1 15 1 https://www.nal.usda.gov/exhibits/speccoll/files/original/beed241e785b94fc9bd023e5a06109dc.pdf 3523666342d3d5bb26133cf78991dd4d PDF Text Text ItomlDNunber °1867 Author Anderson, Ron J. Corporate Author Texas Veterans Agent Orange Assistance Program, Tex Report/Article Title Annual Report Journal/Book Title Year 1985 Month/Day Au ust Color n Number of Images 91 9 Descrlpton Notes Wednesday, July 11, 2001 Page 1868 of 1870 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH AUSTIN, TEXAS A N N U A L August Ron J. Anderson, M.D. Chairman Texas Board of Health R E P O R T 1985 Robert Bernstein, M.D., F.A.C.P. Commissioner of Health Texas Department of Health �1036-1986 Texas Department of Health Robert Bernstein, M.D., F.A.C.P. Commissioner Robert A. Maclean, M.D. Deputy Commissioner Professional Services Hermas L. Miller Deputy Commissioner Management and Administration 1100 West 49th Street Austin, Texas 78756-3199 (512)458-7111 August 23, 1985 Members of the Board Ron J. Anderson, M.D., Chairman Laurance N. Mickey, M.D., F.A.A.P., ViceChairman Bob D. Glaze, D.C., Secretary Johnnie M. Benson, F.A.C.N.H.A. Sister Bernard Marie Borgmeyer, R.N., F.A.CH.A. Frank Bryant, Jr., M.D., F.A.A.F.P. Joaquin C. Cigarroa, Jr., M.O. Barry D. Cunningham, D.O.S. Ben M. Durr, M.H.A. Dennis K. Mclntosh, O.V.M. Robert D. Moreton, M.D., F.A.C.R. Joe N. Pyle, P.E. Arthur L. Raines, M.D. Isadore Roosth Barbara T. Slover, R.Ph. Max M. Stettner, D.O. Edward H. Zunker, O.D. The Honorable Mark W. White Governor of Texas State Capitol Austin, Texas 78711 Dear Governor White: Enclosed is the Annual Report of the T e x a s V e t e r a n s Agent Orange A s s i s t a n c e Program. Pursuant to Section 3 of Article U447w, VTCS, this report is being distributed to the Legislature, V e t e r a n s Administration, T e x a s V e t e r a n s Affairs Commission, veterans' organizations, and interested individuals. It reflects the work of the Texas Department of Health Agent Orange Program to date. The report contains research findings on the effects of exposure to chemical defoliants or herbicides or other causative agents, including Agent Orange, and statistical information compiled from reports submitted by physicans, hospitals, and veterans. I hope you find this report both useful and informative. Sincerely, Commissioner of Health Enclosure �18J6-I986 Texas Department of Health Robert Bernstein, M.D., F.A.C.P. Commissioner Robert A. Maclean, M.D. Deputy Commissioner Professional Services 1100 West 49th Street Austin, Texas 78756-3199 (512)458-7111 Members of the Board Ron \. Anderson, M.D., Chairman Laurance N. Nickey, M.D., F.A.A.P., Vice-Chairman Bob D. Glaze, D.C., Secretary Johnnie M. Benson, F.A.C.N.H.A. Sister Bernard Marie Borgmeyer, R.N., F.A.C.H.A. Hermas L. Miller Deputy Commissioner Management and Administration Frank Bryant, Jr., M.D., F.A.A.F.P. Joaquin C. Cigarroa, Jr., M.D. Barry D. Cunningham, O.D.S. Ben M. Durr, M.H.A. Dennis K. Mclntosh, D.V.M. Robert D. Moreton, M.O., F.A.C.R. Joe N. Pyle, P.E. Arthur L. Raines, M.O. Isadore Roosth PREFACE Barbara T. Slover, R.Ph. Max M. Stettner, D.O. Edward H. Zunker, O.D. From 1962 to 1971 during the Vietnam conflict, 152,000 Texans serving in the m i l i t a r y forces were exposed to v a r y i n g amounts of herbicides used to kill or d e f o l i a t e plants. Since t h a t t i m e v e t e r a n s have a t t r i b u t e d a n u m b e r of illnesses to Agent Orange which c o n t a i n e d a c o n t a m i n a t i n g chemical (TCCD); known to be highly toxic to animals, yet not well understood in its effects on humans. The T e x a s V e t e r a n s A g e n t O r a n g e A s s i s t a n c e P r o g r a m set into m o t i o n a cooperative program between the Texas Department of Health and the U n i v e r s i t y of Texas System to assist these veterans in establishing claims through pilot clinical studies designed to establish the cause and effect relationship of exposed v e t e r a n s and s u b s e q u e n t h e a l t h p r o b l e m s . The U n i v e r s i t y of Texas Agent Orange Project has selected 248 for study from whom 927 specimens have been a n a l y s e d in the v a r i o u s protocols. To date no f i n a l r e s u l t s of the s t u d i e s have been released since i n t e r p r e t a t i o n of the i n d i v i d u a l s t u d y reports requires correlation with controls and the results of the project as a whole. Activities at the federal level have increased, as evidenced by the activities of the Agent Orange Epidemiological Study at the Centers for Disease Control, the VA Chloracne Task force and completion of the morbidity study phase of the Air Force R a n c h H a n d Study, and the r e l e a s e of the B i r t h D e f e c t S t u d y in Atlanta by the Centers for Disease Control. Robert Bernstein Commissioner of Health �TABLE OF CONTENTS TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH . ANNUAL REPORT August 1985 Status Report and Data Sheet, July 31, 1985 Summary of Pilot Studies Protocols (FY 84-85 studies) Report on "Development and Preliminary Results of Pilot Clinical Studies, March 26, 1984 (FY 82, 83, 84 studies) Analysis of Major Demographic Statistics, May 3, 1985 (FY 82, 83, 84 studies) Herbicide Status Report by Department of the Army Veterans Health Survey—Report on Agent Orange studies conducted by the Centers for Disease Control, July 1985 �Texas Department of Health 1836-1986 Robert Bernstein, M.D., F.A.C.P. Commissioner 1100 West 49th Street Austin, Texas 78756 (512) 458-Trtr 7251 Robert A. Mac Lean, M.D. Deputy Commissioner Professional Services Hermas L. Miller Deputy Commissioner Management and Administration DATE: TO: FROM: RE: August 5, 1985 INTERESTED INDIVIDUALS AND ORGANIZATIONS HARRIET FRANSON, Program Manager Agent Orange Program TEXAS AGENT ORANGE PROGRAM STATUS REPORT FOR PERIOD ENDING JULY 31, 1985 Enclosed is the Texas Agent Orange Program Status Report for period ending July 31, 1985. This report is cumulative and reflects program activities since the inception of the program on September 1, 1981. As you may be aware, the Texas Legislature this year did not approve continued funding for the Agent Orange Program. Therefore, funding will expire on August 31, 1985 with resulting curtailment of program activities. Program data analyses are anticipated and study results published. It is our understanding that a nationwide search is underway for individuals to assist in the distribution plan for the $180 million settlement fund approved by the New York State Court in the class action suit against the seven chemical companies. Appointments will be made to an Advisory Group for the payment program, an Executive Director, and a Board of Directors for the Foundation. Names with resumes can be forwarded to Kenneth R. Feinberg, Suite 1150, 1575 Eye Street, N.W., Washington, D.C. 20005. The resumes should reflect relevant background and experience (see attached request). �^•-KAYE, SCHOLER, FIERMAN, HAYS & HANDLER 1575 EYE STREET, N.W. NEW YORK OFFICE 4«« PARK AVENUE NEW YORK. N.Y. IOOJI (til) 4 O 7 - 8 O O O FLORIDA OFFICE 125 WORTH AVCNUC PALM BEACH. FLA. J34* WASHINGTON, D.C. 2 O O O 5 CA1LE ADDRESSES KAYEMACLCR WASHINGTON KAYEMACLER NCW YORK (2O2) 783-I2OO TELEX HUMIERS WASHINGTON a»'*S8 NEW YORK DOMESTIC 128911 NEW YORK INTX 234860 HOMO KONG 62818 •AY NX (3O5) 8 J J - 5 I B I MONO KONO OFFICt CDINCUROH TOweft «OYH FLOOR IB OUCCN'S ROAO CENTRl HOMO KONO For Release: June 7, 1985 PRESS RELEASE Kenneth R. Feinberg, the Special Master reappointed by the Court in the Agent Orange litigation to help develop a distribution plan for the Settlement Fund, announced today that a nationwide search for individuals to assist in implementing the distribution plan approved by the Court would be undertaken as the first step in the distribution of the $180 million Fund. The settlement is between the seven defendant chemical companies and the plaintiff class, which consists of those veterans who served in or near Vietnam from 1961 to 1972, who were exposed to Agent Orange and have injuries allegedly related to that exposure. The class also includes spouses and children of the veterans. Over 240,000 claims have been filed with the Court by class members seeking to participate in the settlement distribution. The Court order requires a $150 million cash compensation program for veterans exposed to Agent Orange who are longterm totally disabled or to the families of those who have died, and a $45 million foundation to provide grants for services to the class, including those children of the class members suffering from birth defects. The Court ordered that members of the class play a significant role in the governance of all aspects of the distribution plan. To that end, the Court ordered the Special Master to take appropriate steps leading to the recommendation of names to the Court for appointment to an Advisory Group for the payment program and a Board of Directors of the foundation. Both the Advisory Group and the Board of Directors are to be comprised primarily, but not exclusively, of class members. �KAYE,SCHOLER. FIERMAN, HAYS & HANDLER - 2 - June 7, 1985 The Special Master announced today that he is soliciting names from all interested groups or individuals who would be willing to serve either as an Advisory Group member or on the Board of Directors. The names will then be submitted to the Court for final review and appointment. All Advisors and Board members will serve without compensation, other than reimbursement of reasonable travel and other per diem expenses. The Advisory Group and the Board will be as representative of the class as possible, cutting across economic, social, racial, gender, geographic and occupational lines. Persons with management, investment, budget and foundation experience would be particularly desirable as members. Resumes showing relevant background and experience should be included with any suggestions of persons for consideration. In another aspect of the outreach effort, Mr. Peinberg announced that a nationwide search would begin for an experienced professional to serve as Executive Director of the foundation. The Executive Director would administer the day-to-day operations of the foundation and would be compensated from the Fund. The Court will initially appoint the Executive Director, who will then serve at the pleasure of the Board of Directors. All inquiries or suggestions for the Advisory Group, the Board of Directors or the Executive Director should be directed, in writing with supporting data, to Kenneth R. Peinberg, Suite 1150, 1575 Eye Street, N.W., Washington, DC 20005. The final outreach effort announced by the Special Master*is the solicitation of insurance companies or other parties interested in bidding on contracts to implement the $150 million payment program. Contracts .for claims processing, investment consulting, claims adjudication, and auditing will be finalized by the Court within the next few months. Contractors interested in receiving bid specifications or in obtaining information concerning the payment program should contact, in writing, Lawrence B. Novey, consultant to the Special Master, who can be reached at the same address as Mr. Feinberg. �IfcAAbUtPAKIMtlN I Uh HtALI H AUSTIN THROUGH: CHIEF, BUREAU OF EPIDEMIOLOGY THROUGH: ASSOCIATE COMMISSIONER FOR PREVENTABLE DISEASES FROM TEXAS INTER-OFFICE THROUGH: DEPUTY COMMISSIONER FOR PROFESSIONAL SERVICES GEORGE R. ANDERSON, M.D. OCCUPATIONAL MEDICINE AND TOXICOLOGY/ AGENT ORANGE PROGRAM Robert Bernstein, M.D., F.A.C.P. Commissioner of Health TO Page 1 SUBJECT TEXAS VETERANS AGENT_ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1985 REFERRALS No. of veterans referred into the program this reporting period (No.-of deceased veterans—1: TOTAL 22) TOTAL TO DATE (6/1/85-7/31/85) 1,962 29 Military and medical records have been requested for all referred veterans: Medical records reviewed to date: (Include VA and civilian records— 105 reviewed this reporting period) 2,073 Military records reviewed to date: (include combat history, DD211, and/or medical—205 reviewed this reporting period) 1,795 No. of veterans referred into program and not in compliance with residency requirements—ineligible 18 CONTACTS Direct contacts from veterans this reporting period 1,352 39 By phone—31 (total to date: 981) By letter—6 (total to date: 326) By visit—2 (total to date: 51) Contact from News Media: Channel 7 TV (Austin) Bryan Eagle (Bryan) 114 Boston Globe Contact from or with other states/countries: Massachusetts (1) Orgeon (1) Washington (1) 287 West Virginia (1) Wisconsin (3) StCNB> DATi _ -CONTINUEDAugust 2, 1985 FORM NO. AG-2-A �TEXAS DEPARTMENI Oh HEALIH AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson, M.D. TO Robert Bernstein, M.D., F.A.C.P. Pa 8e 2 TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1983 Continuing contact with Legislative offices (State Representatives Larry Don Shaw 4 Jerry Yost) Office of the Governor, Office of the Attorney General, State Auditor, Congressman J.J. Pickle, Texas Department of Corrections, Texas Veterans Affairs Commission, Texas Land Commission, U n i v e r s i t y of Texas System, V e t e r a n ' s A d m i n i s t r a t i o n , Vet Centers, Military Personnel Records Center, County Veteran Services Officers, Local Health D e p a r t m e n t s / C l i n i c s , Other State Agent Orange offices, counseling services/physicians/hospitals, veterans' organizations, Dow Chemical Company, law firms, and students 9 f o l l o w u p letters were sent this reporting period to veterans who p r e v i o u s l y inquired about the program but not yet participating. (TOTAL TO DATE: 684) Made/mailed 112 followup phone calls/letters to check on military/medical records requested but not yet received. (TOTAL TO DATE: 1,851) One feedback letter was sent this reporting period to v e t e r a n in our program to apprise him of the status of his case ( m i l i t a r y / m e d i c a l records received, pending, etc.). (TOTAL TO DATE: 540) 10 veterans in the program requested or were placed on inactive status this r e p o r t i n g period, p r i m a r i l y due to i n d i v i d u a l s m o v i n g w i t h no forwarding addressess available (TOTAL TO DATE: 127) Inactive veterans resuming participation in the program. (TOTAL TO DATE: 6) In response to our m a i l i n g to Texas v e t e r a n s on the VA Agent Orange Registry received 0 completed questionnaire (TOTAL TO DATE: 1,511) of which 0 asked to be registered with the Texas Agent Orange Program (TOTAL TO DATE: 1,217). 5 veterans requested and were sent copies of case file records, in preparation for filing a claim: (TOTAL TO DATE: 27) SIGNED DATE -CONTINUEDAugust 2, 1985 FORM NO. AG-2-A �UtrAKIMtIN I Oh HtALI M AUSTIN TEXAS INTER-OFFICE HIOM George R. Anderson, JJ.JK TO Robert Bernstein, M.D., F.A.C.P. SUBJECT TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY"31,1985 Page 3 PROTOCOL STUDIES The second phase of the clinical studies has begun, with the following studies conducted this fiscal year: Cytogenetics at UTS CANCER CENTER, Houston, by Dr. Hsu Bleomycin Test at UTS, CANCER CENTER, Houston, by Dr. Hsu Immune Profile at UT HEALTH SCIENCE CENTER, Houston, by Dr. Kerman Uroporphyrins at UT HEALTH SCIENCE CENTER, Houston, by Dr. Kerman Aryl Hydrocarbon Hydroxylase Induction at UT MEDICAL BRANCH, Galveston, by Dr. Ward The protocols were published in summary and complete format. Questionnaires received from selected veterans and proposed controls continue to be reviewed to establish proper matching of veterans with controls. 17 volunteer control questionnaires for the Agent Orange clinical studies were received. (TOTAL TO DATE: 148, of which 1 is TDH employee. Contacts made with selected veterans and controls to make appointments for the collection of specimens. Contacts made with the clinics/laboratories where specimens collected/delivered. are to be 53 appointments arranged for the collection of specimens (TOTAL TO DATE: 304). Total specimens collected for the 2nd/3rd collection of specimens for the Sperm Study (TOTAL TO DATE: 232). No reminder letters were sent re. collection of specimens (TOTAL TO DATE: 31). Collection of specimens for the Sperm Study is now completed. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO. AG-2-A �ItAAS LJtrAKIMtlNI UMItALIH AUSTIN TEXAS INTER-OFFICE George R. Anderson. M.D. reOM SUBJECT TO Robert Bernstein, M.D., F.A.C.P. Pa 8e 4 TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING~TULY 31, 1985 111 letters were mailed to veterans concerning their participation in the clinical studies (TOTAL TO DATE: 159) and 55 to proposed controls (TOTAL TO DATE: 226). Number of specimens collected and shipped to UTS: (6/1/85-7/31/85) TOTAL TO DATE " CYTOGENETICS STUDY 23 238 IMMUNE SUPPRESSION STUDY UROPORPHYRIN AHH (Enzymes) SPERM STUDY SPECIMEN N O . 2 SPECIMEN N O . 3 23 23 13 0 237 72 58 126 FAT TISSUE SPECIMEN 0 0 9 9 0 9 5 2 Two v e t e r a n / c o n t r o l s requested and were given results of i n d i v i d u a l study specimens analyses. (TOTAL TO DATE: 156) SELECTION PROCESS FOR REFERRAL TO THE UTS SYSTEM Review of cases is an ongoing process for eventual referral to the Agent Orange Selection Committee—700 were reviewed this period for referral to the committee. To d a t e the Selection C o m m i t t e e has r e v i e w e d 1,103 cases (117 being r e v i e w e d more than once), of w h i c h 2U8 have been selected for the clinical studies (of which 126 are for inclusion in the second study phase). 95 v e t e r a n s have also been selected as possible low-risk controls. BROCHURES/POSTERS To date a p p r o x i m a t e l y 35,500 brochures and 7,726 posters have been mailed. In addition to individual requests, brochures and posters have been p r o v i d e d to v e t e r a n s ' o r g a n i z a t i o n s , c o u n t y service o f f i c e r s , clinics/hospitals, and other states. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO A<-,-•>. A �UtrAK I /VltIN I Ur MtALI M AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson^J1.JK ____ TO Robert Bernstein, M.D., F.A.C.P. SUBJtCT _ J^MO^l^liy^AGjra^ ____ STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, Page 5 MAINTAINING STATISTICAL INFORMATION I n f o r m a t i o n is compiled each m o n t h from case files concerning the following medical conditions reported and substantiated by medical records. This information is provided to the Agent Orange Selection Committee and becomes part of our data information. Such information will be compiled for other medical conditions as the need arises. Cancer in Veterans Under Age 36 Cancer in Veterans Over Age 36 Tingling/Numbness in Extremities Post Traumatic Stress Disorder (PTSD) Current Rashes Children with Leg Deformities Miscarriages/Stillbirths Schizophrenia Diagnoses continue to be coded w i t h I n t e r n a t i o n a l Code for c o m p u t e r entry. AGENT ORANGE ADVISORY COMMITEE No meetings were held during this reporting period. SPECIAL ACTIVITIES Continue review of available literature for research on Agent Orange and related topics. Continue to purchase publications for reference library. E x t r a c t i o n of statistical data from case files concerning specific military data and medical conditions, etc. Utilize word processor for the storage/retrieval of data and for multiple reproduction of originally-typed letters when form letters are not warranted. In-house t r a i n i n g on use of computer equipment for R i c h a r d Smith and Harriet Franson (d-Base and Software Users Group) continues. SIGNED DATE -CONTINUEDAugust 2. 1985 FORM NO. AG-2-A �i CA/\a i>cr/m i IVICIN i isrncs\Lin AUSTIN TEXAS INTER-OFFICE FROM George R. Anderson. M.D. _________ TO Robert Bernstein, M.D. , F.A.C.P. SUBJECT TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM STATUS REPORT FOR 2 MONTH PERIOD ENDING JULY 31, 1985 _ Pa 8e _____ 6 Received "Wisconsin Vietnam Veteran Mortality Study" for review Ongoing communication with other state Agent Orange Commissions/Programs as their representative on the VA Advisory Committee on Health-Related Effects of Herbicides. One summer employee is assisting with coding and data entry for the Epidemiological Study. A senior citizen volunteer is also assisting the program on a limited basis. MAJOR ACCOMPLISHMENTS 1. Number of veterans in the program has increased to 1,962 — an increase of 1,565 since the beginning of FY 84. 2. To date 1,243 cases have been reviewed by the Subject Selection Committee, of which over 248 have been selected for referral to the U n i v e r s i t y of Texas clinical studies. A total of 906 blood/sperm specimens have been collected and shipped to the U n i v e r s i t y of Texas System laboratories and one fat tissue shipped for analysis in the V.A./E.P.A. Study of Dioxin Levels in Human Adipose Tissue. MEETINGS ATTENDED None attended or scheduled. Attachment — Data Sheet cc: Agent Orange Selection Committee Agent Orange Advisory Committee Veterans' Organizations and other • interested individuals SIGNED DATE August 2, 1985 FORM NO. AG-2-A �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) NOTE: Variation in totals is due to receipt of only questionnaires to date and/or lack of medical/military information. \ In some instances, the initial complaint and those listed under "Other Medical Problems" were supplied by the veteran rather than a physician. BY (When entering AGE program) 29 30 2 7 32 33 34 35 36 37 38 39 40 II 74 117 134 169 120 97 72 56 BY SEX MALE BY SERVICE Army FEMALE 4 791 Air Force 1958 118 Marines 193 BY RACE WHITE BLACK 244 HISPANIC NaVy 733 277 41 31 42 43 44 45 46 47 48 49 50 36 20 30 25 17 17 16 20 20 51 52 23 20 NO. OF DECEASED VETERANS REPORTED INTO THE PROGRAM 53 54 55 56 57 58 5 9 60 61 20 15 9 11 7 9 8 3 1 ' OTHER 9 NO. REPORTED INTO THE PROGRAM AND DETERMINED NOT TO BE ELIGIBLE ' ' ' 62 5 1 1 2 3 1 1 1 PROGRAM AND RESIDING IN ANOTHER STATE 18 NO. REPORTED INTO THE 63 64 65 66 68 70 72 22 I 26 5? �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) BYjCOUNTY Anderson 5 Andrews 1 Angelina 1 Aransas 3 Bandera 3 Bastrop 14 Bee 3 Bell 50 Bexar 101 Bosque 3 Bowie 9 Brazoria 12 Brazos 8 Brooks 1 Brown 1 Burleson 3 Burnet 5 Calhoun 2 Callahan 2 Cameron 13 Cass 5 Castro 2 Chambers 1 Cherokee 5 Collin 7 Collingworth 2 Comal 3 Concho 1 Cooke 4 Coryell Crockett Dallas Deaf Smith Denton Dewitt Dimmit Donley Duval Ector Ellis El Paso Falls Far-.nin Fayette Fisher Fort Bend Gaines Galveston 10 1 104 1 6 1 1 2 1 6 3 109 3 2 2 1 7 2 21 Goliad Grayson Gregg Guadalupe Hale Hamilton Hardeman Hardin Harris Harrison Haskell Hays Henderson Hidalgo Hill Hockley Hood Hopkins Howard Hunt Hutchinson Jackson Jasper Jefferson Jim Wells Johnson Karnes Kaufman Kendall Kerr Kimble Kleberg Lamar Lamb Lampasas Lavaca Leon Liberty Llano Lubbock Lynn Marion Matagorda Maverick McCullock McLennan Medina Midland 2 11 3 2 1 1 1 2 118 3 1 2 2 26 2 1 2 2 4 6 1 1 1 15 5 5 1 7 2 5 1 3 2 1 3 3 1 6 2 12 1 2 2 1 1 9 2 6 Milam Montague Montgomery Moore Morris Nacogdoches Navarro Newton Nueces Ochiltree Orange Palo Pinto Parker Parmer Potter Randall Reeves Richmond Robertson Rusk San Jacinto San Patricio Shelby Smith Starr Tarrant Taylor Tom Green Travis Tyler Upshur Uvalde Val Verde Van Zandt Victoria Walker Ward Webb Wharton Wichita Wilbarger Willacy Williamson Wilson Winkler Wise Wood Young Zapata 2 1 8 1 1 1 2 'I 53 1 9 1 3 1 10 5 1 1 1 3 2 12 1 6 1 71 3 5 82 1 6 3 6 4 7 38 4 6 1 11 1 1 14 2 1 5 2 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DUTY PERFORMED DUTY PERFORMED Accounting Specialist Administrative Specialist Administrative & Supply ADP Officer Aerial Photo Interpretator Airborne Infantry Aircraft Technician Air Crew Air Frame Repair Specialist Air Mobile Air policeman Air Operation Supervisor/Spec. Air Traffic Control Ammunition Ammo Cargo Handler Armor Unit Artillery Base Maintenance Battalion Clerk Boatswain Mate Calibration Team Technician Career Counselor Cargo Handler Carpenter Chaplain Chemical Operations Combat Cook Combat Engineer Combat Military Police Combat News Correspondent Communications Specialist Construction Controller Convoy Escort Corpsman Counterinsurgency Specialist Courier Coxswain Crane Operator Crew Chief Deck Force Demolition Expert Dining Facility Manager Engineering Equipment Repair Explosives Finance Firefighter Food Service Forward Air Control Freight Handler Grave Registration Ground Crew Guard Gunfire Spotter 1 10 5 1 2 3 42 71 1 2 1 1 2 6 2 12 62 1 2 5 1 2 6 3 3 11 20 22 1 1 30 10 1 4 7 1 1 1 1 5 2 3 2 15 4 2 3 2 Gunner's Mate Harbor Defense Infantry Inspector General Intelligence Interrogator Investigator, Narcotic Journalist Lineman Machinist Maintenance Mechanic Medic Medical Advisor Medical Clerk Medical Corps Mess Steward Meteorologist Military Advisor Military Police Musician NCO Neuropsy Specialist Nurse Operator, Heavy Equipment Paratrooper Personnel Officer Petroleum Storage Supply Photographer Pilot Platoon Leader Plumber Polelinetnan Powerlineman Printer Guard Psychological Operations Radar Operator Radio Operator Radio Repair (field) Recon. Infantry Recon. Forward Observer River Rat 3 6 2 1 4 6 1 1 7 1 456 1 18 2 1 1 4 1 20 32 24 4 1 2 1 1 2 17 1 1 1 3 11 3 4 4 2 16 6 3 1 2 1 3 4 9 3 5 11 3 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS.DEPARTMENT OF HEALTH, AUSTIN, TEXAS DUTY PERFORMED Sea Bees Security Guard Sergeant/Clerk Ship Crew Ship Engine Man Signal Corps Small Missile Repairman Social Worker Physical Specialist Special Forces Advisory Group Supply Sergeant Supply Specialist Support Battalion Switchboard Operator Tank Crewman Telephone Repair Translator/Interpreter Transportation Truck Driver Tunnel Rat Warehouseman Watercraft Operator Weapons Mechanic Wireman 3 5 2 2 1 9 1 1 6 21 36 11 1 9 2 1 23 33 1 4 1 2 5 NO OF VETERANS REPORTING MISCARRIAGES/STILLBIRTHS 329 NO OF VETERANS REPORTING CHILDREN WITH BIRTH DEFECTS ' AND/OR MEDICAL PROBLEMS PRESENT SINCE BIRTH 307 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) CURRENT OCCUPATION CURRENT ^OCCUPATION Accountant Active Duty . Administrative Aircraft Air Conditioning/Refrig. Contractor Apartment Manager Applied Research Lab Army Depot Attorney Automotive Banking Barber Bellman Biomedical Engineering Technician Border Patrol Building Inspector Cable Company Carpenter Carpet Installer Cement Company Chemical Company Child Care Chrome Plater City Employee Civil Service Clergy Clerical Computers Construction Consultant Cook Correctional Institution Counselor Cowboy Custodian Disability Examiner Disabled, medically unemployed Draftsman Editor, publication Education Specialist Electrical Supply Electrician Electrician, Naval Aviation 11 3 34 13 4 2 1 4 3 1 2 3 1 2 1 1 4 18 1 1 6 2 1 8 8 3 8 6 28 5 5 1 2 2 11 1 96 3 1 1 1 14 1 Electric Technician Electronics Technician Employment Interviewer Engineering Environmentalist Equipment Operator Executive Executive, Oil Field Fence Builder Firebrick Company Fire Dept. Fisherman Floor Finisher Food Service Funeral Home Furniture Restoration Gas pipeline operator Glazier Grocer Hair Stylist Helicopter Technician Highway Dept. Inmate Inspector Quality Control Insurance Claims/Agent Investigator, State Ironworker IRS Laborer Laundry Lawman Legal Assistant Library Lineman Lumber Mill Worker 3 14 1 6 1 15 3 1 1 1 9 2 1 7 2 1 1 2 1 1 1 1 46 2 8 5 4 1 14 2 27 1 1 4 2 Machinist 18 Maintenance Management Analyst Meat Packer Mechanic Medical Assistant Medical Lab Tech. Military Base Millwright Mobile Court Owner Musician Newspaper Carrier 19 1 1 52 1 1 1 3 1 1 1 Nurse 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31 • 1985) CURRENT OCCUPATION CURRENT OCCUPATION <;ti short Oil Oilfield Operating Room Technician Optometry Oxygen Plant Painter Parks Service Pest Control Pharmacy Tech. Photographer Physical Therapist Physician Pipefitter Planner Estimator Plant Operator Plumber Porter Post Office Printer Private Investigator Probation Officer Production Psychologist Purchasing Railroad Ranching/Farming Real Estate Recruiter (service) Refinery/Boilermaker Rehabilitation Center Repair electrical equipment Retired Sales Sanitarian Sawmill Operation Seaman Security Self-Employed Service Station Shipping Clerk Shrimper Silver Smith Slaughterhouse Speech Therapist State Employee Steel Company Stocker 3 12 1 1 1 4 1 1 3 2 1 3 5 1 4 12 1 53 5 2 3 1 1 1 13 4 3 1 5 5 1 24 48 1 1 1 24 11 2 5 1 1 1 1 1 7 1 Store Manager Student Supervisor, Computer Supervisor, Production Supply Clerk Teacher Telephone Company Tool & Dye Tree Surgeon Typewriter Repair Unemployed Upholsterer Utility Company Vehicle Driver Warehouseman Welder Woodworker Writer '"> 14 4 9 1 18 7 1 1 1 110 2 6 63 13 26 4 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) INITIAL COMPLAINT (as reported by the veteran) Abdominal Pain Acne Allergies Anxiety Apnea (shortness of breath) Arthritis Asphyxia Asthenia (weakness) Atrophy Back Pain Birth Defect, child Blackouts Blood Disorders Body Aches Cancer Chest Pain Chloracne Confusion Constipation Cysts Depression Diabetes Diarrhea Dizziness Dysphasia (speech impairment) Dyspnea (labored breathing) Edema Emotional Problems Epilepsy Fatigue Fever, recurring Gastritis, chronic Gastrointestinal disorders Hair LOSS Headaches Heart murmur Hematoma Hepatitis, recurrent Hepatomegalia Hives Hyperlipidemia Hypertension Infected prostate Infections 3 17 6 12 10 8 1 9 1 6 37 2 10 4 62 15 10 1 2 9 17 1 9 13 1 4 11 52 1 10 5 1 84 7 107 1 1 2 1 2 1 24 2 11 Itching Joint pain Kidney Lesions Lethargy Liver damage Liver pain Loss of appetite Low potassium level Low resistance to disease Lumps on body Lumps in scrotum Lung disease Memory impairment Miscarriage Multiple sclerosis Muscle spasms Nausea Nerve problems Neuralgia (nerve pain) Numbness Paralysis, extremities Personality change Pneumothorax Pruritus, intense (itching) Rages Rash Rectal bleeding Renal failure, chronic Respiratory problems Reversed sperm travel Seizures Sensorial impairments Sexual problems Skin infection Skin blistering/peeling Skin pigmentation, loss of Sleeplessness Sores/boils Sore throat, chronic Sperm count—low Stroke Sunlight allergy Tendenitis 17 28 10 10 3 17 4 2 2 3 21 1 4 8 7 3 7 2 100 1 123 4 2 1 1 2 524 5 1 5 1 5 1 35 13 36 10 55 18 3 4 1 2 1 Tingling in extremities Tumors, skin Vomiting blood Ulcer Urination frequency Visual disturbance Weight loss/gain Withdrawal regression 42 5 5 8 5 11 5 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) PIAG_NOSIS T(JDx)—as reported by physician Aberrant innervation of third cranial nerve (child) Acalculous choleystitis Acre Acre keloidalis ruchae Acrocyanosis Acrokeratosis verrucofomis Actonic keratoses Adenoma, villous Agent orange symptomatology Alcoholism Allergic rhinitis Alopecia areata Amebic liver abscess Amputation, fingers, congential (chlla) Anemia Ankylosis spondylitis Anxiety, chronic Anxiety neurosis Aortic insufficiency Apnea (cessation of breath) Arteriosclerosis, advanced (carotids & femorals) Arthralgias (joint pain) Arthritis Arthritis, cervical Arthritis, degenerative Arthritis, gouty Arthritis, poly, seronegative Arthritis, post-traumatic Arthritis, rheumatoid Arthritic changes of joints Aspermia Asthma Atherosclerotic occlusive peripheral vascular disease Atrophy of kidney Azoospermia Baker's cyst Barlow's syndrome Bell's palsy Bilateral acanthosis Bilateral internal tibial torsion (child) Bilateral rnetatarus adductus (child) Bilateral mandibular tori 1 1 10 1 1 1 1 1 2 15 2 3 1 1 4 2 17 11 1 5 2 12 16 5 12 5 1 3 2 1 1 1 1 1 3 1 .1 1 1 2 1 1 Bilaterial calycealcalculi Bilateral supernumerary fingers, non-boney (child) Bipolar disorder Bowen's disease Brain syndrome, chronic Bronchitis, chronic Bullous emphysema Buerger's disease Bursitis Calcaneovarus deformity of feet (child) Cancer (Neoplasra)-total 74 Adenocarcinoma of esophagus Adenocarcinoma of rectum stage Dukes C w/ 5/15 lymph nodes positive for Ca Adenocarcinoma of rectum, Duke C Adenocarcinoma of rectum w/seeding of pararectal fat Adenocarcinoma of sigmoid colon Adenocarcinoma of sigmoid colon with metastasis Basal cell Bladder, low grade Bronchogenic carcinoma, squamous cell Carcincoma of esophagus Carcinoma of rectum w/metastasis to liver Differentiated lymphocytic lymphoma, nodular type, Stage 4 w/widespread metastasis Diffuse bilateral adenocarcinoma w/metastases multiple areas bone/brain Embryonal cell carcinoma, Stage 1 w/teratoma, left testicle Epidermoid carcinoma of esophagus Esophagus Fibrohistiocytoma (leg) Giant cell tumor of bone Glioblastoma multiforme, brain Hodgkin's disease Larynx Malignant melanoma Metastatic carcinoma in hilar lymph node Metastatic embryonal cell carcinoma (testis) 1 1 1 1 1 8 1 2 3 1 1 1 1 1 1 4 8 1 1 1 1 1 1 1 1 2 1 1 1 2 2 3 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as^reggrted by physician Metastatic malignant melanoma, bowel and subcutaneous tissue/ renal cell carcinoma, left kidney 1 Metastatic melanoma lesion, right parieto-occipital 1 Metastatic squamous carcinoma to scalene node 1 Mixoid liposarcoma w/chest & spine metastasis 1 Myeloma, multiple 1 Nasopharyngeal carcinoma 1 Neoplasm, malignant (transitional cell carcinoma) kidney 1 Oat cell Ca of lung w/liver & bone metastasis 1 Papillary (transitional cell carcinoma, Grade I) of bladder 1 Pituitary adenoma (brain) chromophobe type w/hypopituitarism 1 Plasmacytoma ilium, recurrent 1 Renal cell carcinoma 3 Right apiccal, large cell Ca w/ resultant Homer's syndrome 1 Right breast 1 Sarcoma, left leg 1 Semiroma, right testis 4 Squamous cell carcinoma of ear (epidermoid carcinoma) 1 Squamous cell of lung 4 Squamous cell carcinoma of anus, keratinizing 1 Squamous cell carcinoma of larynx, keratinizing, Grade I, invasive 1 Squamous cell carcinoma of pinna of ear 1 Testicular 3 Transitional cell carcinoma of bladder, Grade III 2 Undifferentiated liver carcinoma 1 Capillary hemangioma 1 Cardiomegaly 1 Carpal tunnel syndrome 3 Cataplexy 1 Cephalhematoma of foot postional deformity (child) 1 Cerebellar atrophy 2 Cerebellar tumor (child) 1 Cerebello insufficiency Cerebral convulsive disorder Cerebral palsy (child) Cervical adenopathy Charcot-Mar ie-Tooth Chest pain syndrome Chloracne Cholecystitis, chronic Chondromalacia, patella Chronic infection and subcutaneous papular eruption Chronic sclerosing glomerulonephritis Cirrhosis of liver Cleft palate (child) Club-Foot (child) Coagulopathy Colitis Collagen disorder Colon, mass in Colon, spastic Congential absence of tibia (child) Congenital athyriotic hypothyroidism (child) Congential dislocation of hip (child) Congenital heart disease, pulmonary valve artresia (child) Congenital polyneuropathy (child) Condyloma accuminata Congestive heart failure Constipation Convergence insufficiency by Hx Conversion reaction (numbness) Coronary Artery Disease S/P/ Coronary atherosclerosis Costochondritis Crohn's disease Crouzon1s disease (child) Cyst, sebaceous Cyst, vocal cord Degenerated nucleus pulposus Degenerative changes in joint Demorphic erythrocytosis Demyelination of peripheral nerves Depression atypical Depression w/anxiety Depression, endogenous 1 1 3 2 1 1 5 2 2 1 4 2 2 1 4 1 1 1 1 1 1 1 2 1 1 2 1 1 1 1 3 1 1 6 1 1 5 1 1 2 24 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) PI^JL^l^-J^l"!"3.^^reported by physician Depression syndrome, chronic Depressive disorder Depressive neurosis Dermatitis, l)f:rm-'i+,Ltis , '.i'-r'!.•>'-.: \. -,, .><• •r,;.-M MS, atopic ohroric V'r.taot <:r ythematous Dermatitis, perineal Dermatitis, photosensitivity Dermatitis, pruritis Dermatitis, scaly . _ Dermatitis, seborrheic .-., Dermatofibromas Dermatophytosis, recurrent Diabetes Diabetes mellitus Diastematomyelia (child) Dumping syndrome Duodenitis Dysethesias, diffuse Dyshidrosis (disorder of sweat glands) Dysmethic disorder Dysphasia Dyspnea Ecchymosis of legs Ecthyma Eczema Eczema, atopic Eczema, seborrheic Eczematous lesions Emphysema Encephalopathy End stage renal disease Eosinophilia Ependymoma, cerebellar (child) Epididymitis Epilepsy, idiopathic Epilepsy (child) Epistaxis, recurrent (child) Erythema multiforma Erythematous macular Erythematous papular Erythematous, resolving Esophagitis Esophoria (child) Exfoliative erythroderma . Extrarenal Wilms tumor (child) 3 3 4 5 14 6 3 1 2 3 1 11 6 3 4 17 1 1 1 1 4 6 1 3 1 2 12 4 2 5 4 2 1 1 1 7 1 3 1 2 4 1 2 1 1 1 1 10 Fatigue Fatty Metamorphosis Feet turned inward (child) Fibroepithelial papilloma Fibromas Fibromyalgia Fibromyositis syndrome Fibrosis Folliculitis Forefoot Adductus (child) Fundoplasty Furunculos.is (boils) Gastritis, chronic Gastroenteritis Gastroesophageal. reflux Globus heptericus Glomerulonephritis Granulatoma, -fit. scrotum Granuloma Granuloma Annulase Granulomatous colitis Granulomatous pulmonary disease Granulomatous skin lesions Granulomatous ulcer Guillain Barre Syndrome Gynecomastia, breast Headaches Headaches, cluster Headaches, vascular Hematoma Hematuria Hemoptysis, chronic Hemorrhoids Hemorrhaphies, bilateral inguinal Hepatitis, infectious Hepatocellular degeneration, focal Hepatocellular dysfunction Hepatomegaly Hernia Hernia, hiatal Hernia, inguinal Hernia, inguinal indirect (child) Herpes simplex Herpes zoster Hidrosadenitis, chronic, supprative (inflammation of sweat glands) 1 1 1 1 1 l 1 1 15 1 1 3 12 2 2 1 4 1 1 1 1 1 1 1 3 3 16 1 12 1 5 2 18 2 4 1 1 2 2 8 7 1 1 2 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as reported by physician 1 Hilar adenopathy w/calcification Hyaline membrane disease (child) 2 1 Hydrocele 2 Hydrocephalus (child) 1 Hygroma, cystic (child) 1 Hyperanxiety 1 Hyperbilirubinemia 1 Hypercalciuria 1 Hypercholesterum Hyperlipidemia 3 Hyper pigmental scaly plaques 3 1 Hyper pigmentation 2 Hypersomnia Hypertension 59 2 Hyperthesia, extremities 1 Hyperlipemia 1 Hyperlipoproteinemia (Type IV) Hyperthyroidism (child 1) Hypertryglycerdemia (Type IV) Hyperuricemia 1 Hypochondriasis Hypoglycemia 5 1 Hypopigmented areas (face) 1 Hypoplastic breast (child) 1 Hypospadias (child) Hypotension 3 1 Hypotonia (child) 1 Hysteronic personality Infection, persistent, soft tissue (child) Infundible pulmonary 1 stenosis (child) 1 Iritis, chronic Joint disease, degenerative 2 (of back) 1 Joint pain, peripheral 1 Keratitis 1 Keratoderma 1 Left spastic hemiparesis Leukemia, acute, lymphocytic 2 (child) 2 Leukemia, myelogenous, chronic Leukocytosis w/atypical lymphocytos 1 Lichen planus 3 Lichen simplex chronicus 3 Lipoma 13 1 Lipoma, cyst in lumbar area 2 Lipoma, spermatic cord II Liver pain Lumber sprain Lung disease, severe, chronic, obstructive Lupus, discoid Lupus erythematosis Lymphodenitis, chronic Lymphoid hyperplasia Lymphopranuloma inguinale Macular melasna Maculo-erythematous (rash) Mastoiditis, chronic sclerosing Meniere's disease Meningitis, cryptococcus Meningomyelocele (child) Mental Retardation (child) Metatarsus adductus (w/medial tibial torsion) (child) Microtia of ear (child) Microcephaly (child) Missing pectoralis (left) major muscle (child) Multiple sclerosis Musculoskeletal condition Myelomeningocele, lumbrosral (child) Myocardial infarction, acute Myofacial pain Narcolepsy Nephrolithiasis Neuralgias Neuralgia w/headache and recurrent fever Neurasthenia Neuritis Neurodermatitis Neuroma Neurosis, depressive Numbness in extremities Numbness ulnar aspect upper extremities Oligohydramnias (child) Oligospermia Onchomycosis Organic brain syndrome Osgood-Schlatter's disease (knee) Osler-Weber-Rondu disease Osteoarthritis, cervical 1 1 1 1 3 1 1 1 1 2 1 1 2 1 1 2 2 1 1 1 1 1 2 1 1 1 2 1 1 1 8 1 3 14 1 1 2 5 2 1 1 2 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNQ3IS-(Dx)—as reported _by_ physician Osteoarthritis, degenerative Osteoarthrosis, degenerative Osteomylitis Pancreatitis, hyperlipidemia, chronic Papilloma Papular squamous rash Paralysis of vocal chords Paranoid schizophrenia disorder Paranoid state Parapsoriasis Parasthesias of extremities Paroxysmal atrial tachycardia Patent ductus arteriosus (child) Patent ductus arterosis of formen ovale cordus (child) Peptic esophagitis Peroneal palsy Peripheral neuropathy Peripheral ulnar palsy Personality disorder Peyronie's disease Photosensitivity Pityriasis alba Pityriasis rubra pilaris Pityriasis versicolor Plantar, hyperkeratosis, mild Pleural scarring Pneumothorax Pneumothorax, spontaneous Polyarthralgia Polyneuropathies Polyps, nasal/vocal cords Porphyria Porphyria cutanea tarda Posterior cervical pain Post traumatic stress syndrome Premature ejaculation Proctitis, inflammatory Prostatitis, chronic Proteinuria Pruritis Pruritus/onychomycosis of extremities Pseudofolliculitis Psoriasiform lichen simplex chronicus Psoriasis Psychosis, major 4 1 1 1 2 2 1 3 1 1 3 1 2 1 1 1 5 1 11 2 1 1 2 1 1 1 4 5 2 1 4 1 3 1 71 1 2 16 1 13 1 3 1 13 1 Psychotic depressive reaction (child 1) Pulmonary atresia Pulmonary disease, chronic obstructive Pulmonary emboli, massive Pulmonary embolism, ASC VC CVI Pulmonary nodule Pustules, recurrent Pyelonephritis Pylorospasm Radicular neuropathy Rash Rash, maculopapular Raynaud's phenomenon Reiter 1 s disease Renal glycasuria (no diabetes) Rhinitis Sarcoidosis Schizoid disorder Schizophrenia Schizophrenia, chronic, undifferentiated type Schizophrenia, paranoid Schizophrenia, schizo-affective type Schizo-type disorder Sciatica Scleroderma Scoliosis (child) Sebaceous cyst abscess Seborrhea Seizure disorder Soto's Syndrome (child) (cerebral gigantism) Spermatocelectomy Spermatoceles Sperm count, low Spina bifida (child) Spondylolisthesis Spondylosis Stenosis of larynx Sterility Stress syndrome Supple pes planus (child) Syncopy Syndactyly index w/absence and congenital absence of middle phalanx of 4 fingers (child) 3 1 2 1 1 1 2 1 1 1 7 1 2 1 1 3 4 5 19 11 31 3 4 1 1 1 4 12 4 1 1 3 3 4 5 3 1 5 1 1 1 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) DIAGNOSIS (Dx)—as ^reported by physician Tardive dyskinesia Telangiectasia Tendinitis Tenosynovitis (De Quervain's Disease) Testicular mass Testis, atrophic (child) Thrombocytopenia Tibial torsion of leg (child) Tietze's syndrome Tinea corpis Tinea cruris Tinea cruris pedis w/ onychomycosis Tinea pedis Tinea versicolor Tonsillitis, acute, chronic Transurethral resection Trichophytosis Tricuspid atresia, atrial septal defect, ventricular septal defect (child) Triglycerides, high Tropical fungus Truncal dystonia Ulcer, duodenal Ulcer, peptic Uroporphyria Urticaria, giant, recurrent Varicocele Xerosis of skin (dryness) 1 1 1 1 1 2 1 5 1 12 26 4 12 21 1 1 3 1 3 1 1 15 12 1 1 1 3 /3 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) CANCER IN VETS AGE 36 AND UNDER (substantiated by medical records) Case // A§e When Dx #13 #15 30 30 #40 #54 #98 (#106 31 31 35 33 (#106 33 #107 29 #121 * 31 #151 #180 * #242 #315 33 36 36 30 (#316 (#316 #469 * 30 33 36 #474 #523 * #551 34 34 25 #603 #621 #631 #676 #1072 #1213 (#1259 (#1259 * * * * * * 23 25 32 36 35 28 36 38 (#1672 (#1672 #1684 * #1732 #1751 * #1900 35 42 32 30 36 35 Type of Cancer/ICD No. Metastatic malignant melanoma 172.9 M8720/6 Squamous cell Ca w/adenocarcinomatous components, rt. lung 162.9 M8070/3 Basal cell Ca 173.9 M8090/3 Ca of esophagus 150.9 M8010/3 Polypoid carcinoma of sigmoid colon 153.9 M8050/3 Renal cell carcinoma, left kidney (died at age 33) 189.0 M8312/3 Metastatic malignant melanoma, bowel & subcutaneous tissue (died at age 33) 172.9 M8720/6 Multiple melanomas, Stage I (died at age 31) 172.9 M8720/3 Diffuse bilateral adenocarcinoma w/metastasis multiple areas bone/brain (died at age 31) 170.9 M8140/6 Ca of esophagus (died at age 34) 150.9 M8010/3 Ca of larynx 161.7 M8010/3 Giant Cell tumor of bone 170.9 M9250/3 Metastatic embryonal cell carcinoma (testis) with pulmonary involvement (died at age 30) 186.9 M9070/6 Basal cell carcinoma 173.9 M8090/3 Seminoma of right testis 186.9 M9061/3 Squamous cell carcinoma of anus, keratinizing 154.3. M8071/3 Seminoma, testis 186.9 M9061/3 Malignant melanoma 172.9 M8720/3 Pituitary adenoma (brain) chromophobe type w/ hypopitutarism 237.0 M8270/0 Basal cell epitheliomas, nose 173.3 M8090/3 Seminoma, right testicle 186.9 M9061/3 Sertoli cell carcinoma, testis 186.9 M8640/3 Seminona, right testis 186.9 M9061/3 Nasopharyngeal carcinoma 147.9 M8010/3 Renal cell carcinoma 189.0 M8312/3 Sarcoma, left leg 170.7 M8800/3 Osteosarcoma left leg w/metastasis right lung 170.7 M9180/6 Malignant melanoma (Level III) w/cerebral metastasis 172.9 M8720/6 Renal cell Ca. 189.0 M8312/3 Plasmacytoma right ilium, recurrent 203.8 M9731/3 Undifferentiated liver carcinoma 155.2 M8020/3 Myxoid liposarcoma w/spine & chest metastasis 171.9 M8852/6 Veterans who have sought treatment at a Veterans Administration Medical facility.for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) CANCER IN VETS OVER AGE 36 (substantiated by medical records) Case Age When Dx #16 #24 * 51 47 #30 #70 » #76 #146 * #214 53 44 40 41 48 #239 48 #249 53 #295 52 #304 * 41 #360 * 58 #535 #567 * #622 * 39 46 50 #638 #806 * 45 68 #829 46 #890 * #894 * #1041 * 47 46 60 #1053 52 #1089 (#1093 (#1093 #1178 #1182 #1421 50 50 56 60 44 52 #1477 * * * * 41 Renal cell Ca left kidney 189.0 M8312/3 IGA, Multiple myeloma-lumbar spine (died at age 50) 170.2 M9730/3 Ca of lungs, squamous cell 162.9 M8070/3 Transitional cell Ca, Grade I 188.9 M8120/3 Ca breast w/metastasis to axilla 175.0 M8010/6 Basal cell Ca of nose 173.3 M8090/3 Squamous cell Ca anterior fascialpillar 146.2 M8070/3 Neoplasm, malignant (transitional cell carcinoma) right kidney 189.0 M8120/3 Glioblastoma multiforme, brain (died at age 53) 191.9 M9440/3 Squamous cell carcinoma of larynx, keratinizing, Grade I, invasive 161.9 M8070/3 Adenocarcinoma of lung w/brain metastases 162.9 M8140/6 Adenocarcinoma of sigmoid colon metastasized to liver 153.9 M8140/6 Basal cell Ca on scalp 173.9 M8090/3 Testicular cancer 186.9 M8010/3 Bronchogenic carcinoma, squamous cell, poorly differentiated; metastatic carcinoma in hilar lymph node 162.9 M8010/6 Fibrohistiocytoma, leg 170.7 M8831/3 Carcinoma of rectum w'/metastasis to liver 154.1 M8010/6 Metastatic squamous carcinoma to scalene node 195.0 M8070/6 Epidermoid carcinoma left lung 162.9 M8070/3 Epidermoid carcinoma of esophagus 150.9 M8010/3 Adenocarcinoma of sigmoid colon and metastatic to 1 of 3 lymph nodes (Duke C) w/metastasis to liver 153.9 M8140/6 Right apical (lung) large cell Ca w/ resultant Horner's syndrome 162.9 M8012/3 Chronic myelogenous leukemia 205.1 M9863/3 Basal cell epitheliomas 173.9 M8090/3 Bronchogenic carcinoma, left lung 162.9 M8010/3 Adenocarcinoma of rectum, Duke C 154.1 M8140/3 Ca of bladder, low grade 188.9 M8010/3 Adenocarcinoma of sigmoid colon w/metastasis to liver and lymph nodes 153.9 M8140/6 Basal cell carcinoma, nose 173.3 M8090/3 •Veterans who have sought treatment at a Veterans Administration medical facility for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH DATA SHEET (as of July 31, 1985) CANCER IN VETS OVER AGE 36 (substantiatedI by medical records) Case # Age When Dx #1496 48 #1578 * 50 #1582 48 #1622 #1741 37 44 # 1820 55 #1830 37 #1833 39 #1881 65 Type of Cancer/ICD ^Nq,, Adenocarcinoma of rectum stage D u k e s C w/ 5/15 lymphnodes positive for Ca 154.1 M8140/6 Adencarcinoma of rectum w/seeding of pararectal fat 154.1 M8140/6 Bladder - papillary, transitional cell, grade I 188.9 M8130/3 Adenocarcinoma of esophagus 150.9 M8140/3 Squamous cell Ca of pinna right ear (epidermoid carcinoma) 173.2 M8070/3 Transitional cell Ca og bladder, Stage II 188.9 M8120/3 Differentiated lymphocytic lymphoma nodular type, Stage 4 w/widespread metastasis 202.8 M9620/6 Oat cell Ca of lung w/liver & bone metastasis 162.9 M8042/6 Basal cell Ca 173.9 M8090/3 "Veterans who have sought treatment at a Veterans Administration medical facility for their malignancies. �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) QUESTIONABLE RANGERS (substantiated by medical records) #45 #169 24 29 Granuloma Rt. scrotum Liporna cyst in lumbar area CHILDREN WITH LEG DEFORMITIES (substantiated by medical records) Club-foot, secondary to spina bifida Feet turned inward Congenital absence of rt. tibia Cephalhematoma rt. foot positional deformity at birth Metatarsus adductus w/medial tibial torsion Congenital dislocation of hip Club-Foot/Forefoot Adductus Supple pes pianus Bilateral internal tibial torsion Bilateral metatarsus adductus Metatarsus adductus, right foot Club-foot Short leg Tibial torsion, both legs Calcaneovarus deformity of feet Bilateral internal tibial torsion Tibial torsion of left leg #25 #40 //68 #152 #188 #207 #296 #330 #571 #582 #583 #770 #872 #978 #1603 #1622 #1754 CURRENT JRASHES ^(substantiated .by jrcedical records) No. of cases 62 II �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) TINGLING/NUMBNESS IN EXTREMITIES (substantiated by tnedioal records) Case # Year Dx #14 #22 #37 #41 #85 #119 #145 #192 #195 #206 #211 #212 #224 #229 #267 #306 #338 #341 #389 #415 #422 #423 #450 #500 #872 #1315 #1417 #1758 #1808 #1858 1981 1968 1981 1977 1980 1980/1981 1981 1978 1981 1981 1982 1982 1980 1964 1980 1982 1979 1978 1981 1982 1972 1981 1982 1981 1983 1984 1981 1983 1975 1983 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) MISCARRIAGE/STILLBIRTH (substantiated by medical records) Case // #36 #38 #41 #44 #63 #67 #82 #83 #85 #86 #97 #99 #142 #156 #173 #179 #181 #183 #209 #241 #310 #323 #328 #331 #386 #494 #568 #571 #591 #608 #647 #653 #688 #699 #722 #773 #774 #822 #841 #854 #879 #926 #930 #948 #953 #954 Case # Year Dx 1970 1972 (2) 1973 (2) ? 1980 (2) Between 1974-1981 (2) 1971, 1975, 1978 1974, 1977 1974 1979, 1980 1980 1974 1976, 1978 1976 1972 1970 1971 1978, 1980, 1981 1975 1979 1971,1979 1979 1977 1975 1977, 1980 1976 1983 1976 1982, 1983 1975, 1976 1971 1973 1980 1981, 1982 9 1974 1978, 1973, 1972 1982 1982 1981 1970 1977 1974 1978 1979 1974, 1978 #978 #997 #1019 #1095 #1275 #1278 #1283 #1395 #1421 #1655 #1677 #1754 #1780 #1809 #1821 #1835 Year Dx 1971 1981 1978, 1982 1975, 1976 1975 1976, 1977 1974 1972 1971, 1978 1979 1977 1983 1983 1980 & ? 1971 1968 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) SCHIZOPHRENIA (siftstantiated by medical records) Case # #16 #3^ #43 #47 #123 1125 #128 #139 #144 #164 #190 #229 #232 #238 #245 #248 #253 #256 #294 #301 #361 #371 #378 #381 #397 #401 #405 #431 #449 #455 #463 #552 #564 #565 #571 #634 #635 #809 #838 #841 #872 #953 #967 #101? #1080 #1084 #1107 Year Dx Case # #1183 #1198 #1200 #1291 #1303 #1323 #1336 #1519 #1581 #1625 #1631 #1615 #1669 #1678 #1708 #1718 #1718 #1776 #1871 1971 1976 1980 1981 1978 1974 1981 ? 1979 1977 1983 1982 1979 1982 1982 1968 1976 1975 1970 1971 1969 1970 1976 1976 1972 1971 1973 1971 1981 1971 1972 1972 1970 1969 1971 1977 1970 1967 1982 1981 1980 1981 1982 1976 1980 1982 1981 3.0 Year Dx 1971 1982 1982 1980 1973 1983 1981 1982 1968 1968 1977 1982 1969 ? 1976 1983 1977 1978 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) POST TRAUMATIC STRESS DISORDER (Substantiated by medical records) Case // Year Dx Case # #10 #32 . #50 #60 #78 #104 #128 1141 #173 #177 #223 #229 #270 #278 #298 #310 #361 #362 #364 #365 #366 #367 #378 #388 #430 #446 #449 #456 #459 #489 #600 #603 #623 #663 #697 #775 ? 1981 1981 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1982 1981 7 ? 1982 1983 7 7 1982 1982 1983 1982 1981 1982 1983 1981 1980 #1308 #1325 #1327 #1475 #783 #784 #838 #842 #849 #872 #875 #920 #967 #971 1983 1983 1983 1980 1981 1982 1981 1981 1982 1982 1982 1981 1985 1982 1982 #1516 #1541 #1604 #1613 #1776 #1936 Year _Dx 1981 1981 1981 1981 1982 1982 1981 1981 1981 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) OTHER MEDICAL CONDITIONS (as reported by veterans and physicians) Acne 19 Acne, cystic 2 Alcoholism 8 Allergic bronchitis 3 Allergies 19 Alopecia areata (spotty baldness) 1 Anemia, iron deficiency 5 Anorexia 3 Anxiety 23 Apnea (cessation of breath) 16 Arteriosclerosis 3 Arthralgia 1 Arthritis 34 Asthenia (weakness) 35 Asthma 10 Ataxia (lack of muscle coord) 7 Back pain 29 Birth defects/medical problems—child 13 Blackouts 15 Blisters 10 Blood disorders 214 Body cramps/aches 15 Boils 18 Bones, decaying 2 Burning sensation in back/extremities 8 Calcium loss .2 Cancer 44 Chest pains 43 Chloracne 23 Colitis 4 Comedones 1 Constipation 8 Cyst 22 Cyst, retention 2 Delayed healing by first intention 2 Dementia, in remission 1 Depression 86 Dennatitis 6 Diabetes 22 Diarrhea 28 Disruption of circadian rhythms 1 Dizziness 78 Drug addiction 1 Dumping syndrome 2 Dysmorphic erythrocytosis (unusual shape of blood cells) 1 Dyspnea (labored breathing) 11 Dysesthesias, diffuse 1 Ear fungus 1 Ecxema 2 Edema 16 Emotional problems 502 Endocrine problems 1 Epilepsy 1 Fatigue 60 Fat tissue lumps 11 Fever, recurrent 9 Fungus 10 Gall bladder w/mass 1 Gastrointestinal disorders 650 Glands, swollen 4 Gout 7 Growths, skin 32 Hallucinations 3 Hair loss 27 HBsag-Carrier 1 Headaches 566 Hearing problems 29 Heart attack 7 Heart problems 20 Hematuria 2 Hemorrhoids 4 Hepatitis 6 Hepatomegalia 1 Herpes 3 Hirsutism (abnormal body hair growth) 1 Hives 2 Hyperlipidemia 1 Hypertension 80 Hypertension, essential 1 Hypoglycemia 1 Hysteria 1 �TEXAS VETERANS AGENT ORANGE ASSISTANCE PROGRAM TEXAS DEPARTMENT OF HEALTH, AUSTIN, TEXAS DATA SHEET (as of July 31, 1985) OTHER_MED^AL^CpNDITIONS> (as^reportedI by veterans and[. Infections, chronic 20 Immuno suppression 3 Irritability 18 Itching 34 Joint pain 83 Kidney problems 24 Liver problems 161 Loss of appetite 11 Loss of concentration 10 Loss of smell 3 LOSS of taste 2 Low blood sugar 3 Lung problems 30 Melanomas 5 Memory loss 69 Meningitis, cryptococal 1 Moles 6 Muscle problems 37 Myocardial infarction, acute inferolateral. 1 Nails fall out 11 Nausea 24 Nerve problems 575 Neuritis, traumatic 1 Nose bleeds 1 Numbness 323 Pancreatitis, chronic 3 Paresthesias of distal arms/legs 3 Peripheral neuropathy 3 Peripheral tumescense (swollen extremities) 3 Personality change 11 Pleurisy, chronic 2 Polyps 1 Porphyria Post traumatic stress disorder Prostatitis Psoriasis Pulmonary embolisms, multiple 3 6 22 1 1 Pulmonary fibrosis 1 Rash 385 Rectal bleeding, history of 29 Renal cysts 1 Reproductive problems 90 Restricted blood flow 7 Rhinitis (nose inflammation) 2 Respiratory problems 25 Seizures 7 Sensitivity to change in heat/cold 6 Sex, pain during 1 Sexual dysfunction 268 Shingles 1 Sinus problems 24 Skin, dryness 23 Skin hyper/hypopigmentation 24 Sleep disturbance 338 Sores 12 Speech problems 1 Sterility 6 Sweating, excessive 5 Tachycardia 2 TB, subclinical 3 Teeth, loss of 3 Throat, sore, chronic 8 Thyroid problems 1 Tingling of extremities 163 Tinitus (ringing in ears) 22 Ulcer 37 Upper respiratory infections (URI) 3 Urinary infections 21 Vascular insufficiency 6 Venous thrombosis, deep 1 Vision, blurred 22 Vision, decreased 27 Vision, sensitivity to light 9 Vomiting 19 Warts 6 Weight loss/gain 43 �SUMMARY of PILOT STUDY PROTOCOLS for the TEXAS VETERANS AGENT ORANGE PROGRAM September 1984 Protocols for four pilot studies have been developed by faculty of the University of Texas for use in the Texas Veterans Agent Orange Program administered by the Texas Department of Health. They are: 1. Cytogenetic/Bleomycin Testing 2. Aryl,Hydrocarbon Hydroxylase (AHH) Assay 3. Immune Evalution of Veterans Exposed to Agent Orange 4. Uroporphyrin Testing These protocols are described in the attached documents. These studies have special subject selection requirements. They also have limitations and pitfalls that should be recognized by everyone interested in the outcome. SUBJECT SELECTION. Interpretation of data gathered by the proposed pilot studies will depend heavily on the criteria and care used in selecting study subjects. Three categories of age-matched study subjects are required: 1) Vietnam veterans (at high risk), 2) Vietnam veterans (at low risk), and 3) unexposed controls. Vietnam Veterans (at high risk). The establishment of a reliable exposure index is critical and very problematical. It may well be impossible to estimate degree, duration, and route of exposure to Agent Orange in most Vietnam veterans. However, it should be possible to identify some Vietnam veterans whose contact with Agent Orange, as reflected in personal histories and verified in military records submitted to the Texas Department of Health, was substantial and prolonged. From among this group of individuals, participants in the pilot studies should be selected on the basis of a detailed personal interview and medical history that would exclude subjects whose present or previous occupation, habits, or lifestyle might introduce obvious confounding factors into the study. -1- �Vietnam VeteransL (at 1j3W_r1_s_k). Veterans whose service records and personal histories indicate an improbable contact with Agent Orange or other herbicides. Obvious confounding factors would exclude these veterans the same as the "high risk". It would be safe to state that in assigning high or low risk that increasing probability of a difference prevails as the size of the total group increases and the number of veterans determined to be in the nonselected medium group increases. Unexposed Controjs. These individuals, selected to exclude confounding factors, will serve as the normal control group for the pilot studies. These individuals are matched for usual factors and may be civilians or non-Vietnam veterans. LIMITATIONS AND PITFALLS. The limitations of the laboratory-based pilot studies should be clearly understood. Some of these limitations are: 1. Uncertainty regarding degree, duration, and route of exposure to Agent Orange in individual study subjects is a major limitation of these studies. Efforts to cope with this uncertainty are discussed under the topic of Subject Selection. 2. Since exposure of veterans to Agent Orange or other herbicides used in Vietnam occurred more than a decade ago, any evidence or consequences of that exposure may have diminished to such an extent that it is no longer detectable. 3. The tests to be performed in these pilot studies will not detect effects that are specifically attributable to Agent Orange or any other herbicide. Chromosome damage, enzyme abnormalities, and suppressed immune responsiveness can result from any number of causes, some well-known and others yet unrecognized. Because of this, it will not be possible to conclude that disorders detected in any given individual are due to Agent Orange. However, this is not to say that populations of matched veterans whose detailed military, occupational, medical, and personal histories suggest that they differ as groups only in their exposure to Agent Orange. 4. Individuals whose test results are positive cannot be offered therapeutic manipulation or corrective intervention. There is no known way of reversing chromosome damage. -2- �5. Negative results from these tests would not be definitive. In other words, absence of overt chromosome damage in the study population would not mean that other, less easily recognized effects were absent. COSTS. The University of Texas has made every effort to minimize the costs that cannot be absorbed for tests done on veterans in these studies. For each matched set of exposed and unexposed individuals, the Texas Department of Health will cover the unabsorbable costs of $380 for cytogenetic testing, $800 for aryl hydrocarbon hydroxylase assay, arid $800 for immune evaluation and uroporphyrin testing. REPORTS. These studies will proceed at different rates. Upon completion, the investigators responsible for each study will present their data and results to the Texas Department of Health and, in addition, will prepare and'submit their findings for publication in the scientific literature. Interim progress reports will be provided according to a schedule to be decided by mutual agreement of the Texas Department of Health and the individual investigators. -3- �CYTOGENETIC/BLEOMYCIN TESTING. Peripheral blood samples are set up with the standard blood culture medium to stimulate lymphocytes to grow. Standard cytogenetic harvest method (Colcemid block for 1 hr., hypotonic solution treatment for 20 min., fix and air-dried) is used to prepare 48-hr and 72-hr culture samples. The slides are stained with Giemsa. Thus, each blood culture will have two harvest samples. Whenever possible, 100 metaphases are analyzed from each harvest sample to record chromatid-type and chromosome-type aberrations, and the aberrations are finally converted into breaks per cell for comparison. ARYL HYDROCARBON HYDROXYLASE (AHHLASSAY. The purpose of this study is to evaluate veterans for evidence of abnormalities in the levels, activity, or regulation of the cytochrome P-450 microsomal mono-oxygenase enzymes." Lymphocytes will be cultured from blood samples obtained from veterans and matched controls. The cultured lymphocytes will be assayed for levels of the enzyme aryl hydrocarbon hydroxylase both with and without a challenge by 3-methyl cholanthrene to induce the enzyme. Induction of the cytochrome P-450 associated enzymes is the most basic biological effect of TCDD, the toxic contaminant of Agent Orange. IMMUNE EVALUATION/UROPORPHYRIN TESTING. This study will examine various measured immune parameters of 1) Vietnam veterans from Texas who were at high risk for exposure to Agent Orange, 2) Vietnam veterans from Texas who were at low risk for exposure to Agent Orange and 3) matched veteran-controls who were not exposed to Agent Orange. In addition, urine specimens will be collected from these same groups and tests will be performed to measure levels of urinary porphyrins. �AGENT ORANGE ADVISORY COMMITTEE to the TEXAS DEPARTMENT OF HEALTH Development and Preliminary Results of Pilot Clinical Studies Report of the Chairman Guy R. Newell, M.D. Professor of Epidemiology and Chairman, Department of Cancer Prevention The University of Texas System Cancer Center Monday, March 26, 1984' �ACKNOWLEDGEMENTS The principal investigators, their colleagues and I wish to first acknowledge William B. Neaves, Ph.D. of The University of Texas Health Science Center at Dallas who was the first chairman of The University of Texas System Agent Orange Program Committee. It was under his skillful, thoughtful, and statesman approach that the initial pilot studies were reviewed, selected and initiated. We are all indebted to Ms. Harriet Franson, the Program Manager for the Texas Department of Health, who sees to our requests and to those of the veterans we are trying to assist with both speed and compassion. I want to thank Paul K. Mills, M.S., M.P.H. of the Department of Cancer Prevention, UTSCC, who prepared the section describing the criteria/selection methodology and analysed the criteria used in review of the first 255 Vietnam veterans. Without the unending wealth of first-hand knowledge of Vietnam and its environs provided by George R. Anderson, M.D., Director of the Texas Veterans Agent Orange Assistance Program, the task of estimating gross exposure of veterans would have been impossible. Finally, the support given to this program by Robert Bernstein, M.D., F.A.C.P., Commissioner of the Texas Department of Health has been unyielding. �Background During the Vietnam War, U.S. military personnel sprayed large quantities of a herbicide called "Agent Orange" over the Vietnamese countryside. The herbicide, named because of its shipment in orange-striped barrels, consisted of approximately equal portions of the n-butyl esters of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T). These shipments of Agent Orange were contaminated during the manufacturing process with traces of a highly toxic chemical, the dioxin dibenzo-p-dioxin (TCOD). 2,3,7,8-tetrachloro- Its concentration varied from batch to batch but averaged about 2 pom of 2,4,5-T. TCOO is known to be an exceptionally toxic chemical. Concerns have been frequently raised by Vietnam veterans that Agent Orange exposure may result in Infertility, genetic damage, birth defects in offspring, and cancer. No studies to date have confirmed these suspicions. In 1981, the Texas Legislature established a program to assist veterans who may have been exposed to certain chemical defoliants or herbicides, including Agent Orange. An important goal of the Texas Veterans Agent Orange Assistance Program was to determine 1f veterans have suffered physical damage as a result of substantial exposure to Agent Orange. The bill establishing this program called for a cooperative effort between the Texas Department of Health and The University of Texas System to conduct studies that would address the health effects of exposure to Agent Orange. Pi 1ot Studies of VIetnam Veterans Faculty of The University of Texas developed protocols for pilot studies of selected veterans in the Texas Veterans Agent Orange Program. �Three pilot studies were selected for implementation. These were cytogenetic testing, sperm evaluation, and analysis of the immune response in putatively exposed veterans and suitable control subjects. Cytogenetic testing to be conducted at The University of Texas System Cancer Center, will determine if Vietnam veterans presumed to have been exposed to Agent Orange during their military service have more genetic damage as measured by chromosomal abnormalities in cultured lymphocytes than does a suitable comparison group of veterans presumed not to have been exposed to Agent Orange. Sperm evaluation, to be conducted at The University of Texas Medical Branch at Galveston, will determine whether an association can be detected between current production of abnormal sperm and prior exposure to Agent Orange. The percentage of morphologically abnormal sperm and the incidence of nondysjunction of the Y chromosome will be assessed in this study. Analysis of the immune response, to be conducted at The University of Texas Health Science Center at Houston, will compare the immunocompetency of Vietnam veterans thought to have been exposed to Agent Orange with that of age-matched controls having no history of exposure to Agent Orange. In addition, a birth defects study was to be Initiated by the Division of Clinical Genetics of The University of Texas Health Science Center at Dallas. A summary of this study by Jan M. Friedman, M.D., Ph.D. is attached. Study Limitations Every attempt was made to explain the inherent limitations of these studies to all concerned with their outcome. These include, briefly: • Inability to establish a reliable index of exposure to Agent Orange for any individual Vietnam veteran. No exposure Index was available from the Department of Defense, Veterans Administration, or other official source. �• Control subjects could be selected on gross variables such as obvious lack of previous contact with Agent Orange. Ability to match on other variables was limited. « Because exposure occurred over a decade ago, damage or adverse consequences of such exposure may have diminished to an extent that they are no 1onger detectable. • The tests performed in the pilot studies are not specific for measuring effects of Agent Orange or any other specific agent. • Chromosome damage, sperm abnormalities, and altered immune responsiveness can result from any number of causes; therefore, it will not be possible to conclude that any abnormal findings in the group or in any individual are due to Agent Orange. « Individuals whose test results are positive cannot be offered therapeutic manipulations or corrective intervention in that there is no known way of reversing chromosomal damage or sperm abnormalities. 9 Negative results of the pilot tests would not prove the absence of other, less easily or impossible to measure, effects. Although these limitations are substantial, the laboratory-based pilot studies represent a positive step toward resolution of the Agent Orange dilemma. These studies have become part of a diverse and rapidly expanding national effort to answer pressing questions about the health effects of herbicides used in Vietnam. In addition, results of these initial pilot studies could suggest avenues for future scientific investigations of this national concern. �Agent Orange Subject SelectionCommittee Criteria/Selection Methodology The Agent Orange Subject Selection Committee was established to review evidence (military records, medical records, arid other supporting documents) which would indicate if a given veteran was Indeed exposed to Herbicide Orange in Vietnam, and if so how much exposure occurred. Seven criteria were used to evaluate a given veteran's category of exposure. Depending on the combination of exposure variables veterans were classified into one of six exposure categories. These categories included: highly exposed, medium to highly exposed, medium exposed, low to medium exposed, low exposed and disqualified. Those veterans deemed to be In the highly exposed category were then included in the Pilot Phase of the clinical studies. These studies included cytogenetic testing, immune competency, and sperm mobility and mOtility assessment. The criteria which the committee considered when reviewing the military records, medical records, questionnaire, and other supporting documents included the following. 1. Exposure to herbicides. The committee noted the amount (in gallons) of Herbicide Orange, White, and Blue sprayed in the area where the veteran was assigned during the time period he was assigned to that area. This criterion included estimated rates of exposure and exposures other than "Ranch Hand" exposures. �2. Repo rt ed symptoms A. At the time of exposure: since the chloracne rash is path- o gnomon ic of exposure to dioxin, the committee considered the appearance of a rash at exposure in evaluating the individual's exposure status. B. After time of exposure: reports of chloracne after initial exposure were also considered by the committee for evaluation of exposure. 3 * Cu r rent ned ica o b S * T"6 occurrence of current disease which could possibly be related to herbicide exposure was viewed by the committee as an important criterion for evaluating exposure status. *• Current or past^jpccufij^t0^"^L^ffUJ-Al, Jixpgsjjre. Since exposure to non-herbicide related chemicals could occur on the job outside the military, the committee regarded such occupational exposure as a potential confounding factor in the evaluation of exposure status. Such exposure could disqualify a veteran from participating in the Pilot Phase. s * Hi scarriages or sti 1 1 bi rths. The potential genotoxic effects of phenoxy herbicides, including Herbicide Orange were noted by the committee. Hence, the occurrence of miscarriage or stillbirth among the off- spring of the veterans was considered when evaluating the exposure status of a veteran. te 1n (5) "above, the phenoxy herbicides are potential teratogens in addition to being mutagens and carcinogens. Hence, the committee noted the occurrence of birth .defects in evaluating exposure status. �7 ' Dates and types of service dut^. The heaviest spraying of Herbi- cide Orange in Vietnam occurred between 1967 and 1969. operations ceased in early 1971. All spraying Hence, the committee closely evaluated the service dates in Vietnam in establishing the exposure status. duty type in Vietnam was considered. Also, Clerks, truck drivers, repairmen, and personnel assigned to base camps were not considered to be at high risk of exposure in comparison to infantrymen in the field where potential exposure was much higher. The following table {Table 1) demonstrates the relative importance of each of the selection criteria used by the committee in arriving at a judgment of exposure status. The percentages reflect the importance the committee placed on each criteria in placing veterans in a given exposure category. �8 Table 1. Percentage Summary of Criteria Considered in Exposure Classification of 255* Vietnam Veterans Exposure Status High Med./High Medium Low/Med. Low Criteria Exposure (Gallons) 96.4 100.0 94.7 Symptoms at Exposure 42.3 46.1 13.1 16.6 0.0 Symptoms After Exposure 42.3 61.5 18.4 16.6 0.0 Current Medical Problems 70.5 84.6 31.5 50.0 0.0 Occup. /Chemical Exposure 4.7 0.0 2.6 33.3 5.9 Miscarriages 18.8 15.3 10.5 50.0 1.4 Birth Defects 11.7 15.3 10.5 83.3 0.0 Dates and Type of Service 94.1 100.0 68.4 16.6 5.9 38 6 Total No. Veterans 85 13 100.0 52.2 57 *46 veterans were disqualified from the pilot phase of the study for various reasons. Veterans who had previously received chemotherapy were disqualified since such treatment would affect cytogenetic and immune parameters. In addition, veterans with occupational exposure to chemicals which could affect laboratory testing of sperm, cytogenetic or immunological parameters were removed from further consideration. �As of February 29, 1984, the Selection Committee reviewed 320 cases of which 99 were selected for the clinical studies (fifty cases were reviewedmore than once after more Information had been obtained). The goal set for the pilot studies was 50 veterans selected for having received the highest possible exposure to Agent Orange based on all available information. Thus, the study group was intentionally skewed toward exposure and was not intended to be "representative" of veterans who claimed exposure. Nor within the study group was there a gradient from high to low exposure. All veterans in the study group were selected for high exposure. A doseresponse effect was, therefore, not built in to the pilot study design. The controls, by contrast, were intentionally selected because of no possible exposure to Agent Orange in Vietnam. Matching for associated factors such as occupation or for other sources of exposure to dioxin was attempted, but was recognized to be imprecise. The intentional study design to Include maximum possible exposure among cases (Vietnam veterans) contrasted to least likely exposure among comparison subjects (matched controls) was selected because there was virtually no literature describing similar studies in humans. Since these pilot studies represented a "first," it was thought most desirable to design the study for maximum likelihood of detecting a biologic abnormality among the veterans, if one existed and could be measured by the available methods used. Collection of samples of specimens from both veterans and controls was arranged by staff of the TON and shipped to the individual investigators. Samples were coded so that the tests were performed in all three laboratories without knowledge of whether the sample was from a veteran or a control (specimens were "blinded"). After all specimens were analysed by the �10 laboratories the code was sent to each Investigator on the same day so that appropriate analyses could be performed. Preliminary Results of the Pilot Studies A summary of findings of the three pilot studies are presented. All three studies were performed on specimens from the same Vietnam veterans and controls. The total numbers in each group may vary from study to study and from specimen to specimen. These do not represent errors, rather they indicate variability among the techniques used for the studies. The investigator(s) along with their title and affiliation are given for each study. They can provide more technical details if requested. Cytogenetic Testing T. C. Hsu, Ph.D., Principal Investigator Professor of Cell Biology Sen Pathak, Ph.D., Collaborator K. L. Satya-Prakash, Ph.D., Collaborator The University of Texas System Cancer Center M. D. Anderson Hospital and Tumor Institute Each blood sample was set up for short-term culture with standard blood culture medium. Cell chromosomes were examined at 48 and 72 hours after initiation of cultures. This technique 1s standard and has been published by Dr. Hsu and his colleagues. Each cell speciman was critically examined for chromosome changes. These include: 1. Chromatid breaks, isochromatid breaks and exchanges. �11 2. Chromosomes showing acentric fragments, dicentrics, rings, and marker chromosomes indicating translocations. The percentage of cell specimens with chromosome breaks and chromatid breaks were recorded. The frequency of chromosome changes was calculated as breaks per cell (b/c). In previous studies of large numbers of patients, families, and population subjects the b/c ratio was found to be the most useful expression of genetic damage. The results of this pilot study of cytogenetics on veterans exposed to Agent Orange and matched controls are summarized below: Table 2. Cy toge n e t i c data_ojii j^eteranisL and_cp_nt_ro]_s_ Vietnam Veterans % cells with chromosome breaks 0.78 breaks/cell (b/c) 0.03 Matched Controls 0.62 - 0.02 �12 Table 3. Cases with Chromosome-type Aberrations and Breaks/Cell 'Cytogenetic Change Vietnam Veteran No. (*) Matched Control No. (*) 0.0 - 0.9 17 (S6.7) 22 (73.4) 1.0 - 1.9 9 (30.0) 4 (13.3) 2.0 - 2.9 2 { 6.7) 3 (10.0) 3.0 - 3.9 1 ( 3.S) 0 ( 0.0) 4.0 ~ 4.9 1 ( 3.3) 1 ( 3.3) 5.0 and over 0 ( 0.0) 0 ( 0.0) Metaphases with Chromosome -type abberrations * 30 100.0 30 100.0 0.00 - 0.02 16 (61.S) 20 (66.7) 0.03 » 0.07 7 (26.9) 10 (33.3) 0.08 - 0.12 2 ( 7.7) 0 ( 0.0) 0.13 and over 1 ( 3.9) 0 ( 0.0) Breaks/cell * 26 100.0 30 100.0 * Chi square not significantly different between veterans and controls. �13 It should be pointed out that the lack of positive results does not necessarily indicate the lack of genomic toxicity in persons soon after the Agent Orange exposure. Genetic effects induced by Agent Orange, if any, might have been sufficiently diluted by years of lymphocytic proliferation. In other words, we do not have a complete chronological study following persons, before, soon after, and long after exposure to a genotoxic agent. However, the present data, collected some 15 years after the exposure, appear negative. Sperm Tests Jonathan 6. Ward, Jr., Ph.D., Principal Investigator Marvin S. Legator, Ph.D., Collaborator Division of Environmental Toxicology, The University of Texas Medical Branch at Galveston Up to 3 semen specimens were obtained from each study subject at 2 and 3 month intervals. Upon receipt of the samples, a sperm count was determined, morphology (appearance) was classified by shape and size using standard, published methods. Reference slides were randomly included to serve as an internal control for scoring consistency. At least 500 sperm were examined per sample and the percentage of morphologically abnormal sperm was recorded. The percentage of fluorescent bodies (F-bodies) was recorded as well. �14 The results are shown in the table below: Table 4. Mean Values (± Standard Deviation) of Sperm Test Results for Veterans and Controls Sperm Characteristics Sperm Count (X 106) Vietnam Veterans (Mean ± SO) (No. Subjects/ Samples) Matched Controls (Mean ± SD) (No. Subjects/ Samples) 103.7 ± 76.0 116.3 ± 79.3 32 (76) 32 (64) P = 0.43* % Morphologically Abnormal 50.6 ± 14.8 48.7 ± 12.6 31 (73) 31 (61) 47.7 ± 2.1 47.8 ± 2.5 P = 0.78 % One F-body P - 0.96 % Two F-body P = 0.82 30 (70) 0.7 ± 0.2 30 (70) 30 (58) 0.7 ± 0.3 30 (58) *Kolmogorov-Smirnov 2 sample test used for significance of difference of mean values �15 Interpretation and Conclusion: The results of the sperm tests are reported for 32 pairs of veterans and non-veteran controls. No statistically significant differences were observed between the two groups for sperm count, abnormal morphology and 2 F-body frequency. The preliminary conclusion is that none of the three tests employed demonstrated any effect among individuals with prior military service in Vietnam where exposure to herbicide was probable. However, based on the numbers tested, large differences in sperm count could escape detection, while small differences in morphology and F-body frequency could exist, which would not have been detected. Imntjinologic Studies The immune system is charged with the defense of the body against both internal as well as external antigenic challenges. The cells which make up this system are several different types of lymphocytes - T and B cells, macrophages, and a poorly characterized cell referred to as null cell. T-lymphocytes (derived from the thymus gland, hence also called T-cells) play a central role in the overall regulation of immune responses, including both antibody synthesis and the development of cell-mediated immunity. �16 Several measures of T-cells and their functions were determined from blood lymphocytes of Vietnam veterans and matched controls. A brief descrip- tion of these is given below: Table 5. Test Performed Explanation of Test % Total T-RFC All T-cells in the peripheral blood leukocytes (PBL) as measured by sheep red blood cell rosette formation (RFC). % Pan-T cells All T-cells in PBL measured by monoclonal antibody (OKT 3). %Active T-RFC Subpopulation of T-cells which function as immune surveillance cells. % Helper/Inducer T cells "Helper T cells" required for antibody formation, measured by monoclonal antibody OKT 4. % Suppressor/Cytotoxic T cells "Suppressor T cells" Suppress antibody response after initiated, measured by monoclonal antibody OKT 8. Helper/Suppressor Ratio Ratio of T-helper to T-suppressor cells. % HNK Human natural killer cells measured by Leu 7. % OKT 9 T cell actlvational antigen measured by OKT 9. % OKT 10 T cell activational antigen measured by OKT 10. PMLC (S.I.) Panel of mixed lymphocyte culture, measures ability to respond to 3-5 peripheral blood leukocytes. �17 Table 5. (Continued) Test Performed Explanation of Test PHA (S.I.) Response to a mltogen stimulant, phytohemagglutinin S.I. = Stimulation Index Spont. Blasto. Spontaneous blastogenesis, measure of metabolic activity of round cells in peripheral blood leukocytes. The numbers of individuals tested, the mean values for the groups and the standard deviation are given in the table below: Table 6. Mean Values (± Standard Deviation) of Immune Tests Results for Veterans and Controls Immune Test Total T-RFC Pan T cells Active T-RFC Helper T cell (Inducer) Suppressor T cell (Cytotoxic) Helper/Suppressor Ratio HNK OKT-9 OKT-10 PMLC (S.I.) PHA {S.I.) Spont. Blasto. VTetnam Veterans (n*66) 38 61 20 39 24 1.8 11 3 ± 5 ± 29 ± 114 t 17.367 ± 15 13 Matched Controls (n=50) 44 ± 64 ± 15 14 ± 39 ± 11 23 ± 10 1.8 ± 08 . 6 12 ± 3± 5 11 6± 22 ± 21 90 98 ± 9.787 19,943 ± *Stati st1cal ly~TTTfer5nt~at'"P 1ess~than ~O57 19* 13 11* 10 8 0.7 7 1 7 13 78 10,136 �18 Interpretation and Conclusion; Of the 12 measures of the Immune system examined in this pilot study, the Active T-RFC was higher among the Vietnam veterans (20 t 15) than among the matched controls (14 t 11), (P less than 0.05). This test measures the % of Active T~cells which is the subpopulation of T-lymphocytes that function as immune surveillance cells. These cells are a subpopulation of the total T-RFC cells, which is reflected in a decrease of the % total T-RFC among Vietnam veterans (38 t 15) compared to matched controls (44 ± 19), (P less than 0.05). �i 19 .Summary: Because of concerns of Vietnam veterans that exposure to Agent Orange and its contaminants may have caused adverse health effects, The University of Texas System working closely with the Texas Department of Health, initiated three pilot research projects. These were (1) a study of the cellular characteristics of lymphocytes in the peripheral blood (cytogenetics), (2) a study of the number and physical appearance of sperm, and (3) several measures of the immune system. Vietnam veterans were purposely chosen who had the greatest likelihood of heavy exposure and were compared with age matched individuals with maximum likelihood of no exposure. The pilot phase called for 50 veterans and SO matched controls. Specimens were coded so that their Identities were blinded to the investigators when the laboratory tests were performed. The several limitations of these studies were made known from the beginning to concerned and interested Individuals. Preliminary r-esults of the three pilot studies are: Cytogenetlc Testing. No differences were found between the % of cells with chromosome breaks or the number of breaks per cell between Vietnam veterans and matched controls. Sperm Tests. Mo differences were found between the number of sperm, appearance of sperm, or percent of fluorescent bodies of sperm between Vietnam veterans and matched controls. Immunologic Studies. Of 12 tests performed to measure the immune system, the % Active T-RFC (which measures Immune surveillance cells) was higher among Vietnam veterans than among the matched controls (P less than 0.05). The % Total T-RFC was lower among veterans than among controls {P less than 0.05) �SUMMARY OF U.T. AGENT ORANGE BIRTH DEFECTS STUDY 26 MARCH, 1984 Data for the period 1 February, 1982 - 1 February, 1984 Center New Patients Seen 17 8 5 UTHSC Dallas UTHSC Houston UTHSC San Antonio UT Medical Branch TOTAL Disease Type Paternal Agent Orange Exposure* _2 33 = 0.6% Frequency in General Patient Population (Based on Partial Data) Frequency in Children of Agent Orange-Exposed Fathers* Possibly due to Agent Orange exposure in father (sporadic dominant or chromosomal anomaly) 15% 18% Not due to Agent Orange exposure in father (inherited dominant or chromosomal anomaly, autosomal recessive, or X-linked recessive) 18% 3% (Differences are marginally statistically significant) �Estimates of Frequency of Agent Orange Exposure* in Fathers of Children With Birth Defects of Certain Etiological Classes Class Conditions possibly due to Agent Orange exposure in father 0.75% (Difference is marginally statistically significant) Conditions not. due to Agent Orange exposure in father 0.1% CONCLUSION; Trend observed is consistent with fathers' exposure to Agent Orange causing birth defects in offspring, but numbers are very small; most fathers in the "exposed" group do not actually claim exposure; and the trend has become less clear as more data are collected. RECOMMEND; Continue data collection phase for 1 more year and re-evaluate at that time. J.M. Friedman, M.D., Ph.D. Associate Professor of Obstetrics and Gynecology and of Pediatrics Head, Division of Clinical Genetics *Defined as military service in Southeast Asia between 1969 and 1971. Most fathers were unaware of direct exposure to Agent Orange. �en c en «3> en cs> en SS.SiMlffiMiniKiTOWf^ijjlCIIIfiffiSffiWSSiaKffi- D en en cs:» KmiSqji!'Bii!i;i«fii9im KH* CJt ""^ O CO ni f ifii 1 5 Cu 11 %'"l:l; :~3l fJl ,,i. LJ "11 WIMIHtl u.» ni en rri —I LJ «.lH»m.ll " " I " " en CO CD 1 L™.* CO O nmitu, ui fn «jMc:.-wJ ANALYSIS OF MAJOR DEMOGRAPHIC STATISTICS FY 82,83,84 AGENT ORANGE CLINICAL STUDIES MAY 3, 1985 REPORT TO THE TEXAS AGENT ORANGE ADVISORY COMMITTEE BY GUY R. NEWELL, JR., M.D., CHAIRMAN �Demographic Characteristics of Vietnam Veterans and Controls Characteristic Vietnam Veterams (n-84) Controls (n=65) P Value (*) Race 0.44 Black Hispanic White Other 11.9 15.5 71.4 1.2 4.6 13.8 80.0 1.5 0.67 Language Spoken English Spanish Other 85.7 13.1 1.2 86.2 13.8 0.0 0.58 Religion Protestant Catholic Other 65.5 26.2 8.4 64.6 33.8 1.5 0.66 Marital Status Married Single Separated Divorced 66.7 13.1 2.4 16.7 76.9 9.2 1.5 12.3 0.0001 Education Through High School Through College Post College 35.7 56.0 8.3 13.8 53.8 32.3 0.0001 Income/Year <$5,000 5-<10,000 10-<20,000 20-OO.OOO 30-<40,000 40-<50,000 >50,000 13.2 17.1 21.1 23.7 17.1 3.9 3.9 0.0 3.1 10.8 27.7 27.7 18.5 12.3 �Current Consumption of Tobacco Type of Tobacco Vietnam Veterans (n=84) Controls (n=65) P-Value 52.5 35.5 0.04 20.0 20.0 17.5 22.5 20.0 28.6 19.0 23.8 9.5 19.0 1.8 98.2 3.7 96.3 0.97 8.1 91.9 5.5 94.5 0.85 8.9 91.9 3.7 96.3 0.46 Cigarettes (Pk/Yrs) Yes <9 9-<20 20-<26 26-<41 41+ Cigars Yes No I Pipe Yes No Chewing Yes No �Current Consumption of Beverages Vietnam Veterans (n-84) Controls (n=65) (X) Beverage (X) 0.24 Decaffeinated Coffee None 1-4 cups/day 5+ 76.9 18.5 4.6 84.9 15.1 0.0 Regular Coffee None 1-4 cups/day 5+ P Value 0.65 32.1 52.6 15.4 29.7 59.4 10.9 Tea 0.83 None 1-4 cups/day 36.8 63.2 33.3 66.7 0.27 Cola, Regular None 1-4 5+ 31.9 63.9 4.2 30.5 69.5 0.0 0.59 Cola, Dietetic None 1-4 85.5 14.5 80.0 20.0 0.92 Beer None 1-4 5+ 49.3 46.6 4.1 52.5 44.1 3.4 0.69 Wine None 1-4 89.1 10.9 92.9 7.1 Liquor None 1-4 0.21 89.4 10.6 79.7 20.3 �History of Drug Use Type of Drug Vietnam Veterans (n=84) (« Controls (n=65) m Medication, Regularly Prescribed Yes No 0.004 51.9 48.1 27.9 72.1 0.22 Medication, Past '60 Days Yes No 58.2 41.8 45.5 54.5 1.00 Recreational Drug Yes No P Value 8.5 91.5 7.7 92.3 �History of Exposure to Chemicals Vietnam Veterans (n-84) Exposure Controls (n=65) Routinely Exposed P value 0.85 Yes 30.5 27.7 No 69.5 72.3 Symptoms Related to Chemical Exposure 0.06 Yes 8.8 1.5 No 91.2 98.5 1.00 Solvent Yes 2.7 3.1 No 97.3 96.9 0.64 Paints Yes 10.1 14.1 No 89.9 85.9 1.00 Pesticides Yes 5.3 4.7 No 94.7 95.3 �History of Exposure to Specific Chemicals Chemical Vietnam Veteran Control P Value <« 1.00 Solvent Yes No 2.7 97.3 3.1 96.9 0.64 Paints Yes No 10.1 89.9 14.1 85.9 1.00 Pesticides Yes No 5.3 94.7 4.7. 95.3 �Miscellaneous History Vietnam Veterans (n=84) Controls (n=65) (« History w 0.76 Family History of Cancer Yes No Unknown 41.7 53.6 4.8 47.7 47.7 4.6 0.16 History of Cold or Flu Yes No 48.2 51.8 35.4 64.6 1.00 History of Vasectomy Yes No 20.2 79.8 20.0 80.0 0.001 X-Rays for Diagnosis Yes No P value 36.6 63.4 9.2 90.8 �Present or Past Employment by Occupation Occupational Titles Vietnam Veterans No. («) Professional, Technical, and Managerial 47 (04 2.) 107 (57 5.) Clerical and Sales 27 (.) H7 31 (61 1.) Services 33 (43 1.) 20 (04 1.) Agricultural, Fishery, Forestry 6 ( 26 .) 4 ( 2.1) Processing 6 ( 26 .) 3 ( 1-6) 42 (83 1.) 7 ( 36 .) 6 ( 26 .) 2 ( i.o) 7 ( 36 .) 11 ( 57 .) Machine Trades Benchwork Structural kbrk 41 (78 1.) Miscellaneous 22 ( 96 .) Total No. of Individuals No. per Individual X 2 = 80.22, P = 1.00 10 Control No. () % 230 192 83 65 2.8 3.0 �Present or Past Employment by Industry Standard Industrial Classification Vietnam Veterans No. () % Control No. () % Agriculture, Forestry and Fishing 5 ( 2.2) 4 ( 2.1) Mining 3 ( 1-3) 2 ( 10 .) Construction 20 ( 86 .) 5 ( 26 .) Manufacturing 28 (12.1) 18 ( 9-4) Transportation Communications Electric, Gas and Sanitary Services 25 (08 1.) 9 ( 47 .) 7 ( 30 .) 5 ( 26 .) Retail Trade 30 (29 1.) 22 (11.5) Finance, Insurance and Real Estate 10 ( 4-3) 5 ( 26 .) Services 36 (15.5) 60 (13 3.) Public Administration 64 (76 2.) 61 (18 3.) 4 ( 1-7) 1 ( 05 .) Wholesale Trade Not Classified 232 Total No. of Individuals No. per Individual X2 - 26.58, P = 1.00 192 83 65 2.8 3.0 �History of Major Health Problem Vietnam Veteran (n-77) History Control (n=64) Yes 32 ( 1 6 ) 4.% 13 ( 0 3 ) 2.% No 45 ( 8 4 ) 5.% 51 ( 9 7 ) 7.% = 6.3, P = 0.01 Twice as many Vietnam veterans gave a history of a major health problem as did controls. �Frequency of "Major" Health Problems « Veterans Controls No. Health Problem No. () * HBP 35.7 2.4 Hepatitis 15 1 0 0 2 1 2 0 0 0 0 0 1 1 1 3 1 1 1 1 1 1 1 1 1 3 1 1 1 Total 42 17 No. persons 32 13 Heart Irregularity LBP High triglycerides Heart disease, NOS Rh art Ulcerative colitis Low blood sugar Chronic bronchitis Hypersensitive insects High blood sugar Gout Ulcers Hidradenitis Feels sickly Anxiety Tbc Chloracne Liver cirrhosis Blood disorder Headaches Insomnia Chronic proctitis Spinal fracture Combat injury Diabetes Chronic discoid Edema Problem/person 18/42 — — — — — 2.4 2.4 2.4 7.1 2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.4 2.4 7.1 2.4 2.4 2.4 1.3 Heart problems — —8 4 . 2.4 4.8 () * 7 1 1 1 1 1 0 1 1 1 1 1 0 0 0 41.2 5.9 5.9 5.9 5.9 5.9 -— 5.9 5.9 5.9 5.9 5.9 ___ 0 0 — — — __ — __ — 0 0 0 0 0 0 0 0 0 0 0 0 — — — — — __ --— 1.3 (42.9%) 11/17 (64.7%) �History of W>rk and Chemical Exposure Vietnam Veterans Controls (n=82) Exposure (n=65) Yes 25 No 57 (69.5%) X 2 = 0.14, P = 0.85 (30.5%) 18 (27.7%) 47 (72.3%) �History of Kbrk and Chemical Exposures Types of Veterans Controls Exposure No. () % No. 15 50.0 6 19.4 Radiation 2 6.7 4 12.9 Heat 4 13.3 1 3.2 Embalming fluids 0 1 3.2 Solvents 1 3.3 3 9.7 Fumes 3 10.0 1 3.2 Leaded gasoline 0 1 3.2 Paint thinner 0 1 3.2 Tylene 0 1 3.2 Phenol 0 2 6.5 Alcohols 0 1 3.2 Acids 0 1 3.2 Ether 0 1 3.2 Mold spray 0 1 3.2 Insecticides 2 1 3.2 Epoxy 0 1 3.2 Monomers 0 1 3.2 Miscellaneous 3 3 9.7 Noise/sound 6.7 10.0 Total exposures 30 31 No. exposed 25 18 Exposures/person 1.2 1.7 () % �DEPARTMENT OF THE ARMY OFFICE OF THE ADJUTANT GENERAL A R M Y AGENT ORANGE TASK FORCE ROOM 21O. 173O K STREET N.W. WASHINGTON. DC 2OOO6 R E P L Y TO A T T E N T I O N OF HERBICIDE STATUS REPORT The name Herbicide Orange comes from the identifying orange stripe painted on the drums containing a particular herbicide which contained equal proportions of the commercially-available herbicides 2,4-D and 2,4,5-T. These herbicides have been used extensively and in large quantities in agriculture and forest management in the United States (US) as well as worldwide for more than three decades. Only the 2,M,5,-T has been implicated as causing any potential health problems due to the presence of toxic contaminant - dioxin (2,3,7,8,-tetrachloro-dibenzo-paradioxin (TCDD)) - which is formed in low concentrations (parts per million) in the manufacturing process of the herbicide. At the request of the President of the Republic of Vietnam (RVN), the use of herbicides in Vietnam was approved by the President of the United States to primarily deny cover to the enemy and, secondarily, to deny food crops to the enemy. This was done only after testing in Florida, Hawaii, and South East Asia during 1961-1962, and limited operational use during 1962-1965. At that time, the herbicides used had the desired effects of improving visibility in dense jungles and were then believed to be harmless to humans. From 1965 to 1970, extensive aerial spraying was carried out over approximately 10 percent of the land mass of RVN, dispersing 11,300,000 gallons of Herbicide Orange in over 6,000 separate missions conducted by the U.S. Air Force under the code name "Ranch Hand". The missions were often carried out in remote or enemy-controlled areas as a result of the military need to improve observation of enemy activity and to reduce the potential for ambush. Each mission was carefully approved by identical staffing procedures within the US and RVN chains of command. The missions were flown under strict meteorological and operational conditions designed to minimize the drift of herbicide. Additionally, US and RVN commanders were advised to keep their troops out of the target areas at the time of spraying so that Vietcong grouncjfire might be returned by the fighter aircraft protecting the spraying missions. Nonetheless, spraying did occur over US troop positions. These missions are now recorded on computer tape (HERBS tape). In a typical spraying of dense jungle, tests have shown that only 6 percent of the herbicide reached the ground. At normal rates of application, this equals U millionths of a pound per acre of 'the contaminant 2,3,7,8-TCDD. Repeated testing reveals that 2,3,7,8-TCDD is rapidly detoxified by exposure to daylight in a matter of days, with a �half-life of approximately 6 hours. However, pure dioxin which has penetrated below the surface of the soil will persist for years, though it, too, will slowly detoxify. Dioxin is very insoluble in water and has a low vapor pressure. From 1965 on there are detailed computerized records of the dates, locations, types and amounts of herbicide used in fixed-wing "Ranch Hand" spray missions. The enclosed copies of maps, which were drawn from the records of spraying missions, show the locations of all "Ranch Hand" defoliation and crop destruction missions from 1965 to 1971. Herbicides were used, additionally, to clear the perimeter areas around US and RVN bases and along routes of communications to deny the enemy concealment capability and were applied with hand sprayers, and from tank trucks, riverine boats, and helicopters. While there are records of over 3.000 of these smaller scale applications, a complete compilation and computerization has not yet been accomplished, as documenting the instances and locations of firebase perimeter spraying is a painstaking, time consuming process. The DOD, however, considers this as another possible source of exposure and we are, therefore, continuing to search the records to determine the locations, dates, and magnitude of this type of perimeter herbicide spraying. The RVN armed forces are known to have used aerially "dispersed herbicides; however, no records exist of this usage. Finally, a small amount of herbicide was applied during 196? - 1969 in the Demilitarized zone (DMZ) in Korea. This was applied by hand spray apparatus and from trucks operated by Korean Army personnel. No US troops are known to have been involved or exposed in Korea. A study by Monsanto Chemical Company, of an accident which occurred at their Nitro, West Virginia facility in 19^9 has not shown an excess of deaths, cancers or heart disease among the 122 male workers who were conclusively proven to have been exposed to dioxin, in this incident when compared to the general US population. A similar study by Dow Chemical Company of 61 males exposed during a 1964 accident failed to establish a cause and effect relationship. However, because of the small population size in each of these studies, there is an acknowledged limited capacity for detection of normally infrequently occurring abnormalities or effects. Reflecting worldwide interest in the subject, studies of other similar accidents, including the one at Seveso, Italy, in 1976, are being conducted. Recent studies from Europe on forestry, agriculture and railroad workers suggest that two kinds of cancer, lymphoma and soft tissue sarcoma, may result from chronic, high exposure to dioxin. In animal studies, dioxin has been shown to be capable of acting as a promoter of cancer, 'fetal death and congenital defects but, to date, these effects have not been confirmed in humans. The reproductive effects have so far been observed only in pregnant rats and mice from large doses of dioxin, but not in rabbits, sheep or monkeys. There are marked species differences in sensitivity to dioxin1s effects. A recently completed study of male mice exposed to dioxin did not show any increase in fetal deaths or fetal abnormalities in the mated �females thus reducing concern about male-transmitted congenital abnormalities. An extensive study of the use and effects of herbicides in Vietnam was conducted by the National Academy of Sciences (NAS) and was reported to Congress in 1971. That study did not identify any specific health problems. Present interest in Herbicide Orange use in Vietnam centers on a wide range of exposures, from very low to high, actual and potential, htach of the present difficulty with the herbicide issue stems from the lack of concrete information about exposure and its consequences, expecially at low dose levels. There are no known, proven effects on health or reproduction from exposure to low levels of 2,4,5-T or dioxin. Nor do the health complaints voiced by those who believe they may have been exposed to Herbicide Orange fall into any discernible pattern. There is no significant marker or unusual condition such as chloracne, the rare skin condition which is a uniform sign of large, acute exposures to dioxin, to serve as a specific clue that low level exposure may have occurred. For example, with exposure to polyvinyl chloride or asbestos the remarkably consistent high incidence of otherwise very rare cancers substantially hastened an association of exposure to these substances and subsequent ill health. However, such a causal relationship has not been the case with dioxin. Thus, to date, there is no scientifically proven evidence that exposure to dioxin in very low doses leads to ill health or genetic defects. However, the matter is not being allowed to rest on that conclusion. There are many studies presently being carried on, both in and outside the Government, which are designed to investigate many of the unknown aspects of herbicide exposure. The lack of definitive information has heightened public and private concern about the possible human effects of exposure to dioxin. Within the DOD, the Air Force is conducting a study of the 1,200 men from "Ranch Hand" who performed the fixed-wing spraying of herbicides in Vietnam. The Ranch Hand study has been projected over a 20-year period and will be studying the long term health of the members of the "Ranch Hand" crews. The conclusions for the initial phase of this study, which was released in July 1983, were not Indicative of a cause and effect relationship. The conduct of an epidemiology study, originally to be by the Veterans Administration, has been assumed by the Centers for Disease Control (CDC) in Atlanta, and will examine the health of ground troops who were likely exposed to herbicide, as well as those who were likely not exposed to herbicides. Additionally, there will be considered the broader question of health effects of service in Vietnam in general, as it is possible that troops in Vietnam may have been exposed to other potentially toxic substances and exotic diseases. In addition to this large scale study (30,000 soldiers), the Centers for Disease Control is conducting a study to examine the possibility of increased incidence of congenital abnormalities among the offspring of Vietnam veterans. These studies will take several years to complete; however, �they offer the best possible hope of definitive answers to questions which at present have no answers. Critical to these studies, and to concerned individuals, will be information about whether a given individual was actually exposed to Herbicide Orange. In 1980, the Department of Defense initiated an intensive search of Army and Marine Corps unit operational records, morning reports/unit diaries, Combat After Action Reports, and other related troop movement records to determine if it would be possible to correlate locations of battalion and company size units with the Ranch Hand spray missions. We have found it is possible to identify certain selected companies as having been within close proximity of fixed-wing herbicide spray missions. The legislation of PL 96-151 mandated the Veterans Administration to conduct a study of possible health effects related to Agent Orange exposure. Following subsequent Congressional hearings, it was determined, since the majority of personnel who served in Vietnam were Array affiliated, that the Array would play the foremost role in providing the Department of Defense related data to support the VA's and related studies. Consequently, on 21 May 1980, The Adjutant General of the Array established the Array Agent Orange Task Force, drawing on the expertise of staff members already experienced in research methods and intensely familiar with the organization of the Vietnam War records collection. The Army Agent Orange Task Force, originally three full-time and two part-time members, now has a complement of 29 personnel and includes representation from the Air Force, Navy, and Marine Corps, comprising a joint services staff effort to support the veterans. The role of the Task Force involves in-depth research into the Vietnam War records of all branches of the services to locate units, identify those in relation to known herbicide spray missions, identify personnel within units, record incidents of herbicide sprays found in the records and previously undocumented, and to provide support to state and federal agencies conducting Agent Orange related studies. The records searches have demonstrated that there are significant differences in the quality, completeness and accuracy of the data contained in the records of the many units involved. It was never envisioned that these records, compiled and organized under combat conditions, would ever have to serve as th'e basis for scientific studies in determining exposure probabilities. Hence, some of the information needed is simply not available. During 1981, while DOD personnel were researching troop movement* records, another possible source of exposure to herbicides was uncovered — aircraft mission incidents. Records found to date indicate that over the years during which Ranch Hand missions were carried out, there were 155 incidents. These incidents were necessitated for a variety of reasons - engine failure, bad weather, radio malfunction, �navigational errors/problems and, in some instances, battle damage to aircraft. A mission incident did not necessarily mean that the pilot "dumped" the herbicide; however, the herbicide could be rapidly jettisoned through an emergency dump valve in less than a minute, to lighten the aircraft. To date, we have documented that emergency releases of herbicides took place 126 times, 58 of which definitely involved Herbicide Orange. The majority of these releases occurred at high altitudes, over the sea, or in remote areas in the vicinity of enemy held targets. A few, nonetheless, did occur near our bases. Those individuals who have unresolved health concerns from possible exposure to herbicides while serving in Vietnam may contact their nearest Veterans Administration hospital or regional office. Those persons still serving on active duty in the military services should contact their service medical facility. We remain dedicated to seeking answers to questions relative to Herbicide Orange and other dioxin-contaminated substances. �AGENT ORANGE STUDIES IN PROGRESS Compiled by the Veterans Administration STUDY AGENCY DESCRIPTION PROJECTED COMPLETION DATE Vietnam Veteran Mortality Study Veterans Administration To compare mortality To be Determined patterns and specific causes of death between those veterans who served in Vietnam and those veterans without Vietnam service. *Vietnam Veteran Identical Twin Study Veterans Administration To compare mental and physical health status of identical twin veterans, one who served in Vietnam and one who did not. 1986 Survey of Patient Veterans Treatment File Administration To identify morbidity patterns among Vietnam veterans from VA inpatient files. Retrospective Study of Dioxins and Furans in Adipose Tissue Veterans Administration To devise a method for 1985. determining levels of dioxins and furans in adipose tissue of Vietnamera veterans from samples in EPA's Survey of Human Adipose Tissue, to identify Vietnam veterans among the tissue samples and to analyze samples. Case-Control Study of SoftTissue Sarcoma Veterans Administration To determine whether Viet- 1985 nam service, Agent Orange exposure and other factors increase the risk of softtissue sarcoma. Department of Health A Human Services, Centers for Disease Control To evaluate possible longterm health effects of Agent Orange exposure on ground troops in Vietnam and to assess possible health effects of Vietnam service; 30,000 veterans expected to participate. *Epidemiological Study of Ground Troops Exposed to Agent Orange Initial 1983 1987 �Birth Defects and Military Service in Vietnam Department of Health & Human Services, Centers for Disease Control To determine possible Early association between Viet- 198U nam service and subsequent fathering of congenitally malformed children; based on Birth Defects Registry in Atlanta area which includes families of approx. 5,^00 case babies and 3iOOO '• control babies. Soft-Tissue Sarcoma . Investigation National Institute for Occupational Safety & Health To study tissues from Indefinite seven cases of soft-tissue sarcoma in U.S. (H who had been exposed to dioxin and 3 who may have been) in order to identify patterns of cancer that may be unique among those exposed to dioxin. Investigation of Leukemia in Madison County, KY National Institute for Occupational Safety & Health To determine possible association between cases of leukemia and exposure to wood ammunition boxes treated with hexadioxins. Dioxin Registry National Institute for Occupational Safety & Health To analyze causes of death 1985 among workers at 12 production sites where dioxincontaining products were manufactured. Internationa] Registry of Persons Exposed to Phenoxy Acid Herbicides & Contaminants National Institute of Environmental Health Sciences, with International Agency for Research on Cancer To establish an interIndefinite national registry of workers in some 20 plants where phenoxy acid herbicides were manufactured; mortality study planned when enough workers have been added to registry. Case-Control National. Cancer Study of Lymphoma Institute and Soft-Tissue Sarcoma Fall 1983 To compare herbicide 198U exposure among cases of soft-tissue sarcoma and lymphoma with controls of the same age, sex and Kansas county of residence. �Air Force Health Study Department of Defense To compare mortality and morbidity of Air Force personnel involved in Agent Orange spraying in Vietnam with a group of Air Force personnel who were not exposed •to the herbicide. Agent Orange Registry of Vietnam Veterans Biopsy Tissue Armed Forces Institute of Pathology To determine disease Indefinite patterns in biopsy tissue from Vietnam veterans; 1,200 specimens thus far show no unusual patterns,; especially of cancer. Preliminary Mortality 1983 Complete 1999 * Indicates those studies which are being supported through records research and review by the Array Agent Orange Task Force. . �Science Panel of the White House Agent Orange Working Group Represented by the following agencies: Department of State Department of Defense Department of Health and Human Services Department of Agriculture Department of Labor Environmental Protection Agency Office of Management and Budget Office of Science and Technology Veterans Administration Office of Technology Assessment Council on Policy Development of the White House �' VETERANS HEALTH SURVEY' Page l CDC continues to get inquiries regarding the status of its Agent Orange studies. Following is an update, which includes: Background Description of the CDC Research Project Agent Orange and Vietnam Experience Studies Selected Cancers Study Investigation Results h********4HH BACKGROUND Between August 1965 and February 1971 approximately 11.3 million gallons of the herbicide 'Agent Orange' (so named because of the orange markings on the drums in which it was shipped) were sprayed over much of South Vietnam in military operations designed to deprive the enemy of cover and food. A chemical contaminant, 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin, more often called TCDD, or simply dioxin, was created during manufacture of and contained in the Agent Orange which was sprayed. Dioxin has been shown to be a highly toxic substance. In January 1978 the Veterans' Administration (VA) received the first of what was to become many claims from veterans who felt that their current health problems had resulted from their being exposed to Agent Orange while serving in Vietnam. In January 1979 the U.S. Congress enacted legislation (Public Law 96-151) directing the VA to design and conduct an epidemiologic study to determine if exposure to Agent Orange had caused long-term adverse health effects in Vietnam veterans. In November 1981 the scope of the study was expanded (by Public Law 97-72) to include other factors in the 'Vietnam experience,' including medications and environmental hazards or conditions. In January 1983 the responsibility for designing and conducting the investigation was transferred from the VA to the Centers for Disease Control (CDC). In May 1983 CDC scientists completed detailed guidelines (protocols) for the Agent Orange and Vietnam Experience studies, recommending that a third investigation be conducted at the same time to determine the risk of Vietnam veterans developing selected types of cancers. Public 'Notice of Research Project Initiation' was published in the Federal Register on March 13, 1984. DESCRIPTION OF THE CDC RESEARCH PROJECT The study includes three separate but related components: 1) 2) 3) Agent Orange Study. (Study of the* long-term health effects of exposure to herbicides in Vietnam. ) Vietnam Experience Study. (Study of the long-term health effects of military service in Vietnam.) Selected Cancers Study. (Study to determine the risks of specific cancers among Vietnam veterans. ) July 1985 �Page 2 DESCRIPTIONi"AGENT"ORANGE'AND"VIETNAM'EXPERIENCE'STUDIES « Although both of these historical, or ''retrospective,1 studies are in some respects similar, each has a separate purpose. The Agent Orange study is designed to find out if troops who were exposed to the herbicide during service in Vietnam have suffered long-term adverse health effects as a result of that exposure. The Vietnam Experience study is designed to demonstrate whether or not there is any difference in the health of veterans of the Vietnam era who served in Vietnam compared to the health of veterans who served in other countries during the same period of time. The studies require the cooperation of a large number of Vietnam era veterans willing to be interviewed about their health status and experiences before, during, and after those years. TO ENSURE STATISTICAL ACCURACY, NO VOLUNTEERS CAN BE ACCEPTED AS PARTICIPANTS IN THE STUDIES. Participants are selected following scientific guidelines established by the research protocols. With the help of the Department of Defense and other agencies, CDC will identify a minimum of 30, 000 qualified veterans to participate in the studies: 6,000 in each of five separately defined groups or 'cohorts.1 The five cohorts are to be made up of veterans who: 1) Served during 1967-68 in a specified area of Vietnam, and were likely to have been exposed to Agent Orange. 2) Served during 1967-68 in the same area of Vietnam as cohort 1, and were less likely to have been exposed to Agent Orange. 3) Served during 1967-68 in another area of Vietnam than cohorts 1 and 2, and were not likely to have been exposed to Agent Orange. 4) Served in Vietnam during 1966-71. areas. 5) Served during 1966-71 in countries other than Vietnam. Randomly selected from all Data for the Agent Orange investigation will be gathered from cohorts 1, 2, and 3. Cohorts 4 and 5 will provide data for the Vietnam Experience study. PARTICIPATION IN THE CDC STUDY IS ENTIRELY VOLUNTARY. AGREEING OR DECLINING TO PARTICIPATE IN THE STUDY WILL HAVE NO EFFECT UPON BENEFITS A VETERAN MAY BE RECEIVING OR TO WHICH HE MAY BE ENTITLED IN THE FUTURE. �Page 3 fill information given by each veteran will be held in complete confidence. The names of the participants will never be associated with their answers in the statistical summaries studied by scientists. Names and other identifying information, such as addresses and social security numbers or service numbers, will be kept in a separate file that no one will have access to but the U.S. Public Health Service and the private research firms working on this study. No other researchers or government agencies, including the Veterans Administration and the Department of Defense, will be able to learn if a veteran participated or what his answers were. This promise of confidentiality is guaranteed by Federal laws—42 U.S. Code 242(b), (k), and (m). Unless the veterans gives written permission to CDC to release personal information, no one, including the veteran1 s family, will ever be ible to get the personal information provided by the veteran. The interview takes about 45 minutes and is conducted by telephone by CDC's contractor, Research Triangle.Institute (RTI), Inc. Veterans who are selected to be called by RTI receive a letter from CDC telling them to expect the call. From those being interviewed, approximately 2000 veterans from each cohort will have been preselected for the medical examination component of the study. The RTI interviewers have no control over which veterans will be asked to take the medical exams. Only veterans who have already been interviewed by RTI will be selected to be asked to take the medical exams which will take 3 days to complete. Several weeks after being interviewed, each veteran selected will receive a letter explaining the examinations and a telephone call from Lovelace Medical Center asking when he can come to Albuquerque. Veterans can select dates convenient to themselves. The 10,000 medical examinations are being conducted at non-hospital clinical facilities specially constructed for this project by another CDC contractor, the Lovelace Medical Foundation, in Albuquerque, NeW Mexico. All examinations are being done at the same place to ensure that standard testing procedures are used. The examination includes about 60 physical, psychological, and laboratory tests. Blood and urine samples are required, but no tests are included that most persons would find painful. Participants can refuse to take any test or to answer any question. Veterans who complete all the tests receive a $300 stipend. Veterans* expenses for travel to and from Albuquerque, food and lodging, etc., will be paid by!the government. Veterans will stay in private rooms at a first-class downtown hotel and have their evenings free. Each room will accommodate up to four persons without1 cost to the veteran. (The government cannot pay for family members travel or food.) Physicians and other health providers working on the CDC studies will not provide any treatment for individuals. If a veteran1s medical examination indicates the possible existence of a problem of any sort, the veteran will be advised immediately and encouraged to seek treatment from the VA, private, or other sources of medical services. �Veteran interviews for the CDC study began in September 1984, and M i l l continue until about October 1987. The first medical examinations were conducted in March 1985. fill examinations are expected to be completed by about January 1988. RTI, Lovelace, and other non-government research firms have been contracted to collect the data for these studies. These firms are monitored closely by CDC officials, fill analysis and interpretation of data is done by CDC. (((((((«((((((((((((((((«((((((((((((((((((((((((((((((((((((((( DESCRIPTIONS SELECTED CfiNCERS STUDY There is some scientific evidence that exposure to herbicides may increase the risk of several serious, but relatively rare, cancers in workers in industries which manufacture or use similar products. Because these cancers are so infrequently seen, the 30,000 veterans in the other study cohorts do not offer a large enough sample population upon which to base this investigation. Instead, two other groups w i l l be studied in a * case-control* investigation. Because of the design of this study, veterans and non-veterans will be included in both the case and control groups. The tumors selected for the study aret lymphoma, soft-tissue sarcoma, nasal and nasopharangeal cancer, and primary liver cancer. Other types of tumors may be added to the study later. The first (case) group in the Selected Cancers Study w i l l be made up of male patients who have actually had these tumors, and who could have been in the military during the Vietnam conflict. The second (control) group will include men of the same age and from the same current geographic area as the case cohort, but without the tumors. Using information from interviews and military records, CDC w i l l determine which men in both groups are veterans, which veterans served during the Vietnam era, and which veterans may have been exposed to figent Orange. Comparison of data collected from both groups may indicate significant differences in their risk of these cancers which could be associated with military service, service in Vietnam, and exposure to figent Orange. INVESTIGATION RESULTS » The exact rate of progress of epidemiological studies of this size cannot be forecast. Collection and analysis of the large amounts of data needed for scientifically valid findings takes time; particularly when so many thousands of veterans must be identified, located, interviewed, and examined. CDC w i l l report on each component of the study when it has been completed. Final reports on the figent Orange and Vietnam Experience components are expected by September 30, 1988. The final report on the Selected Cancers Study component is expected by September 30, 1989. CDC hopes that these studies w i l l provide answers to many of the important questions being asked about figent Orange and other factors related to service in Vietnam. But, as in every epidemiologic investigation — no matter how carefully designed and professionally conducted--the possibility exists that definitive answers to some questions may never be found. � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 069 Folder The folder containing the original item. 1867 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Anderson, Ron J. Robert Bernstein Description An account of the resource <strong>Corporate Author: </strong>Texas Veterans Agent Orange Assistance Program, Texas Department of Health, Austin, Texas Date A point or period of time associated with an event in the lifecycle of the resource 1985-08-01 Title A name given to the resource Annual Report Subject The topic of the resource state-funded Vietnam veterans study cancer risk assessment PSTD morbidity trends ao_seriesIII