chemicals of interest and bladder cancer. Chapter 8 contains a specific discussion on the new information informing the committee’s decision to change this category of association.
- Myelodysplastic syndrome (MDS): Epidemiologic studies addressing risk factors for MDS were identified in the recent update period, but the available evidence remains insufficiently specific with respect to the four herbicides sprayed in Vietnam and their dioxin contaminant to provide a basis of a decision concerning an association other than the default decision of inadequate or insufficient. In addition, exposure to benzene is recognized as being a risk factor for MDS, and it is a component of the petroleum products used as dispersants with the herbicides. Benzene is so highly volatile that it would no longer be part of the sprayed herbicides as they reached ground level, so it is not covered under the committee’s charge. The relevant available epidemiologic evidence remains inadequate and insufficient to support an association of MDS with exposure to the committee’s chemicals of interest. See Chapter 8 for specific discussion.
FIRST PUBLIC MEETING
November 17, 2014
The National Academies’ Keck Center
500 Fifth Street, NW
Washington, DC 20001
Open Session
| 1:30 p.m. |
Welcome, goals/conduct of the open session, committee member introductions Kenneth Ramos, Committee Chair |
| 1:35 p.m. |
Charge to the committee • Origins of Study • Study Scope • Expected Outcomes R. Loren Erickson, US Department of Veterans Affairs |
| 2:00 p.m. | Vietnam Veterans of America statement |
| Rick Weidman, Executive Director, Policy and Government Affairs, Vietnam Veterans of America | |
| 2:10 p.m. | New Jersey State Council, Vietnam Veterans of America statement |
| Michael Eckstein, Chair, Agent Orange/Dioxin Committee | |
| 2:20 p.m. | Assumed association of long-term adverse health conditions from exposures and related presumptive illnesses— |
| Veteran statements | |
| Carlo Albanese, Veteran (tentative) | |
| Helene Van Clief, Army Staff Sergeant | |
| 2:40 p.m. | Recent literature addressing presumptive illnesses and post-Vietnam exposures, and VA redefinition of “exposure” in the light of post-Vietnam concerns |
| Major Wes Carter, Chair, The C-123 Veterans Association | |
| 2:50 p.m. | Open comment period |
| 3:00 p.m. | Open session adjourns |
SECOND PUBLIC MEETING
January 20, 2015
National Academies’ Beckman Conference Center
100 Academy Way
Irvine, CA 92612
Open Session
| 1:00 p.m. | Welcome, goals/conduct of the open session, committee member introductions |
| Kenneth Ramos, Committee Chair | |
| 1:15 p.m. | Open comment period |
| 3:00 p.m. | Open session adjourns |
THIRD PUBLIC MEETING
March 9, 2015
JW Marriott Tucson Starr Pass Resort
3800 West Starr Pass Boulevard
Tucson, AZ 85745
Open Session
| 1:00 p.m. | Welcome, goals/conduct of the open session, committee member introductions |
| Kenneth Ramos, Committee Chair | |
| 1:15 p.m. | Discussion on grouping B-cell neoplasms Moderator: Karl Kelsey, Brown University |
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Experts in attendance:
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Experts participating remotely:
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| 2:00 p.m. | Comments from Vietnam veterans and their representatives |
| 3:00 p.m. | Open session adjourns |
Written Statements Received from Public
1. Carlo Albanese, Veteran Spokesperson
Submitted: 11/14/2014
Letter via email: Letter Re: Mtg. 1
2. Placido Salazar, Vietnam Veteran
Submitted: 11/16/2014
Letter via email: Letter to Mary Paxton, Study Director, Re: Meeting 1
3. Leroy Foster, Vietnam Veteran
Submitted: 11/16/2014
Letter via email: Letter to Mary Paxton, Study Director, Re: Meeting 1
4. Ralph (Loren) Erickson, Pre-9/11 Era Environmental Health Program, Veterans Health Administration
Submitted: 11/17/2014
PPT: Charge to the Committee: “INSTITUTE OF MEDICINE AGENT ORANGE COMMITTEE: Veterans and Agent Orange, Biennial Update”
5. Major Wesley Carter, C-123 Veterans Association
Submitted: 11/17/2014
PPT: C-123 Veterans Association Presentation
6. Major Wesley Carter, C-123 Veterans Association
Submitted: 11/17/2014
PDF: Written Statement: “Statement of the C-123 Veterans Association by Wesley T. Carter, Chair”
7. Major Wesley Carter, C-123 Veterans Association
Submitted: 11/17/2014
USB/Zip File (44 items): Compilation of documents submitted to the Committee by the C-123 Veterans Association
8. Helene Van Clief, Vietnam Veteran
Submitted: 11/17/2014
Email+ 1 attachment PDF: Information on Women Veterans and Stateside Exposures at Fort McClellan
9. Placido Salazar, Vietnam Veteran
Submitted: 11/17/2014
Letter via email: Letter to Mary Paxton, Study Director
10. Michael Eckstein, Agent Orange/Dioxin Committee, New Jersey State Council, VVA
Submitted: 11/17/2014
PDF: Written statement: Written version of oral presentation to the committee
11. Michael Eckstein, Agent Orange/Dioxin Committee, New Jersey State Council, VVA
Submitted: 11/17/2014
PDF: VAO Report Series Stats Spreadsheet
12. Carlo Albanese, Veteran Spokesperson
Submitted: 11/17/2014
2 DVDs: Video Statement by Carlo Albanese on behalf of the Veterans and Agent Orange Movement Group
13. Charles Kelley, Vietnam Veteran
Submitted: 11/19/2014
Letter via email: Letter to Mary Paxton, Study Director
14. Placido Salazar, Vietnam Veteran
Submitted: 11/23/2014
Letter via email + 1 attachment PDF: Letter to Mary Paxton, Study Director and a Leaked 1990 EPA Memo
15. Michael Eckstein, Agent Orange/Dioxin Committee, New Jersey State Council, VVA
Submitted: 11/25/2014
Excel: VAO Report Series Stats Spreadsheet (full electronic version of item #11 above)
16. Peter Sullivan, The Thomas Joseph Sergeant Sullivan Center
Submitted: 1/23/2015
Email: Fwd: Agent Orange report comes after years of VA denials
17. John J. Bury, Vietnam Veteran
Submitted: 2/23/2015
Email: John Bury Letter Agent Orange Effects
18. Donald Wilbur
Submitted: 3/4/2015
Email: Donald Wilbur Written Statement
19. Rae Grisius, Bladder Cancer Advocacy
Submitted: 3/5/2015
Email: Statement of Rae Grisius
20. John McClun, US Army (Retired)
Submitted: 3/6/2015
Email: John McClun Written Statement
21. Gwendolyn Krossfik
Submitted: 3/6/2015
Email: Statement of Gwendolyn Krofssik
22. Carla Dean, Bladder Cancer Foundation of Florida
Submitted: 3/9/2015
Email: Statement of Carla Dean
23. Carla, Dean, Bladder Cancer Foundation of Florida
Submitted: 3/9/2015
PDF: Carla Dean Attachment EPA Organic Arsenicals
24. Carla Dean, Bladder Cancer Foundation of Florida
Submitted: 3/9/2015
Email: Carla Dean Attachments on Arsenic Exposures (A-–H)
- Carla Dean Attachment A Hazardous Substances
- Carla Dean Attachment B EPA Arsenic Compounds
- Carla Dean Attachment C EPA Cacodylic Acid
- Carla Dean Attachment D Thesis Arsenic Contamination in Ground Water in Vietnam
- Carla Dean Attachment E Full Report Arsenic Contamination in Ground Water in Vietnam
- Carla Dean Attachment F Environmental Health Criteria 224 Arsenic and Arsenic Compounds Link to Full Report
- Carla Dean Attachment G Abstract Increased Lung and Bladder Cancer Incidence in Adults after In Utero and Early-Life Arsenic Exposure
- Carla Dean Attachment H Mortality study of chemical workers exposed to dioxins
25. Judy Bryant, Alderson Broaddus University
Submitted: 3/9/2015 Email: Judy Bryant Statement to Institute of Medicine Committee reviewing the Health Effects in Vietnam Veterans of Exposure to Herbicides
26. Lisa Rimsza, MD University of Arizona, Tucson
Submitted: 3/10/2015
Presentation: Lymphoma Classification
27. Daniel O. Persky, MD University of Arizona Cancer Center
Submitted: 3/10/2015
Presentation: Biological mechanisms in clinical applications for B-cell neoplasms cell of origin in diffuse large B-cell lymphoma
28. Bill Colberg, Vietnam Veterans of America
Submitted: 3/10/2015
Letter: Bill Colberg Statement VVA Presentation Before the IOM Committee
29. Dennis St. Germaine, Vietnam Veterans for America
Submitted: 3/10/2015
A. Audio Vietnam Veterans for America Agent Orange
30. Carolyn C. McGrath
Submitted: 3/18/2015
Letter: Carolyn C. McGrath Statement and Materials
31. Toby Watson, MD
Submitted: 3/27/2015
Letter: Rates of Missing Conditions: It Looks Like Psychiatric Disorders
32. Charles Kelley
Submitted: 3/31/2015
Letter: Concerning TCDD’s role in all cancers
33. Carla Dean, Bladder Cancer Foundation of Florida
Submitted: 5/29/2015
Article: Agent Blue Arsenic Laced Rainbow
34. Jamie Chadwick
Submitted: 6/23/2015
Letter: Jamie Chadwick Statement on Bladder Cancer
35. Cindy Fabbri
Submitted: 7/17/2015
Letter: Cindy Fabbri Statement On Esophageal Cancer
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