Diabetes now tops Vietnam vets' claims

[August 31, 2010]  RALEIGH, N.C. (AP) -- By his own reckoning, a Navy electrician spent just eight hours in Vietnam, during a layover on his flight back to the U.S. in 1966. He bought some cigarettes and snapped a few photos.

The jaunt didn't make for much of a war story, and there is no record it ever happened. But the man successfully argued that he may have been exposed to Agent Orange during his stopover and that it might have caused his diabetes -- even though decades of research into the defoliant have failed to find more than a possibility that it causes the disease.

Because of worries about Agent Orange, about 270,000 Vietnam veterans -- more than one-quarter of the 1 million receiving disability checks -- are getting compensation for diabetes, according to Department of Veterans Affairs records obtained by The Associated Press through the Freedom of Information Act.

More Vietnam veterans are being compensated for diabetes than for any other malady, including post-traumatic stress disorder, hearing loss or general wounds.

Tens of thousands of other claims for common ailments of age -- erectile dysfunction among them -- are getting paid as well because of a possible link, direct or indirect, to Agent Orange.

And the taxpayers may soon be responsible for even more: The VA said Monday that it will add heart disease, Parkinson's disease and certain types of leukemia to the list of conditions that might be connected to Agent Orange. The agency estimates that the new rules, which will go into effect in two months unless Congress intervenes, will cost $42 billion over the next 10 years.

Lawmakers and federal officials who have reservations about the spending are loath to criticize a program that helps servicemen. They have largely ignored a 2008 report in which a group of scientists said the decision to grant benefits to so many on such little evidence was "quite extreme."

"There needs to be a discussion about the costs, about how to avoid false positives while also trying to be sure the system bends over backwards to be fair to the veterans," said Jonathan M. Samet, a public health expert who led that study and now serves as director of the Institute for Global Health at the University of Southern California.

The VA uses a complex formula when awarding benefits and does not track how much is spent for a specific ailment, but AP calculations based on the records suggest that Vietnam veterans with diabetes should receive at least $850 million each year. That does not include the hefty costs of retroactive payments or additional costs for health care. The agency spends $34 billion a year on disability benefits for all wars.

Dr. Victoria Anne Cassano, director of radiation and physical exposures at the Veterans Health Administration, part of the VA, pointed to the wording of the 1991 federal law on Agent Orange that said officials should find a positive link to diseases "if the credible evidence for the association is equal to or outweighs the credible evidence against the association."

It's a low bar. But Cassano said the law requires the VA to act without consideration of cost. She also said it is the best way to ensure that deserving veterans don't get lost in the shuffle.

"Does it make you take a deep breath? Does it give you pause? Yes," she said. "But you still do what you think is the right thing to do."

Agent Orange was a dioxin-laden defoliant that was sprayed over jungles to strip the Viet Cong of cover. American forces often got a soaking, too, and Agent Orange was later conclusively linked to several horrific health ailments, including cancers. So Congress and the VA set up a system to automatically award benefits to veterans who needed only to prove that they were in Vietnam at any time during a 13-year period and later got one of the illnesses connected to Agent Orange.

The VA, interpreting that 1991 law and studies that indicated potential associations, has over time added ailments that have no strong scientific link to Agent Orange. The nonprofit Institute of Medicine's biennial scientific analysis of available research, to which the VA looks for guidance, has repeatedly found only the possibility of a link between Agent Orange and diabetes, and that even a chance of a correlation is outweighed by factors such as family history, physical inactivity and obesity.

"Whatever the relationship between dioxin or Agent Orange and diabetes, it's a very small piece of the puzzle," said Dr. David Tollerud, an environmental health professor at the University of Louisville. He led an Institute of Medicine committee that first reported in 2000 on a possible link between diabetes and Agent Orange.

Tollerud's committee concluded that evidence was limited and that chance or other factors could not be ruled out. Yet the VA in 2001 put diabetes on the list of ailments that get automatic approval for benefits.

One large study released since then, costing $143 million and published in 2005 after 25 years of research, surveyed the airmen responsible for loading and dumping Agent Orange during Operation Ranch Hand, as the spraying missions were called. The final round of testing actually showed the prevalence of diabetes among those participants was slightly lower than among pilots who did not take part -- 18.2 percent versus 19.3 percent.

Some 23 percent of Americans 60 and older have diabetes, according to the Centers for Disease Control and Prevention.

"It's nothing more than a bunch of BS," said Jack Spey, who flew hundreds of Ranch Hand missions during more than three years in Southeast Asia.

Spey, who lives in Hurricane, Utah, and organizes a Ranch Hands reunion every year, said cockpits were constantly covered in Agent Orange. Leaking nozzles dripped on workers who walked under the wings. Punctured lines would spray solution on pilots as they flew. In a bit of machismo, some like Spey said they took swigs of Agent Orange to prove they could handle it.

Spey said he is not drawing any VA benefits and believes veterans face little more than the ailments of age.

While Spey said policymakers have gone too far in granting benefits, Navy veteran Jonathan Haas believes they have not gone far enough. He petitioned the VA for years for recognition of a diabetes link to Agent Orange, saying he saw large clouds of chemicals drift over the waters off Vietnam and engulf his ship. He unsuccessfully challenged the VA rule that provided automatic compensation for diabetes only for those who set foot in Vietnam or worked on the country's inland waterways.

The VA eventually granted him 100 percent disability -- he is now drawing $36,000 a year, according to VA records -- in part for diabetes after medical records from his service indicated that his condition had developed before he left the military. Other Navy veterans, he said, are not as lucky.

"They're getting screwed," said Haas, a 72-year-old who blames diabetes for his blindness, kidney failure and difficulty standing.

Some members of Congress are pushing to include those veterans who served off the coast of Vietnam -- which would add an estimated 800,000 people to the 2.6 million who served there on land. Cassano, the VA official, said the agency is looking at it.

The case of the Navy electrician who spent eight hours in Vietnam is detailed in the documents reviewed by the AP. As with most public portions of VA claims records, the man's name is omitted.

The government's benefit-of-the-doubt policy contrasts with its stand toward Vietnam. The U.S. has approved several million dollars in recent years to help Vietnam clean up Agent Orange. But it has declined to provide health and financial support to Vietnamese people affected by the herbicide, with the American ambassador in Hanoi saying there is insufficient evidence that it causes health problems.

Disability benefits are a lot like workers' compensation, providing income to veterans who incurred ailments from their active-duty service. The benefits can last a lifetime even if the veteran holds a full-time job. They often transfer to surviving family members when a veteran dies of the disability. They are paid in addition to any medical, education and pension coverage that veterans receive.

Many veterans have a combination of ailments that are crunched in a formula to determine their benefits. This makes it difficult to determine how much is being spent solely on diabetes.

Most veterans get a 20 percent disability rating for diabetes, which amounts to about $3,000 per year if it is their only ailment. Others get up to 100 percent. If each of the 270,000 Vietnam veterans got the minimum compensation for their diabetes, it would add up to $850 million every year.

Congress gave the VA the ability to deem ailments "presumptive" -- automatically awarded -- because of exposure to Agent Orange. The VA did that for five illnesses for which the Institute of Medicine found "sufficient evidence of an association," such as leukemia, non-Hodgkin's lymphoma and soft-tissue cancers. Those illnesses have risen dramatically in both Vietnam and the U.S. since the war.

The list of "presumptive" medical problems has grown to include seven ailments with only a "limited or suggestive" link to Agent Orange -- a link that scientists said could be influenced by other factors, such as chance or bias in scientific studies. Those include diabetes along with prostate cancer and lung cancer.

Anthony Principi, a Vietnam veteran and former VA secretary who added diabetes to the list, said he struggled with the decision.

"I did the best I could with the information that was given to me. I wish there was more information that I could have had," he said. Principi said he expected a surge of diabetes claims but is still surprised by the numbers.

The evidence of a link between Agent Orange and heart disease or Parkinson's is inconclusive, according to the Institute of Medicine. But the VA is moving ahead with plans to add both illnesses to the list of presumptive conditions.

The VA estimated earlier this year that heart disease compensation alone will cost taxpayers more than $30 billion over the next decade. About 17 percent of Americans ages 65 to 74 have heart disease, according to the CDC.

Virginia Sen. Jim Webb, a Democrat and Vietnam combat veteran, questioned the decision to spend billions for heart disease coverage. In a letter to VA Secretary Eric Shinseki this year, the lawmaker said Congress intended that benefits would be automatically granted "for relatively rare conditions."

"Over time, however, presumptions have expanded to include common diseases of aging," Webb wrote.

Compensation can also be awarded for ailments secondary to the covered condition. Type 2 diabetes, for example, can bring a host of complications, such as high blood pressure, erectile dysfunction or cataracts.

Erectile dysfunction is now the seventh-most-compensated disability for Vietnam veterans, with more than 80,000 getting benefits for it last year, and an AP review of hundreds of case summaries found that many of the claims stemmed from veterans with diabetes linked to Agent Orange.

Spey, the Ranch Hand veteran, blames politicians who are unwilling to reject the claims of aging veterans.

"We're all going to die someday," he said.

___

Online:

VA list of diseases associated with Agent Orange

Institute of Medicine report on Agent Orange:
http://books.nap.edu/
catalog.php?record_id=12662

[Associated Press; By MIKE BAKER]

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