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Veterans and Agent Orange: Update 2014 (2016)

Chapter: Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee

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Page 1047 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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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
Page 1048 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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  • 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.
Page 1049 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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
Page 1050 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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
Page 1051 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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
 

Experts in attendance:

  • Recent classification paradigms
    Lisa Rimsza, MD, University of Arizona
  • Role of biological mechanism in clinical applications
    Dan Persky, MD, University of Arizona
 

Experts participating remotely:

  • Elaine Jaffe, MD, iOM, National Cancer institute
  • Members of InterLymph Project team:
    • Annaclaire De Roos, PhD, MPH, Drexel University
    • Martha Linet, MD, MPH, National Cancer institute
    • Lindsay Morton, PhD, National Cancer institute
2:00 p.m. Comments from Vietnam veterans and their representatives
3:00 p.m. Open session adjourns
Page 1052 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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

Page 1053 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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

Page 1054 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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)

  1. Carla Dean Attachment A Hazardous Substances
  2. Carla Dean Attachment B EPA Arsenic Compounds
  3. Carla Dean Attachment C EPA Cacodylic Acid
  4. Carla Dean Attachment D Thesis Arsenic Contamination in Ground Water in Vietnam
  5. Carla Dean Attachment E Full Report Arsenic Contamination in Ground Water in Vietnam
  6. Carla Dean Attachment F Environmental Health Criteria 224 Arsenic and Arsenic Compounds Link to Full Report
  7. Carla Dean Attachment G Abstract Increased Lung and Bladder Cancer Incidence in Adults after In Utero and Early-Life Arsenic Exposure
  8. 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

Page 1055 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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

Page 1056 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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Page 1047 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1047
Page 1048 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1048
Page 1049 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1049
Page 1050 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1050
Page 1051 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1051
Page 1052 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1052
Page 1053 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1053
Page 1054 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1054
Page 1055 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1055
Page 1056 Cite
Suggested Citation:"Appendix A: Issues Raised by the Public and Agendas of Public Meetings Held by the Committee and Other Written Submissions to the Committee." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
Page 1056
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From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam.

Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far.

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